colonists. sunday at 6:00 p.m. eastern on "american artifacts," a tour of richard nixon's birthplace located on the grounds of the richard nixon presidential library. and sunday at 8:00 p.m. eastern on "the presidency," three programs on thomas jefferson, on the president's view on education, on interpretation conversations between jefferson and abigail adams, and a tour of his gardens at monticello. exploring the american story. watch american history tv this o weekend on c-span3.ntin john dicken is with us, from the government accountability office, director of the public health and private markets division, here with us to talk about a newew study that was toa commissioned to look at the cost of prescription drugsshsh in the u.s. versus a number of other . countries. johnhn dicken, welcome to "washington journal." role d morning, thank you. >> tell our viewers and y listeners again what the role is of the government accountability

office. >> ernmenyes. the government accountability office often referred to as gao, is independent, nonpartisan congressional agency. gao is often called the government watchdog. policie we do evaluations of federal programs, federal spending, federal policies, at the request of congress and of leadership in both parties. the c and so we do those evaluations and those reports become publicly available both to congress as well as the general public. >> johns requ dicken is joining this morning to talk about one of those evaluations, one of those studies requested by congress. the name of the report is on a "prescription drugs: u.s. priced for selected brand drugs were higher on average than prices in australia, canada, and france." who commissioned the study, asked you to do this report, john dicken? >> yes. as i mentioned, our reports are requested by members of congress. we've had dif a body of work onr

prescription drugat pricing by t number of c different committeea bothl republicans and democrats. this particular report comparing u.s. international drug prices was requested by senator sanders in his role as the chair of theo senateu budget committee.t lo >> is thisok an area that you h looked into previously, gao, that is? >> so certainly gao has a lot of work on u.s. prescription drug spending, looking at a number of different public programs, thep medicaid, medicare, which are big pairs for prescription drugs, also looking in the for private sector. what's unique about this, that r gao hadin not done for more thaa decade, was to compare how the o u.s. prices look when looking ao other -- selected other ha countries that also have relatively high per capita income. >> give us an giv example of th that name pharmaceuticals

you compared with the other countries. >>gu sure.o bran we, you know, looked at really brand name drugs. we were specific to brand name drugs that were a large part of spending and use in the medicar prescription drughad program.ht and so in the end, we had 41 an drugs, brand name drugs that represent significant spending or prescriptions in medicare and that were also available in at least one of the three other countries, australia, france, ald canada.. 20 of those were actually available in all three countries as well as the u.s. one example that we trace through what the different prices were was anora/elipta, a commonly prescribed drug for disease.obstruction we compared the information for 41 drugs that were available ino at least one other country. >> our viewers can read that

report at gao.gov. some of the findings from this report include this. gao's analysis of 2020 data found that, for 20 selected brand name prescription drugs, w estimated u.s.er prices paid at the retail level by consumers es and other payers such as insurers were more than two to e four times higher than prices in three selected comparison countries. and we'll mention those comparison countries, australia, canada, and france. is there a "why" behind that, er john dicken? >> yes, there are a number of reasons as to why prices might be higher in the u.s. compared to the other countries. just at a high level, some of those issues are that the countries vary as to whether s they have universal coverage for prescription drugs. that's true in australia and .sr france but not in the u.s. or canada. whether or not they have national regulations that affect the drug prices, make ceilings

on the prices or require comparative effectiveness. and the other three countries have that. the u.s. has individual programs, individual health plans, individual public es. programs, but not a national approach to regulating drug prices. a third reason is differences in the distribution and supply ctur chain for drugs. in the u.s. there are a lot of entities between the olesal manufacturerer and the pharmacy. that includes wholesalers, it includes health plans, policy benefit managers. entit there's just a complex supply chain where number of entities c involved, each of which the money flows through and gets paid for those services. the two last quick reasons, manufacturers point to the u.s.'s payment for research and development and innovation, and certainly we saw that the u.s. does contribute a larger share of its economy to research and u

development for prescription tr. drugs. but that alone doesn't account t for the differences we saw in the other countries. the last factor i would note atr a high levelug is, the u.s. rear values choice of drugs.ey offer and so often, higher cost drugs may be available whether or notl they offer strong therapeutic advantages, whereas other countries may limit the choice a of drugs to only those that have therapeutic advantages at a certain cost. >> we're talking with john dicken of the gao.her coun they looked at the cost of prescription drugs and compared it with several other countriese we would love to hear from you. particularly if you've bought drugs, say, in canada or whatever, and had that ould l experience or bought drugs, john pharmaceuticals, from overseas, we would love to hear your oint. experience on that.

