The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines

The GADD is not just a good read. It is an important read at a fragile moment.Through clear writing, relatable analogies, and a procedural construction of a faceted argument, Peter Kolchinsky explains and contextualizes our very complicated healthcare system, its various parts, and the highly charged drug pricing debate that threatens to undermine innovation and scientific progress. By making the system and debate accessible, he is enfranchising those impacted - meaning, all of us - to have a voice in them.I appreciated that Peter did not just posit ideas; he also proposed solutions, and, importantly, solutions that require compromise. It would be easy to be cynical and say that Peter’s book is simply “pitching his book” (to borrow a phrase from the investment management world that he is a part of). While he clearly believes, and cogently argues, that the payer system has a unique set of misalignments that need to be remedied, he is not pointing the finger solely at the insurance industry. He recognizes that the biopharma industry has to do its part as well. Taking ownership of the narrative about the biopharma industry's value-add, as this book successfully does, is a tool that the industry needs to utilize in order to reset the drug pricing debate to a neutral position.I enjoyed the bit of self-reflection and personal history that he interweaves, particularly in the beginning when he sets the stage by explaining how his own viewpoint has evolved from abstract idealist to tangible realist. I would have gladly read more about that personal history. I also valued some of the nuanced distinctions he makes, including expensiveness vs. affordability and what “long term” means to different parts of this system.Last but not least, the impactful graphics provide a helpful visualization tool that supports how the written argument unfolds.This is a book I will continue to reference and come back to.

My students think the best part of my Entrepreneurship in Biotechnology class is when I shut up and let my guest speakers take over. I hate to admits it, but they are right: I have convinced some pretty amazing people to travel to Morningside Heights to tell their stories, fleshing out the real-world life sciences concepts that we discuss in the abstract.One of the more memorable guests was Peter Kolchinsky, founding partner of RA Capital Management, who met with the class back in 2013. Peter walked us through his journey from basic science (he has a PhD in virology) to the buy side. He could have spoken for an extra hour and no one would have moved.Fast forward to now, and the release of The Great American Drug Deal, an examination of prescription drug pricing in the United States, in which Peter attempts to solve simultaneous equations, for medical innovation and healthcare system affordability.The book builds off of his provocative Medium series on what he terms the Biotech Social Contract, an idealized framework where patients, through their insurance coverage, subsidize pharmaceutical innovation with premium pricing during the protected, on-patent period, after which drugs become part of an ever-growing, readily available, affordable, and accessible inventory of treatments, a public asset that compounds in value over time. Unlike new surgical techniques that patients pay for each time they are used, or physician expertise or facilities that command consistent economic rent, the growing stock of generic drugs provide a means by which the pharmaceutical and biotechnology industries can pay society back for financing the high upfront drug development costs.Sound familiar? No? It turns out the idealized world of the Social Contract bears little resemblance to a world where even insured patients have to routinely forego needed treatment because they are unaffordable, where the structural aspects of drug distribution and reimbursement have become so convoluted and the “people over profits” incentives have long since disappeared. The social contract of 2020 is no contract at all. Insurance coverage has become one more type of payment program, one that still denies access to necessary and often life-saving treatment for those who cannot jump the copayment hurdles. The drug companies, in concert with pharmacy benefit managers, price to maximal margins, then construct a duct tape and paper clip patient assistance safety net. Premium pricing is protected even beyond patent expiration, generic drugs morph from widely available commodities to supply-constrained scarcities.The Great American Drug Deal examines the disconnect between the idealized Social Contract and the realities of our current system, one that is often hostile to patients and results in a pharmaceutical industry vilified by those outside it. He offers a roadmap to restoring the purity of the generic drug model and thus re-establishing the equilibrium that justifies temporary market dominance: a period high prices, made affordable by insurance, followed by commoditization ever after. The book is a thoughtful and creative approach to discussion of one our most pressing and timely healthcare problems. Highly recommended.

If you are interested in how we can make health care affordable for all without jeopardizing innovation, this is the book for you. Deductibles, other out-of pocket costs and co-pays for medicines are sometimes so high that my elderly parents and I sometimes opt out of picking up a prescription because it's just too expensive. Kolchinsky explains why these costs are so high, how they came to be passed on to patients and he proposes the most effective solution to this problem so many Americans face - significantly lowering if not completely eliminating out-of-pocket costs for patients, while not jeopardizing innovation by ensuring that medicines go generic without undue delay. His writing style is comprehensible, direct, it's as though he is having a dialogue with the reader, knowing how we might respond to his ideas and arguments, and addresses the pros and cons of alternatives. You will come away well-educated on what works and does not work in the current U.S. healthcare system, with a great understanding of the role of biotech in medicine, and especially our future and that of our children if we do not take action to change the status quo.I recommend this book to anyone who wants to educate themselves on the topic, and for those who really think they have their minds made up about how drug pricing should be handled... until they read Kolchinsky's thoroughly researched, data-driven perspective - that of a fellow concerned American, scientist, teacher, father, husband and son who wants everyone to afford and have access to excellent, life-saving healthcare.

Well thought out argument for drug pricing over the lifetime of use from patent protected to generic timeline. Good insight into the benefits of incremental improvements. Hope the next book introduces how this can actually be implemented with the current and expected political and educational divisiveness. This undertaking is by no means assured and may be multigenerational marathon.