Authored by Isabel Lee
Art by Constance Newell
The long goodbye…
The irreversible curse…
A fate worse than death…
Often called many of these names, Alzheimer’s disease is a brain disorder that causes a progressive decline in memory and cognitive abilities [1]. Unfortunately, 1 in 3 seniors dies of Alzheimer’s or another form of dementia in America [2]. So, what is the progress in creating drug therapies that would prevent or slow down the progression of this cruel disease?
In recent years, researchers have made no significant progress in proving the dominant theory around the progression of Alzheimer’s: the Amyloid hypothesis [3]. This theory simply states that the progression of Alzheimer’s disease is caused by the build-up of plaque around neurons, impairing essential neurological functions like carrying electrical impulses across axons [3]. With a whopping zero cases of clinical success in treatments centering around the reasoning behind the Amyloid hypothesis, pharmaceutical companies are currently researching to find new approaches to solve the mystery behind curing Alzheimer’s [4]. However, with the exponential growth in technological innovations and medical data, coupled with the tremendous financial investment in these areas, there is no doubt the pursuit of a successful treatment for Alzheimer’s will continue until a “wonder drug” is released into the market.
So, what if a “wonder drug” was created in the future? A drug that would severely slow down the neurological decline in patients with Alzheimer’s? Protected by patents, the parent pharmaceutical company that created the drug would be heavily protected from generic competition. Additionally, with over 13 million people expected to have Alzheimer’s in the U.S. by 2050, the drug would be heavily demanded in the market [2]. Since the pharmaceutical company would most likely own the single treatment available for this disease, they would participate in “zero-gravity economics,” where the drug therapy would be at a high, generally unaffordable price with no real “grounding” principle [5].
To combat this “zero-gravity economics” situation, the Inflation Reduction Act of 2022 enters this hypothetical with the role of a “grounding” principle: a force of gravity. A truly revolutionary piece of legislation, the Inflation Reduction Act of 2022 allows the federal government to annually regulate ten prescription drug prices for Medicare starting in 2026 [6]. Moreover, this legislation is estimated to save taxpayers around 30 billion dollars annually [6]. What is there not to like?
Although many Americans may view the Inflation Reduction Act of 2022 as a step towards a more equitable and affordable healthcare system, this “grounding” force is bad news for pharmaceutical companies. Profits from market sales, especially sales in the United States, offset the tremendous investment in research and development of drugs for Big Pharma companies. For example, drug prices in the United States are around 150% higher than in other well-developed countries like South Korea and the United Kingdom [7]. Since countries with single-payer healthcare systems (centralized public government insurance programs) have higher negotiating power, pharmaceutical companies are forced to set low drug prices. Similarly, the Inflation Reduction Act of 2022 allows the federal government to inherit some negotiating power. As the federal government represents all Medicare patients, high-cost drugs like Eliquis and Avastin will be forced to be set at a lower price through pure negotiating power [8].
After putting together this hypothetical’s key stakeholders and facts, the final question appears: How does the Inflation Reduction Act of 2022 affect pharmaceutical research and development for Alzheimer’s treatments? Well, taking away the promise of “zero-gravity economics” for pharmaceutical companies leads to an increase in risk-averse behaviors, especially in pricey investments for research and development of drugs proposed to solve complex problems [9]. Therefore, it is likely for pharmaceutical companies to decrease investments in Alzheimer’s research for two reasons. First, Medicare would most likely reduce the drug price of an Alzheimer’s “wonder drug” due to the majority senior nature of the disease. Second, there have been no significant scientific outcomes for developing this “wonder drug.”
However, Sean Nicholson, Professor at the Cornell Brooks School of Public Policy, said, “[there] will be no significant effect on pharmaceutical research and development with Alzheimer’s [due to the Inflation Reduction Act of 2022].” Instead, there will be a “greater effect on post-market research” primarily within “new applications of market released drugs” since “the U.S. government cannot regulate drug prices for seven years until Medicare can step in with price regulations.” Therefore, pharmaceutical companies will be disincentivized to research additional treatment paths of a post-market drug since they will have less than seven years until Medicare can impose price regulations. Professor Nicholson also agreed that pharmaceutical companies would most likely continue investing in research and development for Alzheimer’s treatments due to the promise of unregulated profits for seven years and heavy consumer demand. Therefore, the public should view the Inflation Reduction Act as a step towards a more equitable healthcare system in the U.S. without a detrimental effect on U.S. medical innovation.
Sources
[1] Mayo Foundation for Medical Education and Research. (2023, February 2). Alzheimer's disease. Mayo Clinic. Retrieved March 3, 2023, from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447
[2] Alzheimer's Disease Facts and Figures. Alzheimer's Association. (n.d.). Retrieved March 3, 2023, from https://www.alz.org/alzheimers-dementia/facts-figures
[3] Lovelace, B. (2022, August 2). As new Alzheimer’s drugs have failed, scientists are shifting focus to other potential causes. NBCNews. Retrieved March 3, 2023, from https://www.nbcnews.com/health/health-news/new-alzheimers-drugs-keep-scientists-shift-focus-rcna40288
[4] Lowe, D. (2022, July 25). Faked Beta-Amyloid Data. What Does it Mean? Science. Retrieved March 3, 2023, from https://www.science.org/content/blog-post/faked-beta-amyloid-data-what-does-it-mean
[5] Lee, V. S. (2021). The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone. W.W. Norton & Company.
[6] Hwang, T. J., Kesselheim, A. S., & Rome, B. N. (2022). New reforms to prescription drug pricing in the US. JAMA, 328(11), 1041. https://doi.org/10.1001/jama.2022.15268
[7] Mulcahy, A. W., Schwam, D., Rao, P., Rennane, S., & Shetty, K. (2021). Estimated savings from international reference pricing for Prescription Drugs. JAMA, 326(17), 1744. https://doi.org/10.1001/jama.2021.13338
[8] Bunis, D. (2022, August 17). 10 Prescription Drugs that Cost Medicare the Most. AARP. Retrieved March 3, 2023, from https://www.aarp.org/politics-society/advocacy/info-2022/medicare-prescription-drug-costs.html
[9] Deciphering the Inflation Reduction Act with Michael Ward. (2022). Alliance for Aging Research. Retrieved March 3, 2023, from https://www.agingresearch.org/podcast/deciphering-the-inflation-reduction-act-with-michael-ward/.