为什么美国药品价格越来越高?（二）
Why are US drug prices getting much higher?
译文简介
网友：为什么只有美国的药价如此之高?这种情况会改变吗?
大型制药公司的贪婪和腐败。我是一个住在新西兰的美国人。我的医生是第一个发现丙肝治疗方法的人。在新西兰，任何人都可以免费获得丙肝治疗，新西兰有55000名丙肝患者。在美国，同样的药你要付85000美元。真特么的贪婪和腐败，这就是问题所在。
正文翻译
Why are US drug prices getting much higher?
为什么美国药品价格越来越高?
为什么美国药品价格越来越高?
评论翻译
很赞 ( 0 )
收藏
Why are drug prices so high only in America? Will it ever change?
Sheer greed and corruption from big pharma. I am an American that lives in new Zealand. My doctor was the first eperson to discover the cure for hepatitis C. In New Zealand it is free to anyone who needs it and there are 55,000 people with Hep C here. in the US you will pay $85,000 for the same medication. Total and absolute greed and corruption. That’s what is wrong.
为什么只有美国的药价如此之高?这种情况会改变吗?
大型制药公司的贪婪和腐败。我是一个住在新西兰的美国人。我的医生是第一个发现丙肝治疗方法的人。在新西兰，任何人都可以免费获得丙肝治疗，新西兰有55000名丙肝患者。在美国，同样的药你要付85000美元。真特么的贪婪和腐败，这就是问题所在。
Is it the high drug prices in the US that allows the rest of the world to have much lower drug prices?
No, the high drug prices in the US actually allows the drug companies and medical insurance companies to make much higher profits from the poor and the sick. The rest of the world negotiates acceptable prices for the drugs they will allow to be dispensed, rather than allow price gouging.
是美国的高药价让世界其他地方的药价更低吗?
不，美国的高药价实际上允许制药公司和医疗保险公司从穷人和病人身上赚取更高的利润。世界上其他国家会就他们允许的药品价格进行谈判，而不允许进行价格欺诈。
US drug prices are getting much higher because the United States doesn’t have the federal price controls on prescxtion drugs that we have in Canada.
This is why the four prescxtion drugs that cost a total of $59 a month (I pay $12 a month and the provincial government pays $47 a month) in Canada cost $825 a month in the United States,
美国的药品价格越来越高，因为美国没有像加拿大那样对处方药实行联邦价格管制。
这就是为什么在加拿大总共每月59美元的四种处方药(我每月支付12美元，省政府每月支付47美元)在美国每月要花费825美元的原因。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Do you think the USA need drug price controls?
I think that the U.S. government should repeal the law that Big Pharma got for themselves that prohibited the U.S. government from using their monopsony power (the power of the single or biggest buyer). This is the power that Walmart uses when it takes on suppliers. This is the power that GM uses when it purchases tires. This is the power that countries like Canada and Mexico use when they deal with large, drug-selling corporations who want to sell in their countries. This is why, for instance, a salve that would cost me $110 in the U.S., cost me $2.80 in Mexico.
你认为美国需要控制药品价格吗？
我认为美国政府应该废除大型制药公司为自己制定的法律，该法律禁止美国政府使用其垄断权力（单一或最大买家的权力）。这就是沃尔玛在收购供应商时所使用的权利。这是通用汽车在购买轮胎时使用的权力。这是加拿大和墨西哥等国在与希望在本国销售的大型药品销售公司打交道时使用的权力。这就是为什么一种在美国要花110美元的药膏，在墨西哥花2.80美元。
原创翻译：龙腾网 https://www.ltaaa.cn 转载请注明出处
Why are drug prices so high only in America? Will it ever change?
The biggest drug dealers in the world is the FDA…. If they find something that works, they want to ban it and sell it at 100x the value…. Just look at CBD oil… A bottle costs $50–100 bucks for a 1 month supply, yet the FDA want to make it illegal and sell it themselves for over 20k a year… And you will probably not even get the real product….
A $425,000 cancer killing drug is what it costs a dose, and how many do your need? Yet the same is available in other countries for 1% of the cost…. Highly regulated…. They don’t want the people getting cured, they want money in their pockets….