john dicken, i want to go back h to this point i think i just heard you made. password summer of your report g says, each of the four countries uses varying pricing strategiess to limit, the price of prescription drugs. however, the united states is ve the only country in our review i that does not haveng an overarching national pricing strategy for prescription drugs, although some of it is publicly funded coverage, such as medicaid, department of veterans affairs, use pricing strategies. is there a "why" behind the fact that there's not a u.s. pricing strategy? what do those strategies look like in other countries? >> yeah, so really in the u.s., as you noted, there's just a iv number of different payers for prescription drugs. we rely in large part on private health plans. they're offered through employers, through medicaid, through medicare.e and so each of those programs o have either different statutory

authorities for how they set ach drug prices or different abilities to p negotiate with re manufacturers. so certainly each plan has its own strategies for how they are negotiating prices. but that various across different payers. in australia, france, and canada, there are national approaches that vary in each oft drose e countries, they do thin like set ceiling prices, that ug would be the maximum amount that would be paid for drugs that limit the rate of increase of drugs afterto they've been on t market for a while, or that may compare those drug prices to al other countries or other benchmarks. and so those apply within individual healthwa plans in tho u.s., but it is not applied inh uniformly in the way it is in australia, canada, and france. >> i wanted to point out to our viewers, the chart you have in the report, looking at the u.s., and three other countries. p and the cost per capita of

pharmaceutical spending, the cost per person of pharmaceutical spending per year, $865 per year in canada, $671 in france per person. australia, $651 per person. and in the u.s., $1,229. the u.s. also has, in terms of u gdp, has the highest among the four countries compared in terms of its spending. does that surprise you at all? >> i think that that's what is u prominent in thegs u.s., that i does have not just for dolla prescription drugs but for most health care services, has the highest not only in absolute dollar amounts, cited the $1,200 per person that individuals in the u.s.but are paying for prescription drugs, but also as a share of the economy. and so, you know, i think that was expected.

what our report kind of showed s th thatel a big factor in that actually just the price of the drugs themselves, the spending affects both the prices and the amount that's being spent. and this report shows that the actual price for the exact same drug is significantly higher foh brand name drugs that we looked at in the u.s. and other countries, which contributes to why the u.s. is spending more per person and as a share of its economy on prescription drugs. l >> we have calls waiting for john dicken, talking about the s cost of prescription tdrugs. we'll hear first from jim in east lansing, michigan. good morning. >> good morning. >> hi, go ahead.think >> thank you very much. the drug prices you're talking about now, i think they're very high. there's no excuse for that, to be so darned high. my son is on this one that costd like $6,000 a month, because he

had a kidney replaced, so he's got to get that one that's very expensive. >> john dicken, the other ? countries, are pharmaceuticals covered by government health care, in australia, canada, andn france?he >> countyes, they are covered of the countries, australia and france, do have universal coverage. that includes prescription for drugs. canada, that famously has doe universal coverage for physicians and hospitals, did not include prescription drugs as part of its universal coverage system. so like the u.s., there are somg people that may not have insurance coverage in canada. many get coverage through their employers or purchase private plans or participate in public programs. so australia and france do have that universal coverage for

drugs and the u.s. does not. and that can lead, like the caller, thanks for sharing your experience, with some high cost drugs, that can lead in the u.s. or canada to people paying rugs. either the full cost of drugs oe a high cost sharing, if they are high cost drugs that are not strong incentives by the healthr plans to have lower cost escripi sharing. >> your report at name brand prescription drugs.s. generic drugs compare overseas to the u.s.?t >> thank you, that's an estion important. question, an importaa part of this report is that it is only looking at brand name drugs. it's important to realize that brand name drugs are the presc arjority of spending for prescriptione drugs in the u.s. representing over 80% of spending even though they're la less than ve20%, 10 to 20 persuasive the number of drugs prescribed. so generics play a very ibed i important role in the nu.s., moh drugs that are prescribed in the

are they're a i small share of the e spending. we havey ere is looked at generm prices in the u.s. before., th and the key issue there is if there is competition, generic h drug pricese in the u.s. can b very low. but we also saw some exceptions of drugs that may be generics, have been on the market for a long time, where there is not evmpetition, and there were some extraordinary drug prices of drugs doubling or tripling thos overnight, even in the generic drug market. those were the exceptions. in general, generic drug prices in the u.s. are very competitive as long as there is competition among multiple sources. >> we'll hear next from natasha in birmingham, alabama. >> good morning. >> good morning. >> my thing about those drugs is

