The Future of Pharmaceutical Prices: Successes and Failures of Drug Pricing Reforms

Just like 30 years ago with new HIV treatments, the steep costs of numerous medicines are grabbing the spotlight in the media. These sky-high prices are influenced by various factors, with the main culprits being the lack of competition and the increasing financialisation of pharmaceutical companies. This increase leads to growing challenges in accessibility and the sustainability of health systems, even in wealthy countries.The presence of national and international regulations can contribute to reducing price, and hence enable a larger population to benefit from medications and/or result in significant public savings. Yet, those come with trade-offs: efforts to lower pharmaceutical prices may result in reduced investments and output in research and development, or cause delays and shortages in drug availability. Additionally, choosing not to reimburse promising medicines or quantifying the value and quality of life for price determination might be politically costly. There are also trade-off regarding the basis for negotiating the prices - whether the costs of production (which are rarely very transparent) or the value of the pharmaceuticals (which is often uncertain and speculative for innovative medications and might lead to unsustainable prices (imagine if antibiotics had been priced according to their value).

The willingness and ability of certain governments to implement regulations on pharmaceutical pricing, and the choices of regulations they make, raise fundamental questions about the future of pharmaceutical prices. What prompts or will prompt governments to undertake reforms at a specific moment and not earlier? What factors will determine the success of these reforms? What insights can we deduce from this about pharmaceutical power and the (future) state's capacity to pursue the common good?

In this paper, we present the preliminary results of a funded project asking those questions, with a preliminary analysis of the Italian and US cases - both using a qualitative methodology.