Sunday, June 11, 2023

The U.S. pays more for drugs, yet gets little in return

On average, prescription drugs cost 2.56 times as much in the U.S. than they do in other countries. We’re pharma’s cash cow. The U.S. health care system, unlike health systems in other countries, isn’t set up to bargain with drug companies for lower prices. Until the Biden administration passed the Inflation Reduction Act, even Medicare was specifically prohibited from negotiating drug prices, thanks to the lobbying power of drug companies. (As I recall, preserving that prohibition was the price to be paid for the passage of the Affordable Care Act.) Medicare, by the way, is the world’s largest drug buyer.

Even though we’re overpaying for drugs, pharmaceutical companies report earning hardly any profits on their U.S. sales. They do this by using accounting tricks to avoid paying taxes on profits earned here. The trick is to assign patents and other forms of intellectual property to overseas subsidiaries located in low-tax jurisdictions, such as Ireland, Luxembourg, and Bermuda. The drug companies pay large fees to these overseas subsidiaries for the use of this intellectual property. But the benefit to them is to cause profits to disappear in the U.S. and reappear in one of the low-tax jurisdictions where they go largely untaxed. (In the pharmaceutical industry, patents, rather than manufacturing facilities, are companies’ principal assets.)

Because of these shenanigans, the U.S. government is losing a lot of revenue. Cracking down on tax avoidance could significantly reduce budget deficits. For the moment, however, the House is controlled by a party that wants to deny the I.R.S. the resources it needs to go after tax evaders.  

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