mr. carter one an -- won an election for the new orleans based house seat. later in the week, we will -- to provide consumers from debt collection practices. watch live gavel-to-gavel coverage of the house on c-span, the senate on c-span 2, and you can also watch online at c-span.org, or listen with the c-span radio app. john dicken is with the government accountability office, the director of the public health and private markets division. here with us to talk about a noose study -- a new study that was done. welcome to "washington journal. good morning, thank you. host: tell our viewers and listeners of the role of the government accountability office. guest: the government accountability office, gao, is

an independent nonpartisan congressional agency. often called the government watchdog. we do evaluations of federal programs, federal policies, federal spending at the request of congress, and of leadership in both parties, and so those reports become publicly available, both the congress and the general public. host: john dicken is joining us to talk about one of those evaluations, one of those studies requested by congress. the name of the report is "prescription drugs: u.s. prices on average than prices in australia, canada, and france." who asked you to do this report? caller: -- guest: we have had a body of work on prescription drug pricing by a number of different committees, both republican and democrat.

this particular report comparing u.s. with international prices was requested by senator -- and his role as chair of the budget committee. host: is this an area you had not looked into previously, gao? guest: the gao has done a lot of work on the u.s., looking at a number of different public programs -- medicaid, medicare, v.a., dod -- big payers for prescription drugs also looking in the private sector. gao had not done for more than a decade, comparing how the u.s. prices look when looking at other -- reflecting other company -- other countries that have a high per capita income. host: give us a sense of the brand name pharmaceuticals you have compared to other countries. guest: we look at two brand-name

drugs that were a large part of spending and use in the medicare script drug program, and so in the end, we had 41 drugs that represent significant spending on prescriptions and medicare and that were also available in at least one of three other countries -- australia, france, canada. 20 of those were available in all three countries as well as the u.s., and one example that we traced through with different prices was so nor elect, a commonly prescribed drug for pulmonary obstructive disease. there were 21 drugs that we compared in at least in those countries. host: viewers can read that at gao.com. some of the findings include this. gao's analysis of 2020 data

found that 20 selected brand-name prescription drugs, estimated u.s. prices paid at the retail level by consumers and other payers such as insurers were more than two to four times higher than prices in three selected comparison countries. we mentioned those comparison countries -- australia, canada, and france. is there a why behind that, john dicken? guest: there are a number of reasons to why prices might be higher in the u.s. compared to other countries. and some of those issues are that the country is -- that is true in australia and france, not in the u.s. or canada. whether or not they have regulations that affect drug problems -- jug prices that may -- drug prices that affect the ceiling on the prices. the u.s. has individual

programs, individual public programs but not a national approach to regulating drug prices. a third reason is differences in distribution and supply chain for drugs in the u.s.. there are a lot of entities between the manufacturer and the pharmacy that include wholesalers, health plans, pharmacy benefit managers, and so there is a complex supply chain where a number of entities , each of which the money flows through and people get paid for services. 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. has contributed a larger share of its economy to development for prescription drugs, but that alone does not account for the differences we saw in other

countries. the last factor i would note at a high level is valuing the choice of drugs, and so often higher cost drugs may be available. they offer smaller -- strong therapeutic advantages, whereas other countries may limit the choice to those who have therapeutic advantages at a certain cause. host: we are talking with john dicken. they looked in comparing with several other countries and we would love to hear from you. the lines are 202-748-8000 for the eastern and central time zones. 202-748-8001, fountain and pacific. particularly if you bought drugs in canada or whatever and had that experience or book drugs from pharmaceuticals overseas. we would love to hear your experience on that. john dicken, i want to go back this point. part of the summary of your reports is that each of the four

countries use pricing strategies to limit the price of drugs, but the united states is the only country in our review that does not have the overarching pricing strategy for prescription drugs, although it is publicly funded coverage. such as medicaid. is there a why behind there is not a he u.s. pricing strategy? what do those strategies look like in other countries? guest: really in the u.s., as you know, the number of different payers, we rely in large part or in private health plans to offer through employers come through medicare, and so each of those programs have different statutory authorities for prices, for different buildings to negotiate with manufacturers.

so certainly each plan has both strategies for how they are negotiating prices. but that is across different tiers. in australia and france and canada, there are national approaches that could do things like set ceiling prices. that would be the maximum amount that would be paid for drug limits, the rate of increase of drugs after they have been on the market for a while, and then they compare those drug prices to other countries or other benchmarks. so those apply within individual health plans in the u.s., but it does not apply uniformly in the way it is in australia. host: i wanted to point out the chart you have in the report looking at the u.s. in three other countries and the cost per capita of a pharmaceutical -- of pharmaceutical spending. her year.

age 65 -- 806 to five dollars per year in canada. 671 in france per person. australia, 651 per person, and in the u.s., 1200 -- 1229. in terms of gdp, it has the highest in the four countries compared in terms of spending. does that surprise you? guest: i think that is prominent in the u.s., not just for prescription drugs but for health care services. not only in dollar amounts. the $1200 personal per person that individuals economy and so i think that was expected. what our report showed us just the prices of the drugs themselves.

the prices and the amount and this report shows the actual price for the exact same drug is significantly higher for brand-name drugs that we look for. acute -- it contributes why the united state is spending more. host: we have a call waiting. talking about the cost of prescription drugs. caller: good morning. thank you very much. the drug prices you are talking about now, i think they are very high. there's no excuse for that. my son is on one that costs because he's got a kidney replaced so is got to get that one.

host: our pharmaceuticals covered by health care? >> they are covered in two countries. australia and france do have universal coverage that includes prescription drugs. canada has universal coverage for conditions in hospitals, does not include prescription drugs as its universal coverage system. likely you have, there are people who do not have insurance coverage in canada. so australian -- australia and france have universal coverage. canada and the u.s. do not. to the color, thanks for sharing your experience. -- thanks to