为什么只有美国的药品价格这么高？它会改变吗？
世界上最大的药品经销商是美国食品药品监督管理局。如果他们发现了有效的东西，他们想禁止它，自己再以价值的100倍出售。看看 CBD （CBD Oil，又称为麻繁愫，旧称麻宝愫）：一瓶用1个月的供应成本为50-100美元，但美国食品药品监督管理局却想将其定为非法，并以每年超过2万美元的价格自行销售，你甚至可能得不到正品。
一种价值42.5万美元的癌症杀伤药物是一剂的价格，你需要多少？然而，在其他国家也有同样的服务，只需支付1%的费用。高度管制……是的，他们不希望人们被治愈，他们希望口袋里有钱。
What happened to drug prices dropping as we have been told in the United States?
Here’s the thing - drug prices HAVE dropped. Four years ago a prescxtion for 30 Viagra tablets would have cost a patient $1200 cash. They are now available for less than $30. The antibiotic Zithromax was $7 per pill when it first came out, and is now less than $1. Claritin was $70 per month and is now under $10 (and over the counter to boot). There are other drugs that are still great meds that I use all the time that can be had for $15 per month or less.
As a matter of fact, if you were happy with the state of medications in the year 2005 or so, pretty much everything that was available then is cheap as dirt now.
What hasn’t gone down (and in fact has become much worse) is the price of new drugs. If you aren’t happy with 2005 technology, the stuff that is newest and best is going to cost you. Innovation costs money. If you want drug companies to keep pumping out things that are newer and better, somebody has to pay for it (and, of crucial importance, to pay for the failures that never make it to market but also cost a lot to develop).
When I started in medicine, there were exactly two classes of drugs to treat type 2 diabetes, and they weren’t terribly good. Since then the pharmaceutical industry has brought out 6 or 7 entirely new classes of drugs, providing a huge improvement over the old ones and enabling much better blood sugar control, and because of that a much lower rate of complications like blindness, kidney failure, amputations, strokes, and heart attacks. Those old meds are still around, and if you want me to treat your diabetes and only spend $5 a month, I can do it. I just can’t do it nearly as well as I can with the newer stuff.
Of course, in 10 years, the really expensive stuff today will then be cheap, but will have been replaced by even better stuff. And medical care will be better.
我们在美国听说的药品价格下降是怎么回事?
事情是这样的——药品价格下降了。四年前，30片伟哥的处方将花费病人1200美元现金。现在售价不到30美元。抗生素希舒美刚问世时每粒7美元，现在不到1美元。克敏能以前是每月70美元，现在不到10美元（现在已经过时了）。还有其他药物仍然是我一直使用的良药，每月15美元或更低。
事实上，如果你对2005年左右的药物状况感到满意，那么几乎所有当时可用的药物现在都很便宜。
新药的价格没有下降（事实上已经变得更糟了）。如果你对2005年的科技不满意，那么最新、最好的东西会让你付出代价。创新需要花钱。如果你想让制药公司不断推出更新更好的产品，就必须有人为此付出代价（至关重要的是，要为那些从未上市但开发成本高昂的失败付出代价）。
当我开始从事医学工作时，只有两类药物可以治疗2型糖尿病，但它们的效果都不是很好。从那时起，制药行业已经推出了6到7种全新的药物，与旧药物相比有了巨大的改进，使血糖控制得更好，因此，失明、肾衰竭、截肢、中风和心脏病发作等并发症的发生率大大降低。那些老药还在，如果你想让我治疗你的糖尿病，并且每月只花5美元，我也可以的，只是做不到像用新药那样好。
当然，10年后，今天真正昂贵的东西会变得便宜，但会被更好的东西所取代。医疗服务也会更好。
Why are drug prices rising so much?
Rather than argue about whether all drug prices are increasing, I’d suggest that at least two facts seem beyond dispute:
Some drug prices are very expensive;
More and more, extremely expensive drugs (e.g., for a condition that has no other treatment) are being approved and marketed.
Lack of transparency and complexity of reimbursement contribute, in my opinion, to a system that lets some drugs be much more expensive than they should. Previously pharma companies would say, “We’re basing our prices on development costs.” That’s now longer said. Now it’s, “We feel justified in charging as high a price as the market will bear.”
