Pharmaceutical
Price Controls in OECD Countries, Implications for American Consumers, Pricing,
Research and Development, and Innovation
Testimony of Grant D.
Aldonas
Under Secretary for
International Trade
Before
the
Committee on
Health, Education, Labor and Pensions
February 17,
2005
Thank you, Mr. Chairman and Members of this Committee, for
inviting me to testify today about the Department of Commerce report,
Pharmaceutical Price Controls in OECD Countries: Implications for
It is no secret that governments of Organization for Economic
Cooperation and Development (OECD) member countries maintain a variety of
practices that reduce the return on sales of innovative pharmaceuticals. To examine the effect of such practices
on prices, revenues, innovation and, ultimately, on consumers, Congress directed
the Secretary of Commerce to conduct a study, in consultation with the
Department of Health and Human Services, the Office of the U.S. Trade
Representative, and U.S. International Trade Commission, of drug price controls
in OECD member countries and the implications for American consumers.[1]
Specifically,
Congress requested that the study include the following:
This report we issued responds to Congress’ request. It details the effect of price controls
imposed by various OECD member governments on pharmaceutical prices, R&D,
innovation, and American consumers.
The study examined the drug price regulatory systems of 11 OECD
countries[3]
and involved a quantitative analysis of prices, revenues, and R&D effects,
based on data available for nine OECD countries.[4]
To complete the project, we brought together a talented team
of professionals including economists from the Departments of
Commerce and Health and Human Services (HHS), and the United States Trade
Representative (USTR) and sought input from the Council of Economic Advisers
(CEA). We also consulted closely
with experienced academics in the field of health economics. In the early months, inter-agency
meetings were held with economists from HHS, USTR and CEA to share research and
flesh out methodological issues.
These meetings included discussions about the various methodologies used
in previous academic and government studies that addressed similar, but not the
same, questions posed by the Conference Report.
As those discussions on methodology proceeded, we gathered as
much in the way of factual information as possible, as well as the views of
outside experts. The Department of
Commerce published Federal Register notices requesting input from
industry, non-profit organizations, trade associations, and the general
public. The Department received
written testimony from 18 sources.[5] In addition, the Department held a
public hearing on August 3, 2004.
Three interested parties requested the opportunity to speak.[6] The Department left the record open for
an additional ten days following the hearing in order to provide an additional
comment period for submission of further comments based on information provided
at the hearing or in earlier submissions.
Every attempt was made to ensure that all interested parties had the
opportunity to provide comments and to address comments from other groups.
The information that we gathered during this development
process provided us with the data and tools necessary to make well-informed
decisions about the best way to approach the Conference Report questions. Our extensive efforts enabled us to
develop a balanced methodology for estimating the impact of foreign drug price
controls on consumers, R&D, and innovation. The report, given methodological and data
challenges, provides our best approximation of the impact these pricing systems
have on consumer welfare and industry innovation
My comments today describe the study’s findings, with
detailed information about the methodology used to develop each result. In some cases, the findings will not be
surprising. Numerous studies have
shown
The study examined the drug price regulatory systems of 11
OECD countries and found that all rely on some form of price controls to limit
spending on pharmaceuticals. The
principal methods these governments employ are: reference pricing, approval
delays and procedural barriers, restrictions on dispensing and prescribing, and
reimbursement. These methods
prevent companies from charging a market-based price for their products and tend
to be non-transparent; the criteria and rationale for certain pharmaceutical
prices or reimbursement amounts are not fully disclosed, even to the
pharmaceutical companies marketing drugs.
The most direct method that relevant OECD governments use to
control prices is setting sales prices and outlawing sales at any other
price. Governments are often the
dominant market participant and may negotiate favorable prices with
manufacturers, by leveraging this monopsonistic power. Such negotiations generally result in
prices that are lower than they would be in a free market. OECD governments in our study also set
the reimbursement prices for new drugs at levels well below free market
prices. Since any charge above the
regulated price is borne by consumers, the reimbursement price often functions
as the de facto market price,
whenever such mechanisms are employed.
Finally, some OECD governments regularly cut the prices of drugs already
on the market.
