When I became a physician more than 20 years ago, one of the first things I worked on was how to address unremitting, severe migraines. Since then, I’ve spent much of my energy helping to create new medicines, including an approved medication for these sorts of severe migraines, as well as treatments for diseases such as Huntington’s, which ravages nerve cells in the brain, and for severe asthma.
When I look back a couple of generations and think about how many illnesses our grandparents struggled with, it’s incredible how profoundly life has changed. Coronary heart disease, for example, was an enormous problem in the middle of the 20th century but, since the 1960s, as treatment options have expanded, it has become a problem for a smaller percentage of the American public. A lot of that is due to the fact that the medical and research communities have been able to turn science into medicines so rapidly, thanks to funding from both investors and taxpayers, which is all of us.
I’m privileged to live in the Philadelphia/New Jersey area, which sits right at the center of that effort. Not only are there many people here who work in hospitals and doctors offices, but there are also legions of researchers in offices and labs thinking daily about how to create better medicines. It is reassuring to know that my neighbors are probably hard at work to create cures for diseases I might suffer.
Right now, I head up a company that is working on medications for Parkinson’s disease, epilepsy and lupus. We’re not the only ones. We’re competing and collaborating with many other companies to roll back the pain and loss these diseases impose on millions. Such diseases are costly to manage, sending patients to hospitals and sometimes nursing homes.
Many in our community work in the health insurance industry, which is vital to allowing us all to afford proper care. They can attest to the fact that, through growing insurance premiums, we all bear the increasing cost of these diseases. Though medicines eventually go generic and become less expensive, hospitals and nursing homes are labor intensive and their costs only rise.
So if we successfully create medicines that keep people healthy and out of hospitals, we can reduce suffering and also save money in the long run.
But last year, a new law — the Inflation Reduction Act — included a section that will result in fewer medicines being developed for diseases that come with age. Normally, medicines go generic about 14 years after they launch. Those 14 years are the time that investors, such as those that invest in biotech companies, get to generate a return from having funded expensive research and clinical trials. But the IRA gives Medicare the power to force the price down as low as it wants just nine years after the drug launches.
This means that investors — including funds that handle the retirement accounts of lots of ordinary Americans — are going to migrate away from funding medicines for diseases that matter to the elderly and that genericize, such as the ones that I develop, focusing instead on diseases of the young and on modalities that do not become generic, such as gene modifying therapies.
I don’t think Congress meant to discourage such beneficial investment. They just want to make drugs more affordable, and they have my support for that. But a better way to address that problem — which is, indeed, a problem — is to reduce the out-of-pocket costs that insurance plans charge patients.
I noted that there will now be fewer medications developed for older Americans. Why? Because Medicare primarily covers older Americans. That means that price controls will focus primarily on diseases of aging: osteoarthritis, Alzheimer’s, cancers, emphysema, and Parkinson’s.
The legislation gets some things right. It lowers out-of-pocket costs for some people and makes doubly sure that certain complex drugs become inexpensive around the time their patents would normally expire. But cutting off incentives for investors, as it does, will have unfortunate consequences for our progress in treating diseases of aging.
Some in Congress are now proposing a new bill called the SMART Act to price control all drugs just five years after they launch. If that passes, investors would be better off focusing on real estate, casinos, video games, or solar power, because they won’t see any point to investing in new medicines. Because of the IRA, this migration away from funding medicines is already happening, and the SMART Act would finish the job, disbanding — even in our own neighborhood — collaborations among scientists, doctors, insurers and investors.
So I worry about what the next chapter looks like if Congress doesn’t recognize the importance of relying on insurance — rather than price controls — to solve affordability and keep investors engaged.
Everyone I know who got into this line of work did so because they want to help people. Some are physicians, like me. Others were trained as chemists or biologists.
I really believe in the research that these teams are doing, trying to reduce suffering and keep us all out of hospitals through better medicines.
Marcelo E. Bigal is president at CEO of Ventus Therapeutics. He lives in New Hope.
Join our readers whose generous donations are making it possible for you to read our news coverage. Help keep local journalism alive and our community strong. Donate today.
