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A recent survey by the Washington, D.C.-based trade association Pharmaceutical Research and Manufacturers of America (PhRMA) revealed that 85 potential new drugs for dementias and mental disorders are currently in the U.S. pipeline. The prices of newer psychiatric drugs in the United States, however, are from 1.7 times to 2.9 times higher than in 16 other countries in North America and Europe, according to a study released in July by Washington, D.C.-based Public Citizen Health Research Group.
The U.S. was the only one of the 17 countries studied that lacks national health insurance, and that leaves the price of drugs entirely to market forces, said Public Citizen Health Research Group Director Sidney Wolfe, M.D.
"National health insurance allows other governments to negotiate drug prices, while in the U.S. consumers are left at the mercy of the pharmaceutical companies, which charge what they like," said Wolfe.
The study compared the cost to pharmacists of an average 30-day supply of three newer antipsychotic drugs and five newer antidepressants in 17 countries. "For all of the eight drugs, the cost in the U.S. was more than anywhere else," said Larry Sasich, Pharm.D., who coauthored the study with Wolfe and psychiatrist E. Fuller Torrey, M.D.
The U.S. cost of a month's supply of clozapine, for example, was $317.03, six times the $51.94 charged in Spain. This means that over the course of a year a patient in the U.S. would pay an additional $3,184. The U.S. price of fluoxetine was $72.16 per month, three times higher than the $25.93 cost in Spain, a $554 differential a year.
PhRMA President Alan Holmer condemned the study as flawed. "The report is flawed in that it fails to recognize that drug prices will vary for a number of reasons, including currency fluctuations, price controls, patent piracy, regulatory mechanisms, varying standards of living, variations in medical practice, and other factors."
Holmer was particularly scathing regarding Wolfe's support for negotiated drug prices, commenting that "price controls are a dagger aimed at the hearts of America's patients."
The imposition of price controls would stifle research investment, said Holmer. About half of the world's new medicines are "discovered and developed by U.S. companies," said Holmer. Those companies "take on the extraordinary risk of drug discovery because America's free-market system offers incentives and potential rewards," he added. "In contrast, in other countries around the world, when the free market is stifled by price controls or patent piracy, the lights in their laboratories go out, discovery of new medicines slows down, and patients and their families are denied the medicines they need."
The three antipsychotic drugs for which Public Citizen studied costs were clozapine, olanzapine, and risperidone; the five antidepressants were fluoxetine, fluvoxamine, paroxetine, sertraline, and nefazodone.
The survey covered the U.S., Canada, Mexico, Sweden, Austria, Finland, Italy, the Netherlands, Spain, Portugal, the United Kingdom, France, Germany, Ireland, Belgium, Denmark, and Luxembourg.
Only three of the 17 countries-the U.S., Canada, and Sweden-had all eight drugs available, while in Austria, Finland, Italy, the Netherlands, Spain, and the United Kingdom, seven were available.
According to an analysis contained in the study, U.S. sales of the five antidepressants have reached $3.3 billion to date and sales of the three antipsychotics $1.4 billion. In 1996 total profits for six major pharmaceutical companies selling drugs in the U.S. were $12.26 billion. "These profit levels reflect the fact that pharmaceutical companies selling in the U.S. continue to have one of the highest profit margins of any American industry," the report states.
The study elicited concern from the 185,000-member National Alliance on Mental Illness (NAMI). "We are gravely concerned about the results of [the] study. . .documenting that newer medications used to treat severe mental illness cost twice as much in the United States as in European countries," said a NAMI statement.
The development of new medications for mental illness has raised the hopes of the mentally ill and their families, but "hopes and dreams are dashed when consumers and families learn of a promising new drug only to find out that the medication is not covered by their health insurance company and that they cannot afford to purchase the medication themselves."
The Public Citizen Web site is www.citizen.org. The NAMI web site is