Two new, unrelated reports released at the same time highlight the ups and downs of the pharmaceutical industry. One study shows that, although clinical trials and overall medical research have historically lacked diversity, the tide is finally changing. However, after the clinical trials are successful and the drugs are approved, they are priced significantly higher in the United States compared with other nationals, according to an international report.
Improving diversity and data
Researchers at the Hackensack Meridian School of Medicine (New Jersey) have published a 5-year meta-analysis of clinical trials focused on New Jersey patients from 2017 to 2022. Overall, the results, featured in Global Epidemiology, show a more diverse representation and better reporting of race and ethnicity factors when compared with pre-2017 results.
For example, the research shows 97% of the examined New Jersey clinical trials reported on race and/or the ethnicity of the enrollees. The participation in the trials assessed collectively still showed a majority 76.7% white participants; but Black participants made up about 14.1 percent of the enrollees, which is slightly higher than the 2020 U.S. Census figure (which was used as a reference standard). However, the proportion of patients of Asian and Hispanic descent was slightly lower than the corresponding Census figures.
“Our 5-year snapshot reveals that a very large percentage of trials report on race/ethnicity and inclusivity is improving, presaging the potential acquisition of ever more powerful and meaningful results of such intervention studies going forward,” the authors conclude. “While there is still some way to go to have the demographic numbers in these trials match U.S. Census values, our results suggest that recent efforts are having an effect.”
Increasing prescription drug costs
If you’ve fulfilling a prescription any time recently, this news will not come as a shock: prescription drug prices in the U.S. are significantly higher than in other nations.
According to a new RAND report, prescription prices in the U.S. average 2.78 times those seen in 33 other nations. That gap is even larger for brand-name drugs, with U.S. prices averaging 4.22 times more. Those numbers are offset a bit by unbranded generic drugs, which the report says are about 67% of the average cost in comparison nations.
The new report updates findings from an earlier RAND analysis that compared 2018 manufacturer gross drug prices in the U.S. with other nations using a price index approach. The new study uses the same metrics through 2022, and also includes additional analysis that focuses on price comparisons for biosimilars and changes in price comparison results over time.
The researchers compiled their estimates by examining industry standard IQVIA MIDAS data on drug sales and volume for 2022, comparing the U.S. to 33 Organisation for Economic Co-operation and Development (OECD) nations. The data include most prescription drugs sold in the U.S. and comparison countries.
According to the study results, across all 33 comparison countries and drugs, U.S. drug prices are 278% higher than countries’ prices—ranging from 1.72x the prices in Mexico to 10.28x prices in Turkey.
For just brand name drugs, U.S. drug prices are 422% higher than comparison countries. The analysis used manufacturer gross prices for drugs because net prices—the amounts ultimately retained by manufacturers after negotiated rebates and other discounts are applied—are not systematically available. That means that, even after adjusting prices downward to account for these discounts, U.S. prices for brand name drugs remains more than 3x higher than those in other countries.
The script is flipped, however, when it comes to unbranded generic drugs. The report finds the U.S. has lower prices for generic drugs than most countries—which is significant given that generics account for 90% of U.S. prescription drug volume (compared with 41% for the comparison countries).
Still, even with the lion’s share of drug volume, generics account for only 8% of prescription drug spending in the U.S.
“Overall, the United States' considerable unbranded generic market share and low average unbranded generic prices did not fully offset higher brand name originator prices,” explain the study authors.
In line with this finding, the report shows the U.S. is responsible for an outweighed percentage of drug sales. Across all of the OECD nations studied, total drug spending was $989 billion in 2022. The U.S. accounted for 62% of these sales, but just 24% of the volume.