The country also dominates the research pipeline; its research and development spending accounts for nearly two-thirds of the OECD total. Last year, the US had 10,265 drugs in the works, more than double both China and the EU, and four times as many as the UK.

While this means that US priorities play an outsized role in setting the research agenda, other nations quietly benefit from piggybacking on American innovation. This week’s move by the Biden administration to target 10 top-selling medicines for tough price regulation will rock this global market.

The drive to cut the prices paid for blockbuster heart, stroke, diabetes and cancer treatments will not just trim drugmaker profitability. It could also reshape drug discovery, affecting what medicines are available to patients worldwide.

Americans, who pay three times as much for branded drugs as the OECD average, overwhelmingly support the idea of their government negotiating for price cuts. But policymakers everywhere should be on their guard against subsequent market distortions. There is now a risk that R&D switches focus from the drugs that are most needed, to those that avoid US price controls.

Unlike most of Europe, the US government has not previously controlled medicine prices. Last year’s Inflation Reduction Act authorised Medicare, the taxpayer-funded healthcare system for retirees, to bargain directly with drugmakers. It plans to seek cuts of 25 per cent or more to list prices, focusing on top-selling drugs nearing the end of patent protection. This is expected to save Medicare nearly $100bn over the course of a decade, while reducing out-of-pocket costs for many older Americans.

Drug companies, which must negotiate or pay punitive taxes, have questioned whether this is constitutional; some have sued. They expect private insurers will try to push down what they pay too, sharply cutting revenue. As the list of covered medications expands, the industry warns this will put pressure on R&D budgets and limit the number of drugs in development that it can back.

Price caps may also make it harder to attract venture capital investment because the potential pay-off will be lower. This is particularly concerning because so much early stage drug research is now done by start-ups that later sell out to Big Pharma.

The impact is already starting to be felt beyond America’s shores. “We have decided that we are not going to do certain trials, or that we are not going to do a merger or acquisition or licensing [deal] because it is becoming financially not viable,” Thomas Schinecker, chief executive of Swiss drugmaker Roche, said on a recent media call.

Treatments for the elderly and research into new uses for drugs nearing the end of patent protection are most likely to be affected by the price caps. And manufacturers may prioritise large-molecule treatments, such as gene-therapy drugs or vaccines, over traditional ones simply because the former are exempt from price negotiations for longer.

Much of Big Pharma’s warnings may be scaremongering. The Medicare programme is limited to wildly popular drugs that have already earned back their development costs many times over. And the current system of uncontrolled pricing is not covering itself with innovative glory. Critics say it rewards extremely similar “me-too” drugs that offer little advantage over pre-existing treatments as well as minor reformulations to extend medicines’ patent life. One recent study found that fewer than a third of new drugs approved in Europe and the US between 2007 and 2017 were rated of “high therapeutic value”.

Manufacturers may also benefit from another prong of the IRA reforms that caps out-of-pocket costs for drugs. Some 30 per cent of Medicare patients do not fill new cancer prescriptions because of cost concerns. “They might make up in an increase in volume for the decrease in price,” explains Stacie Dusetzina, a Vanderbilt University professor.

The US has several years to work out the kinks in its new system: the first negotiated prices will not go into effect until 2026. But the upheaval should serve as a wake-up call for both Americans and everybody else.

Sky-high US prices are not the only way to fund global medical progress. Other countries will have to contribute more, but it does not have to be expensive for patients. Governments can give drugmakers a leg up by funding research into the causes of disease as well as the pathways and receptors that can be targets for treatment. They can also reduce risk by helping fund clinical trials and guaranteeing sales. Recent experience with Covid vaccines demonstrates that this can work.

The US drug industry’s size, wealth and scientific prowess mean that it will always play a big role. But it should no longer be the only gorilla in the room.

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This story originally appeared on: Financial Times - Author:Brooke Masters

How times have changed. These days, mindfulness apps and mental health workshops are par for the course in many workplaces. Top law firms Hogan Lovells and Linklaters, and investment banks JPMorgan Chase and Goldman Sachs even offer free therapy sessions — either online or on-site. Not only is this convenient, but the benefit is designed to signal to staff that the companies see psychological care as part and parcel of getting the most from their workers.

Other employers are also trying to get practical assistance to their employees — by designating workers as “mental health first responders” and encouraging people to attend workshops on “mental fitness”. The aim is to reframe the skills involved in managing such issues as positive attributes, thereby removing stigma.

“If people are coming to the workplace with mental health issues, a progressive organisation will recognise that it will affect performance, and there’s a self-interest to support them,” says John Ryan, chief executive of Healthy Place to Work, a data analytics company that focuses on workplace health. “The biggest driver of sustainable productivity is the health of your organisation.”

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Indeed, the World Health Organization estimates that 12bn working days are lost every year to depression and anxiety — at a cost of $1tn to global productivity.

