Marc-André Gagnon

The cost of pushing pills: a new estimate of pharmaceutical promotion expenditures in the United States.

In the late 1950s, the late Democratic Senator Estes Kefauver, Chairman of the United States Senates Anti-Trust and Monopoly Subcommittee, put together the first extensive indictment against the business workings of the pharmaceutical industry. He laid three charges at the door of the industry: (1) Patents sustained predatory prices and excessive margins; (2) Costs and prices were extravagantly increased by large expenditures in marketing; and (3) Most of the industrys new products were no more effective than established drugs on the market [1]. Kefauvers indictment against a marketing-driven industry created a representation of the pharmaceutical industry far different than the one offered by the industry itself. As Froud and colleagues put it, the image of life-saving “researchers in white coats” was now contested by the one of greedy “reps in cars” [2]. The outcome of the struggle over the image of the industry is crucial because of its potential to influence the regulatory environment in which the industry operates.

Corruption of Pharmaceutical Markets: Addressing the Misalignment of Financial Incentives and Public Health

This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives.

CETA and pharmaceuticals: impact of the trade agreement between Europe and Canada on the costs of prescription drugs

On a per capita basis, Canadian drug costs are already the second highest in the world after the United States and are among the fastest rising in the Organization for Economic Co-Operation and Development. The Comprehensive Economic and Trade Agreement (CETA) between the European Union (EU) and Canada will further exacerbate the rise in costs by:• Committing Canada to creating a new system of patent term restoration thereby delaying entry of generic medicines by up to two years;• Locking in Canada’s current term of data protection, and creating barriers for future governments wanting to reverse it;• Implementing a new right of appeal under the patent linkage system that will create further delays for the entry of generics.CETA will only affect intellectual property rights in Canada—not the EU. This analysis estimates that CETA’s provisions will increase Canadian drug costs by between 6.2% and 12.9% starting in 2023. The Canadian government committed to compensating provinces for the rise in costs for their public drug plans. Importantly, this means that people paying out-of-pocket for their drugs or receiving them through private insurance, will be charged twice: once through higher drug costs and once more through their federal taxes.As drug costs continue to grow, there are limited options available for provincial/territorial governments: restrict the choice of medicines in public drug plans; transfer costs to patients who typically are either elderly or sick; or take money from other places in the health system, and threaten the viability of Canada’s single payer system. CETA will therefore negatively impact the ability of Canada to offer quality health care.

Merger mania: mergers and acquisitions in the generic drug sector from 1995 to 2016

BackgroundDrug shortages and increasing generic drug prices are associated with low levels of competition. Mergers and acquisitions impact the level of competition. Record merger and acquisition activity was reported for the pharmaceutical sector in 2014/15, yet information on mergers and acquisitions in the generic drug sector are absent from the literature. This information is necessary to understand if and how such mergers and acquisitions can be a factor in drug shortages and increasing prices.MethodsData on completed merger and acquisition deals that had a generic drug company being taken over (i.e. ‘target’) were extracted from Bloomberg Finance L.P. The number and announced value of deals are presented globally, for the United States, and globally excluding the United States annually from 1995 to 2016 in United States dollars.ResultsGeneric drug companies comprised 9.3% of the value of all deals with pharmaceutical targets occurring from 1995 to 2016. Globally, in 1995 there were no deals, in 2014 there were 22 deals worth

Evaluating the effects of Quebec’s private–public drug insurance system

1.86 billion, in 2015 there were 34 deals totalling

The role and impact of cost-sharing mechanisms for prescription drug coverage

33.56 billion, and in 2016 there were 42 deals worth in excess of

Reforming private drug coverage in Canada: Inefficient drug benefit design and the barriers to change in unionized settings

44 billion. This substantial increase was partially attributed to Teva’s 2016 acquisition of Allergan’s generic drug business. The surge in mergers and acquisitions for 2015/16 was driven by deals in the United States, where they represented 89.7% of the dollar value of deals in those years.ConclusionsThe recent blitz in mergers and acquisitions signals that the generic drug industry is undergoing a transformation, especially in the United States. This restructuring can negatively affect the level of competition that might impact prices and shortages for some products, emphasizing the importance of updating regulations and procurement policies.

A better prescription: Advice for a national strategy on pharmaceutical policy in Canada

KEY POINTS As calls for universal pharmacare across Canada become stronger and models for its delivery are considered, it is worth looking at whether Quebec’s current system of drug coverage could serve as a model for the rest of the country. Canada is the only high-income country with a universal

Combating corruption in the pharmaceutical arena

[See related article [www.cmaj.ca/lookup/doi/10.1503/cmaj.161119][2]][2], and related CMAJ Open article at [www.cmajopen.ca/content/5/1/E198][2] Two linked research studies discuss the impact of cost-sharing mechanisms on cost-related nonadherence to drugs by looking at the introduction of income-