that we live in a capitalistic society, so you've got the persn government not regulating, but as far as the -- i personally s. have diabetes, and diabetes is an expensive disease. and all the drugs that they advertise, i can't pronounce the name of a drug, that means it has a commercial. and if it has a commercial, then i can't afford it. so what happens is, they get fda approval for the medication, and then you can't afford it. my so once you can't afford it, then like what i did was took my

formulary, since i couldn't afford the drugs they were me to get, i took my formulary from my insurance company and asked them to look, because they have different tiers, they have them to look at something that is older, that i could use in place of what they were trying to get me to get. >> natasha, i'll let you go andh we'll get some response from ou john dicken. >> thank you very much for sharing your experience. i think there were just three ad brief things that you mentioned that are really important. one is, insulin and diabetes, you didn't specifically say insulin, but insulin is a key part of diabetes treatment, has been a drug that has gotten a in lot of attention recently in having high price increases.iabe so i think you're not alone in seeing thatse there's very high cost drugs for diabetes.

secondly, what you did is what we suggest people do, if they have very high cost drugs, to look at their health plan and the formularies, which are really the drugs that that plana covers or prefers, and see if there are alternatives that your doctor and the pharmacy and the health plan would recommend. and then the last point you mentioned, direct to consumer advertising of drugs, which is r prevalent in the united states. wi is not used in a number of other countries. and that's an area that gao is also looking at and will be issuing a report in the next month, looking at, to the extent that there's significant spending for direct to consumer advertising and how that alliance with medicare spending for drugs. >> there was news yesterday about the administration supporting the waiving of waiver patents on the covid-19 o vaccines. the u.s. saying it supports the

temporary waiver of intellectuae property provisions to allow t developing nations to produce se the covid-19 vaccines. john dicken, what role do these intellectual patents play in t terms of the cost of prescription drugs, both here and how that affects costs overseas? >> right.proper no, certainly the patents and intellectual property is an important aspect of drug pricing, because both between research in the public sector, therextensive research by the industry, that could be very high cost. and so when there is a breakthrough or innovation, that u.s. law and international -- other countries also provide intellectual property rights an p.a.m. protections so there can

be exclusive use of that drug or that form of the drug for a period of time. so the patents and intellectual property is an important aspect of encouraging that innovation e and research. but it does mean it limits competition. the example you gave, you know, gao is continuing to look at both vaccines.h we've also looked at remdesivir, which is a treatment that's been used in some cases for covid and looked at the role of intellectual property and cotents in those specific areas. so, a key issue both for innovation as well as competition and prices in drugs. >> next from virginia we hear from david. >> good morning, c-span. >> good morning. >> thank you for taking my call this morning. i've got just a couple of ret questions. so th number one, i am a retired and on medicare. so the part d does help quite a

bit on the pricing. but i've noticed recently that the pricing on a few of the drugs, and in particular i'll mention one, truliciti went froa $43 for a month's supply to $21 to a month's supply. and the people said at the pharmacy that i had gotten into the doughnut hole or the gap. and it was my understanding that that was supposed to be that eliminated in 2020. did n but it's also, my understandingt that either congress didn't acto on itn or the white house didn act on it, but don't know what happened there. the second question was that last year i think the trump administration negotiatedbu a tn price of insulin for 35 a month, but yet i don't think that applies anymore. don't know why. and then i will just hang up and

listen to the response. thank you. >> thanks, david.wa >> thank you. and actually the drug you mentioned trulicity was one of the 41 drugs that we looked at. and as you've noted, what we has for 2020 was that kind of the average retail price for that includes both the cost sharing that you or other individuals would pay as well as the payment for medicare or other payers. in the u.s. it's about $761. that was then reduced by rebates that are paid by manufactures tr help plans that cut it notably to $386 per one-month supply. but in australia or in france, it would cost about $76. that's a strong example of where drug prices for the exact same . drug are much higher in the u.s. than in australia or france. you mentioned the doughnut hole.

and so over time since medicared part d was implemented, that has been reduced. and that drug manufactures have agreed to statutorily agreed that they will provide some of the payments that individuals are not paying 100% anymore, i a believe it's d declined about 7. but there is still a doughnut hole where individuals arere paying a significant cost once they met their deductible and before they reach a catastrophii level where the costs are mostly paid by medicare. > i wanted to ask you a little ht bit about tha what you just mentioned, the rebates and other price concessions. you have a chart in the report that looks at two drugs and the epclusa oral tablet.. reba both of those show this dotted area there of the estimated rebates, u.s. rebates and price concessions. does that meanould that if thos pricece concessions weren't the, that drug would be costing that much in the united states?

