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I'm curious as to the pricing structure in less corporatist countries, especially in places with public health care where (unlike the US), the government has the legal right to bargain prices and doesn't just satisfy any arbitrary price set by a manufacturer.



It's flatter, but patients are given their medicine and told to take it rather than being invited to select from a menu. Pharmaceutical companies don't advertise direct to the public and doctors make all the decisions about which version of a drug patients should be taking, based on the clinical outcome (eg whether the side effects of a generic are well-tolerated or problematic). In the US you have to be a lot more knowledgeable about what you're taking and the information is much more available, so in that sense the patient has more control, and arguably more freedom; on the other hand most of us are not doctors and spending time becoming expert on the finer points of your meds is perhaps like becoming an expert on the difference between Coke and Pepsi - you may strongly prefer one over the other, but is it really making any difference to your nutritional outcome?

In other countries the win for the drug companies is predictability; the government will negotiate far more aggressively but will then contract to purchase a certain amount for the next x years, providing the drug companies with a predictable revenue stream. Where public healthcare is the norm, the government also absorbs a lot of the insurance/liability costs; if a drug is approved for sale but later turns out to have problematic side-effects, the government will compensate or support the affected patients, on the theory that since it approved the medicine for sale it accepted the potential risks as well. Obviously, there are exceptions, such as if a manufacturer had data on clinical risks that it concealed to get approval, but those cases are a minority.




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