Unfortunately (or perhaps not), when it comes to something like curing cancer, the market will bear a very high price. Especially this is so when third parties (e.g., insurance companies) actually pay. At a collective (i.e., institutional) level, it may seem quite rational to pay, say, $1,000,000 for a life-saving drug. However an individual person or family, faced with that expense, might simply say, “Maybe we should just aim for ‘death with dignity.’”
Nobody is making that kind of humanistic value decision today. Is adding 60 days of life in bed and with pain worth $1,000,000? But nobody asks questions like “could that $1,000,000 save more lives put to some different use — like famine relief or immunizing infants in Africa?”
In short, we see many astronomically priced medicines because the institutions that choose how much to pay for treatments base decisions on algorithms that basically serve the interests of the pharma industry. Pharma companies spend a huge amount of money on political campaign contributions and lobbying to produce favorable laws and regulations.
Another issue affecting lack of transparency is complex pricing schemes, including discounts and rebates.
I think having companies put prices in their ads is a good idea, even if it isn’t perfect. I also like the idea of paying for an expensive drug only if it works.
为什么药品价格上涨这么快？
与其争论是否所有的药品价格都在上涨，我认为至少有两个事实似乎是无可争议的:
有些药品价格非常昂贵；
越来越多的极其昂贵的药物(例如，治疗没有其他治疗方法的疾病)正在获得批准和销售。
在我看来，缺乏透明度和复杂的报销制度导致了一些药物的价格远远高于应有水平。以前制药公司会说，“我们的价格是基于开发成本的。”现在人们不再这么说了。现在是，“我们觉得有理由收取市场所能承受的高价。”
不幸的是（也许不是），当涉及到像治疗癌症这样的事情时，市场将承受非常高的价格。尤其是当第三方（例如保险公司）实际付款时，情况更是如此。在集体（即机构）层面上，支付100万美元购买一种救命药物似乎是非常合理的。然而，面对这笔费用，个人或家庭可能会简单地说：“也许我们应该以‘有尊严的死亡’为目标。”
今天没有人会做出这种人文价值的决定。在痛苦中卧床60天的生命值100万美元吗?但没有人会问这样的问题:“这100万美元能拯救更多的生命吗?能不能把它用在别的地方——比如赈灾或给非洲的婴儿接种疫苗?”
简言之，我们看到许多药物价格惊人，因为选择治疗费用的机构的决策基于基本上符合制药行业利益的算法。制药公司花费大量资金用于政治竞选捐款和游说，以制定有利的法律法规。
影响缺乏透明度的另一个问题是复杂的定价方案，包括折扣和回扣。
我认为让公司在广告中标明价格是个好主意——即使它并不完美。我也喜欢只在有效的情况下才为昂贵的药物付费的想法。
How do people lower drug prices? Why?
Please clarify what you’re asking.
Is it how much I as an individual spend on drugs? Is it how much that gets paid to the pharmacy for providing drugs I use?
Would it be acceptable for me to accomplish this by reducing the frequency or the dosage that I’m using? How about having laws enacted which restrict the prices that drug companies may charge? Ordering “gray market” drugs from abroad at lower prices? Asking my doctor to prescribe a less expensive medication in hopes that it will be effective? Change my lifestyle to reduce the likelihood that I will need drugs?
Things that I presume would be acceptable are to shop around for a pharmacy that has lower drug pricing (or use the mail order pharmacy service that’s often encouraged to be used by insurnace companies), as well as to use generic medications when they are available.
人们是如何降低药品价格的？为什么？
请澄清你的问题。
这是我个人在药品上的花费吗？是指我付给药房多少钱来让它提供给我药物吗?
我可以通过减少使用频率或剂量来实现这一点吗？制定法律限制制药公司可能收取的价格怎么样？以更低的价格从国外订购“灰色市场”药品怎么样？让我的医生开一种便宜的药，希望它能有效？改变我的生活方式以减少我需要药物的可能性？
我认为可以接受的做法是货比三家，找一家药品价格较低的药店（或使用保险公司经常鼓励使用的邮购药店服务），以及在有仿制药的情况下使用仿制药。
Why are drug prices increasing when the chief said he would reduce prices?
