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The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines Paperback – Illustrated, January 17, 2020

4.7 out of 5 stars 115 ratings

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Editorial Reviews

Review

"Magnificent. Compelling. Authoritative. Every member of Congress, staffer, and researcher interested in understanding the nexus of biomedical innovation, pricing, and affordability should read The Great American Drug Deal. Kolchinsky will amaze you with his knowledge of the industry and surprise you with his unshrinking prescriptions for reform. Clear and accessible, this is the history, science, and finance class that can help American voters steer the healthcare debate."

--Amitabh Chandra, PhD
Ethel Zimmerman Wiener Professor, Harvard Kennedy School of Government; Henry and Allison McCance Family Professor of Business Administration, Harvard Business School

"This book is not only a superb piece of scholarship, but a veritable tutorial on the background (1980-2020) of US drug pricing policies and practices, as well as those of the payers/health insurance industry. The book comes across as a common-sense, temperate manifesto on how biopharma enterprises can not only shape the future debate on drug pricing and health insurance/policy but also offers thoughtful remedies and perspectives. Kolchinsky's command of the material is superb. I liked the book's style - serious while at the same time digestible and almost colloquial in places. Notions such as a 'Public Domain Day' and 'Price-Jacking' were beautiful, delicious. So too was the book's repetitive illustration of the 'generic drug mountain.' Excellent."

--John Hawkins
Author, Conscience and Courage: How Visionary CEO Henri Termeer Built a Biotech Giant and Pioneered the Rare Disease Industry

"We are living in one of the most exciting periods of scientific innovation and drug discovery in history. Peter Kolchinsky steps past the headlines and simple rhetoric to take on directly the most challenging questions we face as a society in balancing the trade-offs between incentivizing and enabling the discovery of breakthrough medicines, and the responsibility we have in ensuring this is done in a sustainable way. This analysis elevates the discussion and offers new important thinking and actionable solutions that would benefit all stakeholders."

--Michel Vounatsos, Chief Executive Officer, Biogen

"What are we getting for what we spend in health care, and why? Read this book, which explains the workings of the pharmaceutical industry in plain language, dispelling myth after myth with facts, figures, and case studies. This long overdue review of industry workings, from brand and generic pricing, to what consumers pay for different products and services, to a greater understanding of what's truly just a cost versus what's an investment in the health of our country, including our business competitiveness internationally, was a joy to read. As a former practicing physician with a 20 year business career in health systems, health insurance payers, and the pharmaceutical industry, I found this to be refreshingly balanced and right on target with respect to looking at the facts as opposed to the hype. So, enjoy the read, and you'll never listen to debates on health care the same ever again."

--Ira Klein, MD, MBA, FACP

In this authoritative survey of the biopharmaceutical industry, a scientist and investor diagnoses current problems and prescribes solutions.

Kolchinsky initially trained as a virologist, but he joined the biotechnology industry later on, and ever since, he says, he's been on the "receiving end of a fire hose of knowledge." He sees his current work as a biotech investor as providing a valuable contribution, but part of his book's agenda is to state a mea culpa: "For too long my utopian view of the biotechnology industry omitted the perspective of patients who couldn't afford their medications." He then articulates what he calls the "Biotech Social Contract," describing the relationship between the pharmaceutical industry and society. This contract would have the drug industry strive to make affordable versions of drugs (as generics), and have a health insurance industry providing universal coverage to keep costs down for patients. The author then enumerates the ways in which the contract has been breached by looking at the cryptic world of drug patents; how health insurance has the overburdened sick subsidize the more fortunate healthy; and the predatory practices of pharmacy benefit managers, who, according to the author, run "a complex shell game." His main point is that although the biotech industry gets a bad rap for hunting big profits, it's the insurance industry that's the real problem; "drug companies must charge temporarily high prices for new drugs," he argues, as long as their drugs go generic in a timely manner--but insurers, not patients, should bear that cost.

This meticulously organized and extensively supported book offers a thorough introduction to the factors and politics of drug pricing. In clear, deliberate prose, the author engages with and explains a range of concepts to lay readers. Even when Kolchinsky details rather elementary principles--one subsection is titled "How Insurance Is Supposed to Work"--he never strikes a condescending or pedantic tone. It's hard not to share his ire towards insurance companies, although many readers may see his transfer of blame from the biotech industry and pharmaceutical companies to insurance providers as a self-serving maneuver. Still, his frustration with a dysfunctional system that allows patients to slip through a "patchwork of gaps" is unquestionably warranted. In the final chapter, he calls upon the biotech industry to continue linking revenue to innovation. This lacks the righteous punch of simply stating, "Let's be ethical actors," but the writer clearly knows that his industry has to uphold its end of the bargain. Kolchinsky stocks his pages with evidence, explanatory sidebars, and clarifications in regular footnotes. Sometimes, the most interesting point gets buried in the fine print. For instance, in one footnote, the author addresses a hot-button issue of the feasibility of a single-payer system. In the main text, he states that the single-payer model is "beyond the scope of this book," but he expresses a firmer opinion in the footnote: "Basically, for a country the size of America, a single-payer system is likely only appealing in theory...but would be a tragedy of human incompetence in practice."

A serious, impassioned, and informed call for change.

--Kirkus Reviews

About the Author

Peter Kolchinsky is a biotechnology investor and a scientist. He co-founded and runs the Boston-based investment firm RA Capital Management, writes and teaches about biomedical entrepreneurship and its potential to transform global health, serves on the boards of several public and private drug development companies, and has served on the Board of Global Science and Technology for the National Academies of Science. He lives in Massachusetts with his historian wife, strong-willed children, and reasonably well-trained dog.

Product details

  • Item Weight : 14.1 ounces
  • Paperback : 292 pages
  • ISBN-10 : 1733058915
  • Dimensions : 6 x 0.73 x 9 inches
  • ISBN-13 : 978-1733058919
  • Publisher : Evelexa Press; Illustrated edition (January 17, 2020)
  • Language: : English
  • Customer Reviews:
    4.7 out of 5 stars 115 ratings

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