Intended for healthcare professionals


High US drug prices have global implications

BMJ 2022; 376 doi: (Published 22 March 2022) Cite this as: BMJ 2022;376:o693
  1. Kristina Jenei, researcher1,
  2. Vinay Prasad, associate professor2,
  3. Mark P. Lythgoe, academic clinical fellow3
  1. 1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States
  3. 3Department of Surgery and Cancer, Imperial College London, London, United Kingdom
  1. Corresponding author: K Jenei kjenei{at}

Lower income countries need better protection from an unfettered US market

This is a critical time for pharmaceutical reform in the United States. The Biden administration introduced the Build Back Better Bill, which included several provisions to reduce prescription drug costs.1 But the fate of the bill is uncertain. Although these reforms have direct implications for the US healthcare system, their international impact is seldom appreciated. Given the global influence of the US drug market and increasing unaffordability of medicines worldwide, the stakes of pricing reform are high.

The US has the largest drug market in the world, estimated at over $480bn, over four times larger than the next country (China $88.3bn), and accounts for an estimated 46% of global pharmaceutical sales.2 The US is also the world’s largest funder of biomedical research, so it is responsible for funding a substantial proportion of global medicine development. For this reason, many drug and biotechnology companies have a large presence in the country. But drug prices are so high in the US that companies typically earn enough to cover all global research and development costs associated with a new molecule.3 These features combined—research and development and …

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