"In the United States of America, no senior should ever have to choose between whether they are able to fill a prescription or fill their refrigerator." This promise by US Vice President Kamala Harris was no idle boast since nearly nine million people in the country are currently forced to make this choice. The challenge is to put an end to the shocking situation, which sees the richest country in the world unable to care for all its citizens.
The US government has just published a list of 10 drugs to be the subject of negotiations between pharmaceutical companies and Medicare, the federal health insurance system for people over 65.
The medications concerned are common and expensive long-term treatments, such as Bristol’s anticoagulant Equilis or Lilly’s anti-diabetic Jardiance. Taken together, these drugs represent an annual outlay of almost 50 billion dollars (46 billion euros) for Medicare. The objective for the department is to halve the bill and use the savings to cap the out-of-pocket expenses for patients.
The measure is a little-known aspect of the infamous Inflation Reduction Act enacted in August 2022 from which Europeans mostly recall protectionist subsidies to "made in the USA" electric cars or green industries. The bill also included an important section authorizing Medicare to negotiate drug prices for the first time. The unprecedented nature of the arrangement is being contested in court by the pharmaceutical companies, who allege that the extension of Medicare’s powers – which will include the possibility of punishing recalcitrant offenders – is unconstitutional.
The stakes are therefore high for the pharmaceutical industry in the US and beyond. While many of the substances on the list have reached the end of their patent monopolies, some are still cash cows. Equilis represents annual revenues of over 11 billion dollars for Bristol. Beyond this, it is the progressive alignment of the US with Europe's social security systems that frightens manufacturers as it calls into question a long-time-proven business model. The cost of healthcare in the US is very high in hospitals and pharmacies alike. Total expenditure is around four trillion dollars or almost 18% of GDP. This is much higher than France’s and Germany’s 12%.
The additional cost is the windfall that finances research in the sector, including for European manufacturers. Patients, rather than taxpayers, subsidize the excellence of the pharmaceutical industry, hence the trade-off between the fridge and the prescription. A societal choice is gradually being called into question.
Translation of an original article published in French on lemonde.fr; the publisher may only be liable for the French version.