药价比欧洲贵5-10倍，美国“天价药”背后“操盘手”是谁？

Core Viewpoint - The article discusses the complexities behind the high drug prices in the United States, exploring the interplay between government, pharmaceutical companies, and insurance providers, as well as the philosophical and systemic issues that contribute to this phenomenon [2][5]. Group 1: Trump's Executive Order and Its Implications - Trump's executive order aimed to reduce drug prices by 30%-80%, but it lacked a clear implementation plan, leading to confusion and a rise in pharmaceutical stock prices instead of a decline [9][10]. - The historical context reveals that U.S. law prohibits the government from negotiating drug prices directly with pharmaceutical companies, reflecting a philosophical stance that separates government intervention from market operations [12][13]. - The political influence of pharmaceutical companies on Congress complicates efforts to reform drug pricing, as many lawmakers are reluctant to impose price controls due to concerns about stifling innovation [20][21]. Group 2: Drug Pricing Mechanisms - Drug pricing in the U.S. is influenced by various channels, including government insurance (Medicare) and commercial insurance, each with different pricing strategies and negotiation dynamics [22][23]. - Pharmaceutical companies set initial list prices based on historical pricing of similar drugs, perceived value, and market competition, leading to a significant gap between list prices and actual prices paid by patients [27][28]. - The negotiation process for drug prices is complex, with discounts varying widely across different channels, making it difficult to ascertain the true cost of drugs [34][35]. Group 3: Global Drug Price Comparisons - Drug prices in the U.S. are significantly higher than in Europe, with some drugs costing 5-10 times more in the U.S. compared to European countries [52][53]. - The article highlights that while U.S. drug prices are high, European countries have their own pricing philosophies that can lead to lower prices for certain medications, particularly for life-threatening conditions [58][59]. - China's approach to drug pricing has evolved, with recent reforms allowing for more aggressive negotiations that have led to lower prices for some drugs, reflecting a shift towards a more competitive market [66][67]. Group 4: Industry Dynamics and Future Outlook - The pharmaceutical industry faces a delicate balance between maintaining high prices to recoup R&D costs and the need for affordable access to medications for patients [73][74]. - Recent legislative changes in the U.S. may allow for some negotiation of drug prices, potentially aligning more closely with practices seen in other countries [71][72]. - The industry's long-term sustainability hinges on finding a balance between innovation incentives and patient access, as well as adapting to evolving regulatory environments [90][91].