In order to estimate the impact of these price controls, a
detailed study of pharmaceutical prices for nine OECD countries was conducted.
The nine countries represented both the largest OECD markets and a range of
population wealth. To conduct the
study, the Department of Commerce, in cooperation with HHS, purchased revenue
and related data for all products containing the active ingredient in the 60
best-selling products in the
The analysis focused specifically on patented
pharmaceuticals, which are produced by research-based pharmaceutical companies
and biotechnology companies. The
study assumed that, in the absence of drug price controls, average prices in the
OECD countries for innovative pharmaceuticals would be equal to
Patented Drug
Prices in OECD Countries Are Below
We found that patented drugs that were best sellers in the
Developing the appropriate data set to
conduct international price comparisons presented a number of challenges. For example, since innovative drug
manufacturers fund most private R&D spending, any attempt to analyze the
effects of foreign drug price regulations on the development of new drugs
requires understanding how price regulation affects revenue for such firms. Because their revenue depends primarily
on patented drugs, the study uses a set of the best-selling drugs with patented
active ingredients (molecules) from the total IMS Health data set[7]
to serve as the basis for price comparisons and to clarify the implications for
revenue and R&D spending.
Defining the patented data
set was additionally complicated by the fact that patent expiration dates vary
across nations, and the patent expiration date itself is not a reliable
indicator of when generic competition begins, as those two dates don’t always
coincide. In the
The second step involved classifying the
information in the patented data set in a fashion that would ensure the
comparison of similar products’ prices. The IMS Health data set contained
products that varied across countries.
So, we had to determine the best way to classify products across
countries. There are many ways to
classify pharmaceutical products.
Most studies have classified products at the molecular level, which is
both the broadest and the most basic definition of any product. Other studies have used more detailed
approaches, comparing products by brand name, therapeutic use, dose form
(tablets, capsules, injections), strength (milligrams) and package size. We found that comparing products at more
detailed levels, such as strength and package size, severely limited the data
set available for analysis.
Therefore, this study compared products in the
The on-patent drug data set includes details that are
reported at the ex-manufacturer levels, before hospital or pharmacy markups or
dispensing fees are taken into account.
This is an important condition because data at the manufacturing level
offer a more reliable basis for comparison internationally than do pharmacy or
hospital prices. For example,
manufacturing level data does not require further adjustments for differences in
tax frameworks or other markups that tend to vary across countries.
Since the IMS Health data set excluded prices,
it was necessary to estimate prices based on two other variables in the data
set: revenues per molecule and
amount of drug consumed (volume).
While revenue data were provided in U.S. dollars, the price calculation
was complicated by the existence of two alternative volume indicators:
standard units and kilograms of the active ingredient. While both volume measures are widely
accepted in the academic literature, each generates a different price for the
same product.
A standard unit is
equivalent to a standard dose of medication, and it is derived from other IMS
Health volume measures. Kilograms
are the amount of active ingredient in a molecule. While neither measurement has proven
superior to the other, each has its own drawbacks. The standard
unit measurement, for example, varies across countries, as the smallest common
dose in one country is not necessarily the same in another. A second difficulty is the implicit
assumption that all pills have the same value to the patient, independent of
dose. The drawback to using the
kilogram measure is that it can vary according to the individual sample because
potency in molecules varies.
Given this challenge, we decided to present a range of
results based on both standard units and kilograms. Interestingly, the differences between
the aggregate prices, based on the two volume measures, were moderate for all
countries except
Despite these data quirks, we included
Another important detail in our price
computation methodology was the decision not to make adjustments for off-invoice
manufacturer discounts related to patented drugs. This constituted a break from previous
studies, which have tended to factor in such discounts, as
The decision not to adjust
The final step in comparing prices across
countries was to produce a price index. There are three generally accepted
methods of indexing prices: Laspeyres, Paasche, and Fisher. The methods vary by the quantity
(volume) used to weight the prices.
