U.S. Drug Prices a Rip-Off, But . . .

As if we needed more evidence, here’s a recent analysis of how much Americans pay for big-ticket drugs and how much money pharmaceutical companies collect in the U.S. compared with their worldwide revenues for these drugs.

Manufacturer Drugs Revenues (billions) U.S Share of Total
U.S. Rest of World
AbbVie Humira
$20.4 $3.7 85
Bristol Myers Squibb Eliquis
$17.7 $10.5 63
Johnson & Johnson Imbruvica
$11.9 $6.0 66
Pfizer Eliquis
Prevnar 13
$10.3 $8.3 55
Roche Avastin
$9.0 $6.1 60
Merck & Co. Keytruda $8.4 $6.4 57
Gilead Sciences Biktarvy $6.1 $1.2 84
Regeneron Pharma. Eylea $4.9 $0.0 100
Amgen Enbrel $4.9 $0.1 97
Eli Lilly Trulicity $3.8 $1.2 76
Astellas Pharma Xtandi $2.2 $2.0 52
AstraZeneca Trulicity $1.6 $2.8 36
Bayer Eylea $0.0 $8.5 0

This graphic was drawn from a report issued by Public Citizen, the consumer advocacy group founded in 1971 by Ralph Nader.

“For 17 of the 20 top-selling drugs worldwide in 2020,” the report said, “pharmaceutical corporations made more money from U.S. sales than from sales to all other countries in the rest of the world combined.”

This situation has been largely caused by U.S. laws that prohibit Medicare – far and away the nation’s largest health care payer – from negotiating directly with drug companies over prices.

In other countries, by contrast, national governments do have that power.

It’s not clear (to me at least) the extent to which drug companies do not push back against foreign governments because they don’t have to so long as Uncle Sam shoulders the bulk of global drug revenues.

It’s also not clear to me how much industry revenues could drop before discouraging drug companies from spending the huge sums of money needed to develop the kinds of blockbuster drugs we want.

Wouldn’t it be nice to find out? Congressional approval for Medicare to negotiate drug prices would be a great place to start.