By NextBestFitKeep the current patent system
Leave patents unchanged and control prices through negotiation instead.
Draft decision:RejectedConfidence: medium · not yet reviewed
Thickets keep delaying generics.
Review ledgerHow this path connects
This path
Keep the current patent system
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- No patent-law changes; rely on negotiation
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
The question it answers
Patent thickets and evergreening delay genericsLeaving patents unchanged preserves innovation incentives and avoids trade disputes while relying on price negotiation instead. Patent thickets still delay generics and biosimilars.
What it fixes
None identified.
What it creates or worsens
- Brand-name drug prices far above production cost
Leaving patents unchanged keeps prices high until all patents expire.
6 paths soften this
National negotiation for all drugsBrand-name drug prices far above production costChosenInternational reference pricingBrand-name drug prices far above production costRejectedPublic manufacturing of off-patent drugsBrand-name drug prices far above production costChosenPrize funds and advance market commitmentsR&D is funded by high prices, which ties innovation to unaffordabilityChosenValue-based prices that reward real innovationR&D is funded by high prices, which ties innovation to unaffordabilityChosenAccept somewhat slower adoptionSlower access to new drugs and technologyRejected
Who's affected
Who gains
- Drug and device makers
- Brand-name drug prices far above production cost: Market exclusivity supports high prices and shareholder returns.
- Pharmacy benefit managers and their pharmacies
- Brand-name drug prices far above production cost: High list prices generate rebates for benefit managers.
Who loses
- People with unaffordable deductibles or coinsurance
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Uninsured people
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Health insurers, brokers, and their shareholders
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- Taxpayers and public budgets
- Brand-name drug prices far above production cost: Market exclusivity sustains drug prices far above production cost.
- People with ongoing or specialist care needs
- Brand-name drug prices far above production cost: Leaving patents unchanged keeps prices high until all patents expire.
Where it has been tried
- Most peer countries: Similar patent law; lower prices from negotiation.
- France: In 2023, patented medicines sold in both France and Canada had a French-to-Canadian average list-price ratio of 0.69.