A Short Lesson in Drug Competition

Calling RFK Jr.: See the new treatment that will break a Pfizer monopoly on a drug for heart disease

WSJ editorial. 

"Whoever says the Food and Drug Administration is too cozy with Big Pharma isn’t paying attention to the bonanza of new treatments launched by biotech startups. Late last week the FDA approved BridgeBio’s novel medicine for progressive heart disease, which will challenge Pfizer’s market monopoly.

Drug makers are increasingly focused on developing medicines that treat subsets of diseases. One example is transthyretin amyloid cardiomyopathy, a form of heart failure caused by the liver producing misshaped proteins that form amyloid deposits that stiffen the heart muscle. The condition can result from aging or a genetic mutation that is present in 3.4% of African Americans.

Most patients don’t live more than 3.5 years after being diagnosed, though two Pfizer treatments approved in 2019 can extend life for years. BridgeBio’s Attruby may be even more effective. The twice a day pill regimen reduced the risk of death and recurrent cardiovascular hospitalizations by 42% after 30 months of treatment.

Unlike Pfizer’s treatments, Attruby almost completely fixes the defective protein. BridgeBio is also launching Attruby at a lower price. “We’re like the David versus these two massive Goliaths in this space,” CEO Neil Kumar told STAT News.

Another competing treatment by the small biotech firm Alnylam Pharmaceuticals based on a different technology is expected to be approved next spring. The stepped-up competition will almost certainly lower prices, even before Pfizer’s medicines lose patent protection in 2028.

We point all this out because a growing condominium on the political right and left supports government price controls based on the misguided notion that Big Pharma extracts monopoly rents. That includes RFK Jr., Donald Trump’s nominee to run Health and Human Services. But monopolies even on breakthrough drugs rarely last, patent protection expires after 20 years (much of which is taken up by the approval process), and profits are needed to fund research and development into new treatments—some of which may compete with blockbuster drugs.

To wit, Amgen on Tuesday announced its experimental obesity drug resulted in 20% weight loss over a year in a Phase 2 trial, more than Novo Nordisk’s Wegovy and roughly the same as Eli Lilly’s Zepbound. Despite the good news, Amgen’s stock price plunged 12% because Lilly’s next-generation experimental treatment has shown even larger benefits in trials.

A sure-fire way to reduce drug innovation and competition is to let the government dictate prices."