Drugs are being invented and manufactured right here in the U.S. by Americans, for Americans. So why doesn’t the industry hold the same respect as steelworkers or other all-American pursuits?
Americans are fiercely proud of the things they make—the steel industry being a prime example of patriotism tied to a manufacturing sector that creates jobs and products. The pharmaceutical industry does that too, with a level of innovation that is enviable the world over. And yet, the specter of Big Pharma has become an American boogeyman.
“It’s really hard to understand why the steel industry might be deemed not only a necessary industry but a gem in the sort of industrial firmament of the United States. But somehow, the pharmaceutical industry are just a bunch of bad guys,” Michael Abrams, a managing partner at Numerof & Associates, told BioSpace in a recent interview.
This isn’t about picking on the steel industry specifically. It’s just an example. But this issue of why pharma gets such a bad rap is key to the ongoing narrative over drug pricing, according to Peter Rubin, executive director for the patient advocacy group No Patient Left Behind. The lack of value attributed to pharmaceutical innovation “vexes us,” he told BioSpace in an interview.
“The American people won’t protect what they don’t value.”
Everyday Americans don’t understand that most innovation happening in biopharma is coming from investors and small U.S.-based companies. They make up two-thirds of all drugs that go before the FDA. Americans even contribute as investors via their retirement funds, a fact pointed out in a recent No Patient Let Behind campaign, Rubin said.
“The reason why people beat up on the industry is because they hear it from their constituents,” Rubin said of politicians who have taken up the drug pricing gauntlet. “And why do they hear it from their constituents? Because they get charged high out-of-pocket costs at the pharmacy counter for a pill that looks like a Tic Tac.”
But that Tic Tac probably took a decade to make, with brilliant scientists, clinicians, researchers, doctors and executives pushing it along. And those people may just be your neighbors, especially if you live in Massachusetts or California.
“The pharmaceutical industry that is centered here in the United States is the leader of the world. And it’s odd that for all the other industries we have—which you can probably count on one hand—that lead the world, they’re all stars,” Abrams said. “But the pharmaceutical industry is in the doghouse.”
The Big One
The pharma industry emerged from the pandemic with an incredible amount of goodwill, thanks to innovative treatments and vaccines that saved countless lives around the world. But the drug pricing issue has never gone away, and today the industry is once again the villain in a complex health system that ends with patients paying sometimes high and unpredictable prices for their medications.
Various parties have previously taken initiatives to lower drug prices in the U.S., but no major policy hasstuck. Today, it’s a different story. The Inflation Reduction Act is well on its way to instituting negotiated prices for medications that pass through Medicare; and President Donald Trump has returned to the White House eager to revisit his Most Favored Nation policy, which aims to tie U.S. drug prices to what equivalent nations pay.
Abrams said the pharma industry is undergoing a massive regulatory change right now, one that executives should have seen coming but instead assumed would go away like the other attempts to rein in prices have.
“For 15 or 20 years, the issue of government mandating pricing for pharmaceuticals has been coming up periodically. And for all that time, it would come up, and then it would go away,” Abrams said. “Most of the Big Pharma companies that we work with had gotten to the point where they assumed that every time it would come up, it would go away. And so you cannot imagine the shock when it didn’t.”
Abrams likens this to the San Andreas fault. “Occasionally there’d be a small slip and there would be a shudder or there’d be a small earthquake. But that wasn’t really the end of it. Every small earthquake was just letting off energy so that The Big One didn’t happen.”
The IRA was The Big One. It paved the way for Most Favored Nation, tariffs and other policy initiatives that the industry has been vehemently pushing back on—from their back foot, according to Abrams.
“They’re still trying to figure out which way is up at this point, and that has really made the job of CEO that much more difficult,” he said of today’s pharma leaders.
Rubin said he understands the public sentiment. He, too, pays thousands in insurance premiums and still gets hit with a big bill at the pharmacy, even for generic drugs, which are generally cheaper and manufactured largely outside of the U.S. Or he’s had to deal with prior-authorizations from insurance companies that he says incentivize profit over care.
Absent fixing America’s health insurance system—a tall order—pharma executives are left with a huge public relations problem.
“Pharmaceutical companies . . . have done an abysmal job of selling the public on the value that they provide, both the financial value and the sort of human value that comes from having products that, quite literally, not just ameliorate some illnesses but actually make them go away,” Abrams said. “Some of it is truly astounding and we’re on the verge of so much more.”
That’s why No Patient Left Behind is trying to reframe the narrative to remind Americans of the people behind the industry. The group just launched a chat tool called Call The Inventors, where patients can type in a drug name to find the manufacturer and tools for access to the treatment. The aim is to connect people with the drugs they need when their insurance company says no or when the co-pay is too high, Rubin said, but the messaging behind the word “inventor” is just as important.
Consumers also need to understand the biotech/Big Pharma relationship, Rubin said. Many drugs are developed at scrappy startups—many of them American—with small teams of researchers pushing a drug in the earliest stages. Big Pharma often joins later on, providing funding to get the drug to market.
It’s an invaluable service, and one that gets lost when Big Pharma is dismissed as the boogeyman.
The general public doesn’t have visibility into the great financial risk involved in drug making, with millions poured into therapies that never succeed. For every FDA-approved pill or injection, dozens of investigational therapies flopped in the clinic. The industry had to pay for that.
Rubin said pharma leaders have been participating in good faith as drug pricing policy comes up, agreeing to certain regulations like the Affordable Care Act and even the IRA. But the industry has asked for a revision to the IRA to scrap the pill penalty to incentivize innovation, and that wish has not yet been granted, despite Trump indicating support for the idea.
At the end of the day, Rubin wants the general public to know that there are real people behind the medicines, and that what they want most of all is to improve access to the life-saving drugs they have created.
“The inventors behind these medicines are real humans. Like all of us, they care deeply about addressing the unmet needs for the patients that they work with through decades in bringing a drug to market,” Rubin said. “They’re passionate about being entrepreneurial in the sense of building something that’s going to be good for society. There’s a reason why they’re doing this versus building apps for Netflix or whatever.”