The message seems to be getting through. In the most recent Edelman Trust Barometer Survey of 13 countries, 72 per cent of respondents said they trusted their employer to do what is right on health-related concerns. And nearly 8 in 10 people expected their company’s chief executive to set an example on healthy behaviour — for example, by respecting work/life boundaries — and to talk about the importance of mental health. 

Some commentators have argued that the shifting attitudes are due to generational change, as young people who are used to sharing on social media begin to replace older employees who are more reticent. But the Edelman survey found that the figures were only marginally higher for those aged 34 and under than they were for the general workforce.

“People want the same things; Gen Z and millennials are more vocal about it,” says Cydney Roach, global chair for employee experience at Edelman. “Employees have this unprecedentedly high trust in their employers, but with that trust comes high expectations.”

“The employer is now expected to solve things that other institutions could not,” she adds.

However, that is where future problems could lie. 

Given how much productive time has, historically, been lost to stress and other mental health issues, it is good news that employers are trying to make it easier to access treatment. But the more employers insert themselves into the whole area of supporting mental health, the more they open themselves up to claims that they are falling short.

Work remains a significant source of stress and unhappiness for many people — and training programmes and mindfulness apps are not enough to help someone who is stressed because of a toxic manager or an unmanageable workload. “If the problem is the workplace, then a mental health first responder [programme] is a joke,” Ryan warns. “Organisations need to get down and dirty with what is going on.”

A new poll of more than 2,500 US workers by recruitment consultants Robert Walters found that 60 per cent said they were suffering workplace stress, and nearly half said concerns about job stability were the biggest trigger. Despite a big increase in corporate spending on wellness initiatives since the start of the pandemic, 62 per cent still told pollsters that their employers were not doing enough to combat stress.

And separate research by Wellable, which works with companies on their wellness offerings, suggests that companies are only willing to go so far to deal with mental health issues. While more than half of companies said they were spending more on employee assistance hotlines and digital health tools in 2023, less than 15 per cent planned to offer their staff extra time off. 

This tension is only going to get worse if the economy contracts. Although some workplaces invested significantly in health programmes during and after the pandemic, it is not clear that these commitments will survive. Many employers are already moving to reverse the promises made on hybrid working in the face of what they see as a drag on productivity. Goldman Sachs and JPMorgan, despite their generous therapy offers, are on the leading edge of companies pushing for a return to five days in the office.

If companies respond to falling revenues by cutting both staff and spending on mental health, the double blow of increased workloads and reduced support could seriously undermine the progress made to date.

This story originally appeared on: Financial Times - Author:Brooke Masters

The new guidance from the US Financial Stability Oversight Council — a group of the country’s top financial regulators led by the Treasury department — details how it would go about singling out individual non-bank financial entities for supervision by the Federal Reserve, which would mean closer scrutiny.

“Some are based on a flawed view of how financial crises begin and the costs that they impose,” she said, noting that under current guidance, the process to finalise any designation could take up to six years.

This story originally appeared on: Financial Times - Author:Brooke Masters

Strip away the angry rhetoric about bodily integrity and unborn babies and focus on what has happened to this New York-based company’s basic livelihood over the past two weeks.

This story originally appeared on: Financial Times - Author:Brooke Masters

Things have changed. Employers are now more involved in women’s health than ever before. The Covid pandemic brought down some barriers, as many managers and human resources departments realised they needed to check regularly on the physical and mental health of employees who were working from home.

Social movements, such as #MeToo and Black Lives Matter also had an impact, albeit indirectly, as they prompted many employers to set up or give more power to affinity groups, including those for women. These, in turn, began asking companies to provide more support for female employees experiencing discomfort or pain due to menopause, menstruation, pregnancy, and IVF treatment.

In the UK, more than 600 employers, including the civil service, drugmaker AstraZeneca, and the BBC, have responded with public pledges to support women during menopause.

And, in the US, the Supreme Court decision in June that overturned constitutional protections for abortion rights has taken corporate involvement up another notch. A wide range of companies — including Amazon, Citigroup and Ikea — have pledged to pay travel expenses for employees who are forced to leave their home states to access abortion services.

Some went even further. Clothing retailer Patagonia, which has a history of taking progressive stands, said it would not only pay for abortion care and out-of-state travel, but would also cover bail for any employee arrested in an abortion rights protest.

We are a long way from my early days in the workplace when many employer healthcare plans did not even cover oral contraceptive pills. But I worry we have not come as far as optimists would have us believe.

Companies seeking to support women through the physical effects of menopause are finding that it is easy to put policies in place but much harder to make the programmes effective. Many managers find it awkward to launch nitty gritty discussions of night sweats and hot flashes, and that can discourage staff from seeking help.

Bringing abortion issues into the workplace will further complicate the choices for female employees. Some people are squeamish about menopause, but others are profoundly uncomfortable with, or actively oppose, abortions. Often coupled with discomfort around female sexuality, such views are bound to affect managers’ attitudes towards women who seek abortions.

This story originally appeared on: Financial Times - Author:Brooke Masters