Introduction

Abstract

Across Europe, at home in the United States, and around the world, countries are struggling with the high and growing costs of pharmaceuticals and with cash or co-payments as a barrier that keeps patients from taking what their doctor prescribes. Doctors without Borders (Médecins Sans Frontières 2013) recently reported that the cost of a basic vaccine series in developing countries has risen 2,700 percent. In the United States, more than one hundred oncologists united to protest the high, monopoly prices of new cancer drugs, most of which offer few advantages. They point out that drug co-payments alone cost their insured patients $20,000–$30,000 a year out of their household budget (Pollack 2013). Indeed, problems in the United States abound, as the vast majority of new, highly priced drugs offer only minor innovations rather than clinically superior drugs for patients (Light and Lexchin 2012), and they are producing an epidemic of harmful side effects so that drugs are a major cause of hospitalizations and death (Light, Lexchin, and Darrow 2013). Only a few countries (and ironically the US Department of Veterans Affairs) have policies for holding down drug costs equitably. These countries reward the development of superior drugs by deciding which drugs they will reimburse and at what level based on added clinical value: more for better drugs, a lot more for breakthrough drugs, but no more or no coverage for therapeutically similar drugs (Moïse and Docteur 2007).Value pricing plays a central role in the recommendations by Caroline Rudisill, Sotiris Vandoros, and Joseph George Antoun in their policy report on how Russian leaders are trying to provide health insurance for drugs, hold down costs, encourage domestic manufacturing, and encourage pharmaceutical research as well. What trade-offs and compromises might work best? Will they estimate the costs of harm as well as the costs of the drugs against the gain of benefits to arrive at value? This issue's Report from Europe conveys the struggles, contradictions, and unfolding policy efforts to make a set of sensible policy recommendations. One hopes for a follow-up report in five and ten years' time.