>> that's right. the higher price is really whats the gross price is. o but that would be paid by both individuals and all payers. but that's offset, for many significantly offset that are paid by by the manufacturer of the health planu or others. in those examples that can see reduce the per-month price by fr hundreds or thousands of dollars. we've seen in the past in about medicare on average for brand drugs rebates may be offsetting about 20% of what the cost would otherwise be. the issue there, though, is that may help reduce the help plans overall cost, may help them hold their premiums zero or lower for people like the last caller who are getting medicare part d. thh but it doesn't necessarily reduce the cost for the individual at the pharmacy that are paying the higher price

based on the gross price. >> what's the number one reason we look across three countries, australia, canada, andwhat i fr and see significantly lower prices particularly on the drugs. what's the number one reason those prices are lower? >> right.it i yeah. i wish i could give a single reason. it is a combination of i think the regulation, the competitions and that they are able to have formularies that prefer drugs where they have reached negotiations and believe there's comparative effectiveness, this whereas in the u.s. that is something that's done not plans individually allowing more voicn and individuals to choose their health plans or have different drugs even if they're more expensive drugs. >> typically how long does it take you toto put together a st: like this?e >> well, we've issued reports that take weeks or months. others take years. this was a fairly intensive study in that the complexity of the issue, the fact that we had notot looked at countries, othe

countries for some time. we started with a much larger group of countries, and we needu to identify data. and frankly in the u.s. just was analyzing prices in the u.s. is a big undertaking. so this study was longer than a typical study. we give the actual dates in thep reports. i think it waso year roughly, yh know, over more than a year approaching two years. but that is a much longer and rigorous study given the amount of data that we need to get fro other countries and from the u.s. to make sure we could make these apples-to-apples o call comparisons. bo was a big undertaking. >> back to calls. bob, yuma, arizona.i live good morning. o >> good morning. i live in yuma, arizona, which is a border town. and in mexico you can get your drugs at least 50% less than th you'd get iney the united state. even the canadians when they d a

wereke allowed to come down her would go to mexico and buy thei? drugs and take them back to canada with them. does that make any sense to you? [ laughter ] thank you. >> okay, bob. hea yeah,rd thank you.u. and certainly have heard similar of ies and experienceses people both at the mexico border, at the canadian border, and able to go and see that thef drugs are much lower. that may not make sense from a a logical perspective, the exact same drug that in your case mayt just be a few miles away and inr another country costs a very owr different amount. there are challenging proposals pricesuld either tie thehe to other countries or allow mors importation for drugs from other countries. but i think one of the for considerations isex on a small scale that that's done now, i know, for example in canada, at there were studies thatof indicated that if there were

larger importation of drugs h since the u.s., the u.s. drug market's much bigger. that may have unintended consequences that manufacturers mayy raise the prices that they have in other countries. peo so it gets complicated. but your experience is one thati wedu hear that many people can cross the border on an individual level and find much lower prices in mexico or canada. >> here's damian in georgia. > yeah, mr. dicken, how are you doing this morning?er >> good. >> a question i want to see if you'll answer it't first of all, the fda don't care what we do here, whether we've r got. drugs that hurt people, prices, whatever. we have a way of wanting to f ts always ensure -- please answer me this. aoc did a thing on capitol hill

about how we do and pay for theo american public pays to do their taxes. when the drug we give comes outm that if it's been tested and it's okay, we give it to a family, and then that family controls that or a company, whatever you want to call it, ol comes out ands controls that dg instead of us give it to the to public. you bring up australia a lot. that same drug was sent to australia for, let's say, $8 a month what we was paying 200 a month for it over here.t of why is it that america is just the land of greed and out of wo controlness thatli we have in ts country? >> i'll get some final thoughts on the study for you. if you'd like to respond to the caller, that's fine, too. there >> thank you. i think just a range of he thoughts, just that certainly in the u.s. fda is responsible for

assuring the safety and efficacy of drugs. that's a big challenge, but n that's their primary mission in improving drugs that are available on the market.ther there are other countries also have their ownco processes, ands there is some collaboration between fda and other countries to make sure that given drugs are a global market, that the drugs are available or safe and effective but may defer across to different countries. certainly the drug prices ount reflect that the u.s. is payingl a significant amount for innovation, research, and drug development, and having choice of drugs leads to where we are,t which is our drug prices are often significantly higher two to four times or more higher than in other countries. >> the report can bebe read at gao.gov, john dicken is the public health and public markets, the public health and private markets director for the government accountability office. thanks)n>y for the update.

>> thank you.f the i apc