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Americans have clear reason to think they’re paying too much for prescription drugs. The cost of medicines is rising faster than any other category of health-care spending, standing at almost 17 percent of total health costs. What’s harder to discern is what to do about it, in part because so little is known about how drug prices are set, what discounts and rebates drugmakers negotiate with wholesale buyers, and to what extent savings are passed along to customers at the pharmacy counter. Addressing this lack of transparency would be a good first step. (4/18)

Americans are rightfully concerned with rising medical costs, but some of the ways by which costs rise can be tedious and difficult to understand for those not already familiar with broader regulatory issues. What’s going on, though, is actually pretty straightforward: Brand-name producers regularly take advantage of systems designed to protect consumers to instead protect their bottom lines and crush out competition from their generic competitors. One common way by which anti-competitive behavior occurs is by preventing access to the materials needed to test generic or biosimilar alternatives. In other words, pharmaceutical companies refuse to let competitors prove their safety, and then enjoy the monopoly that results when theirs are the only drugs proven to be safe. (Jonathan Bydlak, 4/18)

The drug importation debate, sparked by Sen. Bernie Sanders’ introduction of legislation that would allow Americans and pharmacies to import medicines not approved by the FDA from foreign countries through and including Canada, is largely focused on one key question: A­re medications imported from outside the FDA’s jurisdiction safe for consumers? (Marvin D. Sheperd, 4/19)

When President Donald Trump and Sen. Bernie Sanders, (I-Vt.) see eye to eye on an issue, you know that it is politically volatile. That is the state of the current debate around prescription drug pricing, which has become a cause célèbre for lawmakers across the political spectrum. The frustration is justified. For too long, patients have endured repeated price hikes for the medicines they need to go about their daily lives. An opaque pricing system and supply chain that effectively operates as a “black box” of rebates, clawbacks and middlemen only serves to exacerbate patient anger. (Larry Smith and Larry Ellingson, 4/18)

In recent months, we have seen encouraging signs of a new commitment to the social contract drug makers have with patients. Novo Nordisk and Allergan have made pledges to hold the line on drug prices. Mylan has taken responsibility for the price increases for EpiPen, and is promising to do more to advance affordability. More recently, Regeneron engaged early on in a meaningful and responsible way to discuss pricing of a new therapy. (Steve Miller, 4/14)

Among the drugs that helped bring Valeant Pharmaceuticals International low, none did more damage to its reputation and stock price than Syprine. Syprine is a drug that treats a rare illness called Wilson disease, which prevents the body from metabolizing copper and can lead to liver failure and death if left untreated. For decades, the price of Syprine was $1 per 250-milligram tablet, according to a recent article in the medical journal Hepatology. For most people, a maintenance dose requires four pills a day, bringing the price during that era to $1,460 a year. (Joe Nocera, 4/18)

If you’re like most Californians who have health insurance, you know two things about how prescription drugs fit into your health plan. You know that you receive some level of coverage for medications, and you know that soaring prices for prescription drugs are a major cost-driver that have caused insurance premiums to soar. What you don’t know is how your coverage for prescription drugs works, who determines which drugs are covered, or who gets how much from the money you pay for your prescription drugs. The fact is, almost no one knows those things. (Jim Wood, 4/17)

Big Pharma wants us to believe that such costs reflect the expensive nature of research and development. But what the pharmaceutical companies spend on research, clinical trials and their 24/7 advertising campaigns is kept hush-hush. One study found that for every $1 drug companies spend on R&D, they spend $19 on advertising. (Ed Hernandez and Tom Steyer, 4/18)

In a now-leaked email, a senior executive at a large  pharmaceutical company discussed destroying supplies of generic cancer drugs as part of a pricing battle with health authorities in Spain, according to a report in the British newspaper The Times. The idea was floated in 2014 in an exchange with another staff member at Aspen Pharmacare, which has a market valuation of $10 billion and sells products globally, including in the United States, according to the company website. (Nick Mulcahy, 4/17)

It's much easier to tell a story of unlimited promise and sales growth than to deliver on it. Eli Lilly & Co. has been aggressively talking up its revamped drug pipeline. Investors who bought into this got a rude awakening Friday, when the company disclosed that the FDA had declined to approve baricitinib, an expected blockbuster arthritis treatment. Many investors assumed baricitinib would hit the market this year. But the FDA has asked for data on the drug's safety and optimal dose, meaning it may not be approved for years. (Max Nisen, 4/17)