Prescription drugs: Innovative medicines are worth the price

Doctors affiliated with the world-famous Mayo Clinic recently called out the pharmaceutical industry for the high cost of cancer drugs. They argued that the prices for advanced treatments — some of which total $120,000 a year — are unsustainable, so the government must step in with price controls. The assertions, made in a number of articles, including a commentary in the journal Mayo Clinic Proceedings (tinyurl.com/mcp-commentary), are interesting but misguided. It is also strange in that many of these same doctors advocated for repeal of Medicare's global budget and price controls for physician services just this year.

New medications are often staggeringly expensive. But this pricing doesn't come out of thin air. High drug prices reflect the enormous costs of developing new medications and the huge — but often ignored — value that pharmaceuticals deliver to patients. Imposing price controls, as these misguided doctors suggest, would stifle drug development and hurt patient well-being.

Producing a new medication — like building a health system — requires massive investments. To see a new treatment through to approval by the Food and Drug Administration, pharmaceutical firms spend an average of $2.6 billion and between 10 to 12 years per therapy.

An overwhelming majority of potential new medications under development simply fail to pan out. Only 1 in 1,000 drug candidates makes it out of the lab to human testing. Just 20 percent of the drugs that make it out of the lab emerge from clinical trials to win FDA approval.

That means pharmaceutical firms have to price their drugs so that they can recover the development costs not only of successful medications, but of all those experiments that fail. Pharmaceutical companies must also factor in the cost of researching and developing future treatments into their current prices.

The U.S. conducts a majority of the world's pharmaceutical research and development (R&D). Of the 5,000 drugs currently in development, more than 3,000 are being studied on U.S. soil. Since 2000, the FDA has approved more than 500 new treatments.

Many of these are advanced, breakthrough therapies. Of the 41 new drugs approved by the FDA last year, more than 40 percent targeted rare diseases with either few or no existing treatments.

Other countries have proposed price controls for drugs, as the Mayo Clinic doctors propose. They've paid dearly to achieve these lower upfront expenses. For example, when Germany imposed 16 percent price cuts on drugs in 2004, pharmaceutical R&D spending dropped. Less R&D ultimately leads to fewer new medicines for patients.

Economists predict that if the U.S. government slashed drug prices by 40 to 50 percent, the number of new R&D projects on new medicines would drop by 30 to 60 percent.

Advocates of price controls also fail to consider the tremendous value that these treatments deliver, in terms of both health and economic savings.

Consider the new hepatitis C drug Sovaldi. Critics complain about its hefty price tag — $84,000 per treatment course that cured 90 percent of patients. Before Sovaldi, patients received a combination drug therapy that treated symptoms but that was hard and painful to take. And the therapy cost about $115,000 per year for as long as the patient was alive. But you didn't hear the critics talk about Sovaldi being cheaper and more effective, thereby saving what can amount to decades of treatment costs.

The Sovaldi experience is hardly unique. A recent study found that every dollar spent on a newer medicine saves more than six dollars on other health care expenses, such as hospital stays.

Just last year, critics argued that Sovaldi would bankrupt American health care. Guess what? There are now four products competing for the hepatitis C market. The resulting competition has led to lower prices and costs, with spending on all four products level and currently totaling just 0.001 percent of all health care spending. So the critics have moved onto to the next headline grabber.

Cancer medicines have also had a huge impact on human health and the economy. Between 1988 and 2000, treatment advances saved 23 million life-years and $1.9 trillion in the United States.

These advances will continue, provided that policymakers remain attentive to how the market for pharmaceutical research really works.

Trimming health care costs is a noble goal. But imposing price controls on prescription drugs — or any health care product or service — is not the way to do it. Such controls stifle innovation, increase costs throughout the system, and leave individuals sicker and with fewer choices. Competition is what works in driving down costs for drugs, devices, or even physician and hospital services.

It's too bad the smart doctors at Mayo apparently don't agree.