21评论｜美国药价改革的转折：市场机制与政府作用的再平衡

Core Viewpoint - Pfizer has reached a "Most-Favored-Nation Price" agreement with the U.S. government, promising discounts of up to 85% and an average of about 50% on drugs for American patients, while receiving tariff exemptions and policy facilitation in return [1][3] Group 1: U.S. Drug Pricing Mechanism - The U.S. drug pricing mechanism has historically relied on free pricing and market regulation, with the 2003 Medicare Modernization Act prohibiting direct government negotiation, leading to high drug prices [2] - A 2024 RAND report indicates that the average price of drugs in the U.S. was 2.78 times higher than in 33 other OECD countries, with brand-name drugs averaging 4.22 times higher, contributing to the label of the U.S. as a "global drug price island" [2] Group 2: Policy Shifts - The Inflation Reduction Act (IRA) of 2022 marked a significant policy shift, granting Medicare the authority to negotiate drug prices and allowing the Department of Health and Human Services to set "Maximum Fair Prices" for high-cost drugs [3] - The first round of negotiated drug prices under the IRA saw reductions of 38% to 79% compared to original prices, indicating a move towards government intervention in drug pricing [3] Group 3: Future Drug Pricing Initiatives - The TrumpRx platform, set to launch in 2026, aims to provide discounted prices through government-led direct purchasing, using the "Most-Favored-Nation Price" principle to narrow the price gap between the U.S. and other developed countries [5] - The platform seeks to enhance government bargaining power, reduce intermediaries, and improve price transparency, similar to external reference pricing in Europe and centralized procurement in China [5] Group 4: Global Implications - Adjustments in U.S. drug pricing policies may influence global pharmaceutical value chains, potentially shifting multinational companies from regional pricing strategies to fair pricing based on clinical value and cost-effectiveness [6] - For China, the U.S. reforms present both challenges and opportunities, as the loosening of high price anchors may lead to lower profit expectations for global innovative drugs, prompting Chinese companies to accelerate their transition from "fast followers" to "original innovators" [6] Group 5: Overall Trends in Drug Pricing Governance - The U.S. drug pricing reform reflects a global rebalancing in pharmaceutical governance, with countries seeking to balance expenditure control, innovation promotion, and accessibility [7] - The agreement between Pfizer and the U.S. government exemplifies this trend, indicating a potential shift towards a more flexible and complementary role for government and market forces in the pharmaceutical industry [7]