All of those issues affect drug prices, but you have to have something to sell before you can talk about its price. The real problem is that we in the drug industry haven't been discovering enough useful new drugs. As someone who works in the drug discovery labs, I'm just as guilty as everyone else: twenty years in the labs, and I've never worked on anything that's on a pharmacy shelf. If you want to know why your prescriptions cost what they do, blame me.
It's not like much that comes from Washington will solve our problems, either, even assuming that the administration wants to try. The research productivity drought isn't going to be ended by any fiscal or regulatory initiatives, because those aren't what got us here. The causes are complicated, and not everyone agrees on all of them, but I think that most of us in the labs would agree that (for one thing) we've used up a lot of the (relatively) easy drug targets. We don't even have a good idea of what causes many of the diseases that we'd most like to tackle.
For another thing, we've learned a lot more about potential problems with drug candidates, but not so much about how to fix them. Aspirin, acetominophen, and penicillin wouldn't have made it through a modern drug discovery effort. We'd have found their problems early (intestinal bleeding, liver toxicity, and anaphylactic shock, in that order), and either killed them off or spent years trying to get around them. Some of the things our modern safety assays turn up are unfixable show-stoppers, others are just warning lights that put the fear into companies who decide that they'd rather spend the money on something that looks cleaner.
These are all medical, chemical, and biological problems - no legislation is going to make them go away. I'm afraid that we're just going to have to learn our way out of them. And that has already been a slow, expensive process, for which no end is in sight. The best we can hope for is that things don't get worse while we stagger our way through.
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