Premium Prices in the United States
But any way that development expenditures are evaluated, the cost of drugs is unevenly shared globally, with the United States far outspending other nations on prescription drugs. In 2012, the United States was projected to spend $883 per person on prescription drugs, which was nearly twice as high as the amount spent in other wealthy nations. For example, Canada spends about $0.70 for each dollar spent in the United States per person, the United Kingdom spends just under $0.40, and Denmark spends only $0.35, according to a report from the Center for Economic and Policy Research.
An analysis in Health Affairs found that from 2000 to 2011, the average price of 29 cancer drugs in Europe was 10% lower than the average wholesale price in the United States (Health Aff. 2013;32:762-770). It was also about 8% lower than the average sales price in the United States, including the Medicare Part D price.
Overall, cancer drug prices are 20% to 40% lower in European countries than in the United States, according to IMS Health, a data and consulting firm.
Imatinib will cost Canadians and New Zealanders less than $1000 a dose. In the Netherlands, Spain, and Switzerland, it runs about $3500. In the United States, the price jumps to more than $6000.
Prices for patented brand-name drugs are also about 18% lower in Japan. Nivolumab (Opdivo, Ono Pharmaceutical), the first immunotherapy to act on the programmed death pathway, was approved in Japan for metastatic melanoma. The annual cost for the drug will be about $143,000. Bristol-Meyers Squibb, which will be distributing the drug in the United States when it is approved, has declined to say how much it will cost when it arrives on the American market, but the price tag could be substantially higher, given the usually lower rates in Japan.
"The US makes most of the discoveries, the taxpayer funds 85% of the basic research, and yet at the end of the day when a drug is FDA-approved for cancer as well as for other indications we as Americans are paying at least twice the price as those outside the US," said Dr Kantarjian. "In the setting of most cancer drugs, you can find them at half the price in Canada. For the hepatitis C drug [sofosbuvir], in the United States we pay $80,000 to $160,000 for a 3- to 6-month course, but in Egypt and India, the drug company has an agreement to give the total course of treatment to an individual patient for $900."
Even at that cut rate, they still make a large profit, he emphasized. "That's because the total cost of treatment is only $138. In the US, we are in a very awkward situation because we fund most of the research as taxpayers and we get zero in return," he explained.
"In fact," he said, "it is double jeopardy because we pay more than anyone outside the United States."