You noticed that, huh? It’s a gift to big pharma. When Trump scares the drug sellers about legislatively lowering their profit margin, and then sits back and watches as they respond by trying by all means to squeeze even more out of sick consumers, you are witnessing a morally vulgar Kabuki dance. Gun manufacturers have a similar thing they do
为什么上层说要降价，药品价格却在上涨？
你注意到了吗？这是送给大型制药公司的礼物。当特朗普用立法降低他们的利润率来吓唬药品卖家，然后袖手旁观，看着他们以各种手段从生病的消费者那里榨取更多的钱作为回应时，你正在目睹一场道德败坏的歌舞伎表演。枪支制造商也有类似的做法。
Do you think the USA need drug price controls?
Imagine a scenario where the US suddenly has universal healthcare. There is still private health care if you choose it but every American, rich or poor, is covered by their taxes * and is entitled to treatment for every ailment they have. No co pays, no dealing with insurance companies, no denial due to a pre existing condition, no medical bankruptcies, no bills in the post, ever. No fighting with insurance companies protecting their profits. No worries if you lose your job because you are still entitled to treatment. Companies no longer have to organise cover for their employees.
Suddenly you have this huge, mega corporation called a government that has real power over the now, not so mega, pharmacutical companies. The government says we want someone to supply all of our X drug or Y drug, or medical equipment, or joint replacements, etc. They say send us your quotes and if we pick you then you get a mega deal but, in order to win the contract, you have to compete with blind quotes from every pharmacutical company in the world. Suddenly those very expensive drug prices start to come down. Overall costs go down.
Personally that is the most powerful drug control you could have.
Taxes are a touchy subject in the USA I know. However, the reality is that you are currently paying healthcare tax in the form of insurance payments, co-pays, prescxtion and drug costs not covered by insurance, etc. Plus the time you personally waste fighting with insurance companies over costs, refused cover and bills. Take that all away and increase tax only slightly for everyone and voila you could have the best universal healthcare in the world without a doubt. Everyone would pay tax, even those who want to pay for private cover. Why? Because your tax would not be much higher, you would be contributing to a fairer society and, if your circumstances change, universal healthcare is there ready and willing to catch you when you fall. If you are too selfish to think this is a good thing then shame on you.
你认为美国需要控制药品价格吗？
想象一下美国突然拥有全民医疗的情景。如果你选择的话，仍然有私人医疗服务，但每个美国人，无论贫富，都有权享受由他们的税收支付，并有权治疗他们的每一种疾病。没有共同支付，无需与保险公司打交道，没有因预先存在的条件而拒绝，没有医疗破产，无需支付账单。无需与保险公司争夺利润。如果你失业了，不用担心，因为你仍然有权得到治疗。公司不再需要为员工提供保险。
突然间，你就有了一个巨大的巨型公司，叫做政府，它对现在不那么大的制药公司有真正的权力。政府说，我们希望有人给我们提供所有的X药或Y药，或医疗设备，或关节替代物等。政府说，把你的报价发给我们，如果我们选择你，你就会得到一笔大宗交易，但为了赢得合同，你必须与世界上每一家制药公司的盲目报价竞争。突然之间，那些非常昂贵的药品价格开始下降。总体成本下降。
就我个人而言，这是你能拥有的最有效的药物控制的方式。
据我所知，在美国，税收是一个敏感的话题。然而，现实情况是，你目前正在以保险费、共同支付、不在保险范围内的处方费和药品费等形式缴纳医疗税。此外，你还浪费了与保险公司就费用、拒绝保险和账单进行扯皮的时间。去掉所有这些，只对每个人略微加税，瞧，毫无疑问，你可以拥有世界上最好的全民医疗。每个人都要纳税，即使是那些想为私人保险买单的人也是如此，为什么？因为你的税收不会高很多，你将为一个更公平的社会做出贡献，如果你的情况发生了变化，全民医保随时准备好并愿意在你跌倒时扶住你。如果你太自私而不认为这是一件好事，那么你应该感到羞耻。
Why are drugs expensive?
It depends on which country you are buying your medications from. In USA for example, the prices are most of the meds are insane. While the Canadian neighbors pay 50 to 60% less for the same meds.
Americans spend about $1,200 on prescxtions drugs a year, according to the latest figures from the Organization for Economic Cooperation and Development. That’s more than people pay in any other developed country in the world.