The Laspeyres index weights prices based on
We found that by depressing prices for patented
pharmaceuticals, the price controls in OECD countries yield lower revenues for
those patented products than would otherwise exist in a competitive market. Our estimates indicate that, after
extrapolating to a broader set of OECD countries, the diminished returns are in
the range of $18 billion to $27 billion annually. Adding them back would represent a 25 to
38 percent increase in revenues over actual 2003 revenues from sales of patented
drugs in the OECD countries considered in this study.
While a variety of factors influence demand
for different drugs in different countries, one consistent factor affecting
demand is income. Thus, we made the
assumption that
Prices for
pharmaceuticals in the absence of price controls were calculated at the
individual drug level, by multiplying each price by a uniform adjustment
multiplier. The uniform adjustment
multiplier, designed to capture the difference in price between the free and
controlled markets, is calculated by dividing the ratio of foreign per capita
income to
These new, market-based prices were
then used to compute new revenues.
It is worth noting that in conducting this calculation, we did not adjust
volumes to reflect changes in consumption related to higher drug prices. It was not possible to determine a
justifiable and economically sound method for making upward or downward
adjustments to consumption for such a scenario. For example, we could have assumed that
following the removal of price controls, volumes would rise to levels observed
in the
The final step in estimating
the impact of foreign drug price controls on the global revenues of innovative
pharmaceutical manufacturers involved extrapolating the revenue changes from the
patented data set to the total patented market in 11 OECD countries (Australia,
Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Spain, Sweden,
and the United Kingdom) for the year 2003.
As mentioned earlier, we chose these 11 OECD countries because they
collectively represented a significant share of the pharmaceutical revenues
generated in developed markets for the year 2003.
The study uses published academic research to estimate the
impact of increased revenues on pharmaceutical R&D. By limiting the return that would
otherwise accrue to companies that
make risky investments to develop new drugs and bring them to market, the price
controls that OECD countries in the study maintain also reduce pharmaceutical
R&D globally; research and development spending exists at lower levels than
would be the case if these countries maintained market conditions similar to
those in the United States. The
study estimates that this reduction falls in the range of $5 billion to $8
billion annually, once prices are fully adjusted. This represents between 11 and 16
percent of current private R&D worldwide, based on figures from the CMR
International (CMRI).
Based on the estimated cost of developing a new drug, an
increase in R&D spending of $5 billion to $8 billion could lead to three or
four new molecular entities annually, once markets fully adjust. The U.S. Food and Drug Administration
approved, on average, 30 new molecular entities between 2000 and
2003.
The long-term effects of
higher revenues and prices for consumers are linked to R&D and
innovation. Both economic theory
and empirical evidence indicate a close correlation between revenues and profit
margins on the one hand and R&D expenditures on the other. We relied heavily on the economic theory
and empirical research on the relationship between revenues (cash flow) and
R&D expenditures to provide the foundation from which we then estimated the
amount of R&D funding that would be available, in the absence of price
controls. This included work by
Henry Grabowski,
John M. Vernon, and John A.
Vernon, who developed the parameters for estimating how an increase in revenues
following the deregulation of price controls would presumably impact R&D and
the number of new drugs available in the marketplace.
We made a few key assumptions about how innovative drug
manufacturers would interpret increased revenues, most critically that
innovative drug manufacturers would believe that increased revenues from price
deregulation were permanent. If
they did not view the price changes as permanent, but rather as short-term
windfall, there would be much less incentive to make long-term investments in
increased R&D spending. In
addition, we assumed there would be a fixed corporate tax rate of 33 percent on
all additional earnings, and that pretax profits would not be consumed by
additional production and distribution costs. The principle weakness in this
assumption is that a portion of the increased revenues might be devoted to
marketing.
The empirical work necessary to predict industry R&D
investment decisions includes examining several financial factors, both
separately and together, including: cash flow, profit margins, prices, and a
number of other non-financial factors.
Several studies that analyze the effect of changes in cash flow and
profits on
The regression equation developed by John A.
