A New Drug Pricing Social Contract: The Great American Drug Deal

5 min readFeb 18, 2020

By Alex Karnal and David Beier

In The Great American Drug Deal, biotech investor Peter Kolchinsky outlines a vision for the future of the pharmaceutical industry. It’s a future in which the interests of society align both with the firms developing new medicines and the patients who depend on new treatments and cures.

Now that might sound far-fetched when you consider no industry stands in lower regard among Americans than the pharmaceutical sector, according to Gallup’s latest data. That’s exactly why Kolchinksy’s contributions are timely. In compulsively readable prose, he is proposing a new social contract between biopharmaceutical companies and American patients. In its substance, the contract includes incentives for innovation, avoids counterproductive price controls, opens treatment access by reducing what patients pay out of pocket, and intensifies government intervention in emerging therapies like gene and cell therapies.

Kolchinsky’s cutting-edge ideas should generate a broad discussion on the principles we should adopt to ensure any new policies balance the competing interests of a web of stakeholders; from scientists to patients, insurance, government, hospitals and doctors, to name just a few. The discussion should revolve around a simple question: does the new paradigm improve the current system?

We propose the following elements to sort through the varied policy issues:

Economic certainty

We all know that meaningful scientific advance doesn’t happen overnight. It’s a process in which pharmaceutical investors make a 10- to 15-year commitment with the understanding that it can take at least that long for a breakthrough therapy to move from discovery to market approval.[i] Putting it simply, if you want innovation, then you need economic certainty. Innovators need to know the rules of the road and that those rules won’t be changed on them mid-process.