Contributor: How Much? Addressing Medicines’ Cost and Value

“Drug companies should no longer charge…more for prescription drugs made in America here in the United States than they charge for the same drugs overseas,” the President said.¹ No, not President Trump. President Clinton in 1993.

Drug pricing has been a stubborn political topic for decades for 2 main reasons. First, the pharmacy counter is where Americans have their most frequent interaction with health care. Second, new prescription medicines cost more and generate more societal value. How much has always been the question.

Most agree that what we collectively pay for medicines over the long run should be aligned with the value they provide to patients and society. Concerned about cost and budget impact, governments are increasingly intervening to set the price of medicines.

Despite many misaligned incentives within the prescription drug marketplace, powerful market principles lead, including that buyers seek lower prices, and sellers seek higher ones.

When governments set prices, they intervene in the market. Intervention has consequences. Simply put, collectively paying too little for medicines means fewer of tomorrow’s treatments and cures. Collectively paying too much can result in affordability and patient access challenges.

Beginning in the 1960s, an effort began to bridge evidence to policy through health technology assessment (HTA). Many European single-payer health care systems adopted HTA in the 1980s.

When used with proper humility and the best intentions, HTA can ensure a technology’s evidence and impacts are considered prior to decisions on its use.

However, unintended consequences of HTA—to continue the metaphor—risk bridge collapse. A primary example is when HTA makes rigid and narrow judgments of value (using a subset of a medicine’s impacts), HTA can be used as another reason for buyers to either say no or pay too little. When this happens, appropriate patient access suffers, both today and in the future.

Prescription medicines are among the most efficient components of health care. They generate health gains and eventually go generic, increasing societal value. I believe the world needs more biopharmaceutical innovation to improve global health—not less.

This topic is personal. As a kid, I had deep relationships with all 4 of my grandparents. My memory is full of card games, stamp collections, World War II stories, joining me on my paper delivery route—or simply giving me a smile and warm embrace as only a grandmother can.

Alzheimer disease took 2 of them. Now my parents are facing brain health challenges that threaten their very being. These challenges have broad impacts for family, friends, and community. My wife and 2 children worry that, absent intervention, I may face similar challenges.

The good news is that we’ve seen innovation in brain health. I am hopeful for more breakthroughs in the future. And I worry that we may not only be underappreciating the value medicines provide patients and society—we are at risk of losing it altogether.

For example, the Health Economics Methods Advisory (HEMA) group just published its inaugural report, “Defining Appropriate Benefits for Economic Evaluation of Health Care Technologies.”² HEMA is a joint effort by the Institute for Clinical and Economic Review (ICER), Canada’s Drug Agency (CDA-AMC), and England’s National Institute for Health and Care Excellence (NICE).

The HEMA report topic was initially presented as an exploration of opportunities to broaden the benefits considered in HTA. Advancing more comprehensive approaches to value assessment methods is supported by a broad coalition of stakeholders and by countless peer-reviewed publications.

However, the final report advances a prescriptive framework of principles and recommendations that largely reinforces the use of existing HTA methods, which assess a narrow set of treatment benefits.

But in patient-centered value assessment,³ all the consequences of a technology and its next-best alternative should be measured, including caregiver and family impacts, employer impacts, and others. As in any market, it is up to both the seller and buyer to provide justification for how the collective benefits are aligned with its price.

And HEMA’s recommendations—which are sympathetic to current HTA processes—blur the value and price steps. The assessment of a technology’s value should be separate from any form of price negotiation. This conflation of value and price is where I believe HTAs overstep and potentially cause harm.

To me, the outputs from HEMA aren’t so much “right” or “wrong”—but predictable. HTA bodies funded their work. HTA bodies often work directly on behalf of government buyers (eg, CA-AMC and NICE) or indirectly on behalf of payers. HTA primarily takes on the perspective of the buyer and, therefore, is incentivized to seek lower prices. It is no surprise that HTA bodies underappreciate the value that medicines provide to patients and society. Buyers seek lower prices.