In the past, pharmaceutical companies have attributed high prices to innovation, arguing that new and improved drugs are naturally more expensive. But a new study published in the journal Health Affairs complicates that idea.
It suggests that, largely, costs have gone up because companies are raising the price of drugs that are already available.
“We found that, in the case of brand-name drugs, rising prices were driven by manufacturers increasing prices of medications that are already in the market rather than [by] the entry of new products,” lead author Inmaculada Hernandez, an assistant professor at the University of Pittsburgh School of Pharmacy, tells.
‘Out-of-pocket costs continue to soar’
为什么药物很贵？
这取决于你从哪个国家购买药物。例如，在美国，大多数药物的价格都很疯狂。而同样的药，加拿大邻居要少付50%到60%。
根据经济合作与发展组织的最新数据，美国人每年在处方药上的花费约为1200美元。这比世界上任何其他发达国家的人都要多。
过去，制药公司将高价格归因于创新，认为新药和改良药自然更贵。但发表在《健康事务》杂志上的一项新研究使这一观点变得复杂。
报告显示，成本上升主要是因为制药公司提高了现有药品的价格。
匹兹堡大学药学院助理教授Inmaculada Hernandez是该研究的主要作者，他说：“我们发现，就名牌药物而言，价格上涨是由制造商提高已上市药物的价格驱动的，而不是由新产品的进入驱动的。”。
“自付费用持续飙升”
These percentage changes reflect list prices, which are set by manufacturers and don’t fully match what consumers pay, since they don’t account for rebates or insurance discounts.
Some increased prices, such as those for specialty and generic drugs, seem to be driven by the entry of new medications into the market, the researchers found. Otherwise, price increases don’t necessarily reflect improvement or even change.
In 2014, the list price for a Sanofi brand of insulin called Lantus increased nearly 50 percent, for example, even though it had already been on the market for more than a decade. (The average net price, or what consumers pay, for Lantus has actually decreased in recent years, though, a spokesperson for Sanofi tells.)
Pharmaceutical companies kicked off the new year with significant price hikes. Dozens of drugmakers raised the list prices of hundreds of medications an average of 6.3 percent on Jan. 1, according to a recent analysis from the health software company Rx Savings Solution.
通过查看约2.7万种处方药的批发数据，埃尔南德斯（Hernandez）和她的同事发现，在2008年至2016年间，著名品牌的口服处方药每年增长9%，而注射药物每年增长15%。与此同时，通货膨胀率仅为2%左右。
这些百分比变化反映的是标价，标价是由制造商设定的，并不完全符合消费者支付的价格，因为它们不包括回扣或保险折扣。
研究人员发现，一些价格上涨，如专业和仿制药的价格上涨，似乎是由新药进入市场所推动的。否则，价格上涨不一定反映出改善甚至变化。
例如，2014年，赛诺菲品牌甘精胰岛素，尽管它已经上市十多年了，但是标价上涨了近50%。（赛诺菲的一位发言人说，近年来，甘精胰岛素的平均净价或消费者支付的价格实际上有所下降。）
制药公司在新年伊始大幅提价。根据健康软件公司Rx Savings Solution最近的一项分析，1月1日，数十家制药商将数百种药物的标价平均上调了6.3%。
Gerard Anderson, professor of health policy and management at Johns Hopkins University, tells that raising the cost of existing drugs benefits drugmakers and insurers.
“Research and development is only about 17 percent of total spending in most large drug companies,” he says. “Once a drug has been approved by the FDA, there are minimal additional research and development costs so drug companies cannot justify price increases by claiming research and development costs. ”
The study did not examine why prices of existing drugs have gone up, but the researchers say a lack of competition and the regulatory environment in the U.S. allow “for price increases much higher than in other countries.”
Critics contend that the study offers an “inaccurate portrayal of the U.S. marketplace,” and they take issue with the fact that the researchers focused so much on wholesale price numbers.
“On average, 40 percent of the list price of medicines is given as rebates or discounts to insurance companies, the government, pharmacy benefit managers and other entities in the supply chain that often require large rebates in order for a medicine to be covered,” says Holly Campbell, deputy vice president of public affairs for the Pharmaceutical Research and Manufacturers of America, which represents the drug industry.
