Patients, patents and expensive mistakes

High drug prices are often blamed on the patent system, which gives drug innovators a monopoly of about 20 years.  It is well known that patents are used by pharma companies to stop the launch of generic "copycat" versions of their drugs during the lifetime of the relevant patents, and this can contribute to the high prices of patented drugs.  However, simply attributing high prices to patents is not only misguided, but diverts attention away from the other factors that affect drug prices.  This could lead to opportunities to take action to lower drug prices being missed, which would be an expensive mistake.  

A recent study identified various factors that contribute to the high cost of prescription drugs in the United States, but in the conclusion highlighted patents as a key factor driving up prices.  This part of the conclusion was promptly picked up by various news reports, which failed to emphasise the other issues identified in the study.  In particular, this particular report alleged that drug prices in the US could be lowered if only the US Patent Office did not grant patents for marginal developments that have no therapeutic value.  

Is the answer really that simple? To me, this allegation begs the question why any doctor would prescribe a new version of a drug if it offered no therapeutic improvement over an existing (potentially off-patent) drug.  If such prescription practices are indeed taking place, then surely attention must be paid to the factors that influence those practices, to try to ensure that drugs are prescribed because of their efficacy, and not as a result of, e.g., misinformation or marketing strategies.  

The fact that patents are only one of the factors that can affect drug prices was highlighted by the uproar caused when Turing Pharmaceuticals raised the price of pyrimethamine, an off-patent drug for toxoplasmosis, by 5500%.  The company was able to set such a high price because no other manufacturer was licensed to market the drug in the United States.  

Thus, we cannot overlook some of the other conclusions of the study, which include:

-enhancing competition by ensuring timely generic drug availability; 

-providing greater opportunities for meaningful price negotiation by governmental payers; 

-generating more evidence about comparative cost-effectiveness of therapeutic alternatives; 

-and more effectively educating patients, prescribers, payers, and policy makers about these choices.

Interestingly, the US health system is very different from the UK health system, which operates a Pharmaceutical Price Regulation Scheme (PPRS), so some of the problems that arise in the US are mitigated in the UK.  Perhaps rather than making the patent system the easy scapegoat, the US government could learn some lessons from the UK to make drugs more affordable.