The expenditures by
specialized biotechnology companies, on the other hand, are not included in the
data. CMRI figures differ
from PhRMA figures because they include R&D performed outside the
We realized that the estimated increase in R&D would not
be devoted exclusively to the development of innovative drugs. Research by the
Various studies have been done regarding the cost of
developing new drugs; the most recent and often cited study is that by DiMasi,
Hansen, and Grabowski, who report that the total cost per new drug was $802
million in 2000. The estimate
reflects capitalization of the out-of-pocket costs to ten multinational
pharmaceutical firms developing self-originated new molecular entities (NME)
with a mean approval date of 1997, including losses on unsuccessful
research. Assuming the same rate of
growth in the inflation-adjusted capitalized costs of drug development, between
this most recent work and a comparable earlier
work, the authors estimated that the capitalized cost for drugs approved in 2001
would be $1.1 billion. Applying
these same assumptions would suggest that the cost of drugs approved in 2003 was
about $1.3 billion in 2003 dollars.
Due to time and data constraints, we could not complete a
rigorous investigation of the short- and long-term effects of a price
deregulation on
In the long-term, the “increased competition” in the
conclusion was based on written comments and testimony
submitted to the Commerce Department that suggested increased competition would
lead to long-term changes in
Using More
Generic Drugs at Lower Prices in OECD Countries Means Potential Savings
Analysis by the Departments of Commerce and HHS found that
higher utilization of generic drugs at lower prices could result in significant
savings to OECD countries. The
estimated savings, after extrapolating to a broader set of OECD countries, range
from $5 billion to $30 billion annually. This range of potential savings suggests that
if prices of on-patent drugs rose to competitive market levels, then a more
competitive generic market could significantly, or even fully, offset any
additional cost to OECD countries.
Specifically, we examined how foreign price controls impact the
off-patent (generic) drug market, using a second data set from IMS Health
composed of 29 of the world’s top selling off-patent drugs. HHS did much of this analysis, on
behalf of the Department of Commerce, because HHS had access to
proprietary data from the Center for Medicare and Medicaid Services (CMS) that
illuminated the analysis of generics.
HHS analyzed both the prices and utilization of generic drugs across the
same nine OECD countries that the Department of Commerce examined in its
empirical analysis of innovative drug prices.
Generic drugs were defined within this data set as those
drugs not produced by an innovator or licensed company. All drugs using the same active
ingredient are treated as one product.
The quantity sold is measured as the total kilograms of the active
ingredient (with an adjustment for the salt factor) or number of standard
units.
HHS went on to consider a
scenario in which foreign countries would shift their usage of generic drugs to
match
OECD governments in
various countries have relied heavily on government fiat rather than competition
to set prices, thereby lowering drug spending, as price controls are applied to
new and old drugs alike. Such
controls, when applied to new drugs, reduce company compensation to levels
closer to direct production costs, leaving less revenue available for R&D
efforts. Collectively, individual
nations’ efforts to limit prices can diminish investments in R&D that would
provide substantial health benefits to all. Improvements in health care and life
sciences are important for health and longevity worldwide. The development of innovative
pharmaceutical products plays a critical role in ensuring these continued
gains. To encourage the continued
development of new drugs, it is essential that we preserve sound economic
incentives to develop and market new health technologies.
[1] Section 1123 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, P.L. 108-173.
[2] See H.R. No. 108-391
[3]
The overview of drug price regulatory systems corresponds to
[4]
The prices effects analysis corresponds to
[5] Submissions were received from AdvaMed; Alberto Frati, M.D./Mexico; BIO; Consumer Project on Technology Response; GphA; AEI (Kevin A. Hassett); Aidan Hollis, University of Calgary; Industry Trade Advisory Committee (ITAC) 3; Jana Thompson/Indiana; Donald W. Light, Ph.D., University of Pennsylvania and Joel Lexchin, M.D., York University; Novartis Corp.; Kevin Outterson, West Virginia University; Pedro Reyes Ortego/Mexico; PhRMA; U.K. Department of Health; Dan O’Day, Chairman of the Pharmaceutical Committee of the American Chamber of Commerce; The Manhattan Institute for Policy Research; and The Amyotrophic Lateral Sclerosis Association.
[6] PhRMA, AEI (Hassett), and Dr. Donald W. Light.
[7] IMS Health is a leading provider of business intelligence services, strategic consulting services, and data for the pharmaceutical and health care industry.