美国药价为何居高不下

Here's why the bipartisan push to lower drug prices never works

美国药价为何居高不下

The United States spends far more on prescription drugs compared to other high-income countries, despite having similar prescription drug usage — a phenomenon that is often explained by the sky-high prices at which drugs are sold across the nation and the enormous cost of high-risk research and innovation.

尽管与其它高收入国家相比，美国的处方药用量相差无几，但其处方药开支却更加高昂——全美药品的高价售卖以及研发药品的高成本通常可以为这一现象作出解释。

The battle over how to lower drug prices in the U.S. — and how to revamp the nation's health care system, more generally — has moved to the center stage of the 2020 presidential race, as President Donald Trump has repeatedly vowed to "bring down drug prices" and as several Democratic presidential candidates have unveiled proposals that would target the rising costs of prescription drugs. Polls have indicated that a majority of voters — across the political spectrum — support a range of federal policies aimed at curbing prescription drug costs.

关于如何降低美国药价的争论——以及如何更全面地改革美国的医疗保健体系——已成为2020年总统竞选的关键议题。唐纳德·特朗普总统一再发誓要“降低药价”，而几位民主党总统候选人已公布了针对处方药成本飙升的提案。民意调查显示：大多数选民——在整个政治领域——支持一系列旨在控制处方药成本的联邦政策。

Americans are also frustrated that they spend more on prescription drugs — average costs are about $1,200 per person per year — than anyone in the developed world, despite the fact that generics represent roughly 84% of the U.S. market, the greatest proportion among high-income countries.

美国人对此也感到沮丧：他们比其它发达国家的人民在处方药上花费更多——平均每人每年支出约1200美元，尽管仿制药占美国市场的84%左右（在高收入国家中占比最高）。

Natasha Sriraman, a practicing pediatrician and professor of pediatrics at Eastern Virginia Medical School, said that the price of medications in the U.S. have made treatments increasingly out of reach for millions of Americans. She said a growing number of Americans are not filling a prescription, skipping a scheduled dose or taking an expired medication due to high costs.

东弗吉尼亚医学院的儿科医生和儿科学教授娜塔莎·斯瑞拉曼（Natasha Sriraman）说道，美国的药价使得数百万美国人得不到治疗。她表示，越来越多的美国人由于药价高昂而无法照配方抓药、无法按规定剂量服药、甚至服用过期药物。

"I don't think people are realizing how that is affecting my 7-year-old patient who could die if he doesn't get the EpiPen or the 4-year-old who has a walnut allergy," Sriraman told Salon, referring to the high cost of the epinephrine auto-injectable medication that stops allergic reactions. (EpiPen's manufacturer, Mylan Pharmaceuticals, has come under intense scrutiny for steadily hiking the price for anaphylaxis drug from less than $100 to $600.)

“我觉得人们尚未意识到这一现象对患者的影响，一名7岁的患者和一名对核桃过敏的4岁儿童若无法注射EpiPen，都可能会死，”斯瑞拉曼对Salon期刊说道，意味着售价高的肾上腺素自动注射药物可救治过敏反应。（EpiPen的制造商迈兰制药公司将其过敏药物的价格从低于100美元提升至600美元，现已受到严格审查。）

Drug manufacturers often cite their research costs in an attempt to justify high drug prices, arguing that steps to cut costs would stifle innovation in the future. And while it's true that research and development is expensive, experts have questioned Big Pharma's assertion that research spending ultimately determines prices.

药品制造商经常提及他们的研究成本以说明药价高的合理性，认为降低成本的政策将压制未来的创新。虽然研发成本高昂，但专家也对大型制药公司的说法（研发成本决定最终药价）提出了质疑。