America's Health Care System is Broken: What Went Wrong and How We Can Fix It. Part 4: The Pharmaceutical Industry

Abstract As is true for most aspects of the US health care system, we pay much more for medications than do patients in any other country. Not only are new "breakthrough" products expensive, but existing products see price increases that regularly outstrip general inflation, making the pharmaceutical industry very profitable and resulting in many patients skipping or cutting the doses of such critical medicines as insulin. There is little relation between the effectiveness and the price of many medications. Drug firms like to cite the high cost of R+D but spend more on marketing than on R+D. The firms also spend large sums on lobbying and to influence medical thought leaders to keep their profits high. We are alone in spending $billions on pharmacy benefit managers that add little value. With new gene-based therapies on the horizon, the price of therapeutics may be unsustainable.