Opposite HTA is industry-funded value and cost-effectiveness research. There may be no one as knowledgeable about the value of a drug as the manufacturer, yet industry-funded cost-effectiveness research is viewed by some as more favorable to the estimated value of a selected medicine. Sellers seek higher prices.

This is why value assessment should be viewed as a tool, not a rule. Unlike mathematics, there is no proof or one-size-fits-all equation that gives us a single answer to value—let alone to price.

The findings from the HEMA report should be interpreted as an HTA-funded effort by leading academics that takes the status quo of HTA practices as given. But it remains unclear how the HTA bodies that funded the HEMA report will use this report in their own practices. With increased government intervention in pricing, the risk of governments or other large buyers misinterpreting the HEMA report as “truth” could have lasting detrimental consequences for society when it comes to future innovation and patient access.

I am personally seeking a world where my kids do not have to make difficult decisions about their lives based on my brain health.

How can we get to a world where future advances in science are accessible to patients, valued by society, and sustainably reimbursed?

First, let’s continue debating good evidence that contributes to the value of medicine for patients and society. This recent contribution from the Office of Health Economics is notable.⁴

Second, given that HTA includes both science and judgment, let’s recognize that moving from value to discussions about price requires additional considerations.

These include what our values and preferences are.⁵ The US has historically held a mindset of medicines as an investment, not simply a short-run expense. It is encouraging to hear CMS Administrator Mehmet Oz, MD, express this view.⁶

Finally, neither buyers nor sellers have all the answers. Finding new ways to trust the other is important.

By thinking differently—and identifying those parts of our health systems that fail to generate value back to patients and society while stopping practices that have misaligned incentives—we can build a future where patients can access today’s treatments and tomorrow’s cures. That’s a bargain we can all get behind.

Author Information

Jonathan D. Campbell, PhD, is the chief science officer of the National Pharmaceutical Council (NPC), a 70-plus-year-old health policy research organization. He is a member of the HEMA Steering Committee, which advises HEMA on topic selection and process. He is not an author of the report, which is authored by the HEMA Working Group. He previously served as senior vice president for health economics at the Institute for Clinical and Economic Review (ICER).

References

1. Rampell C. Bill Clinton on health care, 1993. New York Times. September 9, 2009. Accessed March 19, 2026. https://archive.nytimes.com/economix.blogs.nytimes.com/2009/09/09/bill-clinton-on-health-care-1993/index.html
2. McQueen RB, Wailoo A, Tsuchiya A, et al. Defining Appropriate Benefits for Economic Evaluation of Health Care Technologies. Health Economics Methods Advisory. March 11, 2026. Accessed March 19, 2026. https://hemamethods.org/wp-content/uploads/2026/03/HEMA-Report_For-Publication_031126.pdf
3. Guiding practices for patient-centered value assessment. National Pharmaceutical Council. March 13, 2016. Accessed March 19, 2026. https://www.npcnow.org/guidingpractices
4. Radu P, Biurrun C, Boysen M, Whittington M, Skegdel C. The case for adopting a broader perspective on value in health technology assessment. Office of Health Economics. March 3, 2026. Accessed March 19, 2026. https://www.ohe.org/publications/the-case-for-adopting-a-broader-perspective-on-value-in-health-technology-assessment/
5. Patterson JA, Wagner TD, Nordyke RJ, Campbell JD. Contributor: American patients vs foreign governments—a tale of 2 value sets. AJMC^®. February 12, 2026. March 19, 2026. https://www.ajmc.com/view/contributor-american-patients-vs-foreign-governments-a-tale-of-2-value-sets
6. Dr. Mehmet Oz on fixing American healthcare + fraud | live from Davos. All-In Podcast YouTube page. January 24, 2026. Accessed March 19, 2026. https://www.youtube.com/watch?v=b5p40OuTTW4