“However,” she adds, “these savings are often not shared with patients whose out-of-pocket costs continue to soar.”
埃尔南德斯说：“这些增长就是我们所说的现有产品同比通胀的例子。”。
约翰霍普金斯大学卫生政策和管理教授GerardAnderson说，提高现有药物的成本有利于制药商和保险公司。
他说：“在大多数大型制药公司，研发只占总支出的17%。”。“一旦一种药物获得美国食品药品监督管理局的批准，额外的研发成本就很低，因此制药公司不能通过声称研发成本来证明价格上涨的合理性。”
这项研究没有调查现有药物价格上涨的原因，但研究人员表示，美国缺乏竞争和监管环境允许“价格上涨远高于其他国家”。
批评者认为，这项研究“对美国市场的描述不准确”，他们对研究人员过于关注批发价格数字这一事实提出了异议。
美国制药研究与制造商协会负责公共事务的副总裁Holly Campbell表示：“平均而言，药品标价的40%是作为回扣或折扣提供给保险公司、政府、药房福利经理和供应链中的其他实体的，这些实体通常需要大额回扣才能为药品提供保障。”，它代表了制药行业。
“然而，”她补充道，“这些节省下来的钱通常不会与自付费用继续飙升的患者分享。”
What will have to happen for drug prices to decrease in the United States?
There are a few options, but they almost all involve government action.
The methods open to the government would be actions like installing pricing regulations. Various subsidies could also be effective, though are less preferred. Reorganizing systems to allow for collective bargaining is another big option.
Another option would be to reduce patent duration, making it far easier for generic manufacturers to produce useful drugs .
I also will hasten to point out, that you can put in price reducing measures, and the R&D budgets would not even be touched. The actual financial contribution of companies in R&D is surprisingly low, and a quick look at their income statement reveals that quite clearly.
要使美国的药品价格下降，必须发生什么?
有几种选择，但几乎都涉及政府行动。
政府可以采取的方法是制定价格法规等行动。各种补贴也可能有效，不过不太受欢迎。重组系统以允许集体谈判是另一个重要选择。
另一种选择是缩短专利期限，使仿制药制造商更容易生产出有用药物。
我还要强调一点，你可以采取降价措施，甚至不影响研发预算。公司在研发方面的实际财务占的比例低得惊人，快速浏览一下它们的损益表就能清楚地看出这一点。
Why are medications so pricey?
Because many people work for years using hideously expensive high tech equipment , specialty supplies and reagents, data resources, expensive specialty biological models, high tech facilities and then it goes to wildly expensive 3 level clinical trials with very extensive FDA approval process and then safe drug production and marketing. You will have hundreds of specialized well-trained expensive people working on each drug for years and committed all these expensive resources and facilities for years. Drug companies have to pay for all this up front and they have stock holders and have to eventually show a profit on they go down. US drugs go through wildly extensive safety and efficacy screening, which is why it is seldom that one is pulled after it is in clinical use. The complexity of finding a way to target just one specific disease process, which will itself be just some subtle modification of something that goes on all over the body, without accidentally effecting the process elsewhere in the body is daunting; especially when you consider how complex the human body is and realize that we don't yet understand much of the fine details of many processes in the body. From that perspective, even the new expensive specialty drugs are cheap.
为什么药物这么贵？
因为许多人工作多年使用昂贵的高科技设备，专业用品和试剂，数据资源，昂贵的专业生物模型，高科技设备然后进入非常昂贵的三级临床试验经过非常广泛的被美国食品和药物管理局批准程序然后是安全的药物生产和销售。你将要数百名训练有素的专业人员花费数年时间研究每种药物并投入所有这些昂贵的资源和设备。制药公司必须预先支付所有这些费用，他们有股东，最终必须在股价下跌时显示出利润。美国药物经过了广泛的安全性和有效性筛选，这就是为什么很少有药物在临床使用后被撤回的原因。要想找到一种只针对一种特定疾病过程的方法，而这种方法本身只是对全身发生的事情进行一些微妙的修改，而不会意外地影响身体其他部位的过程，其复杂性令人望而生畏；尤其是当你考虑到人体有多复杂，并意识到我们还不了解身体许多过程的细节时。从这个角度来看，即使是新的昂贵的特效药也很便宜。