Melissa Barber

@mbarber.bsky.social

2594 Followers 430 Following

Health economics, law, global health, and access to medicines. Economist @ MSF-USA but views my own. https://melissajbarber.github.io.

Abstract: The U.S. market for prescription drugs is failing many Americans. Drug prices in the U.S. are nearly three times higher than in comparable countries, and evidence shows that patients regularly forego essential medicines because they cannot afford them. Additionally, shortages of important medicines are common. In partial response, California recently passed a law to enable public manufacture and distribution of medicines, starting with insulin, a drug needed by millions of diabetics in the state. Many other states, as well as the federal government, are considering similar action to drive down prices of older drugs and to help resolve shortages. Public production could yield important benefits, but there are legal obstacles to overcome at every step, from developing the product at the bench to getting it to the patient. This Article maps the primary legal and logistical issues these programs will face and describes how they can be overcome. We focus most of our attention on a major challenge that has not yet been properly described: even if states succeed in manufacturing affordable, high-quality drugs, how can they ensure that the drugs will actually reach the millions of patients who need them? After all, private, generic manufacturers already struggle to enter the market and distribute cheaper alternatives. We propose that states can succeed in ways that private entities cannot because they have unique legislative and regulatory mechanisms to counteract the concentrated power of market intermediaries. Using tools like mandatory contracts and regulatory requirements that require middlemen to carry publicly produced medicines, states can facilitate market entry and ensure that the maximum number of patients can access low-cost public products. This bottleneck, therefore, provides a further justification for public pharma—it can not only mitigate drug pricing and access issues, but possibly improve market access for private firms too.
Jawaharlal Nehru at the Penicillin Factory, Poona, 1 August 1956.
Advertisement for penicillin produced by Hindustan Antibiotics Ltd.
Red Satellites denounce US Role in WHO. News article in New York Herald.