Innovation Incentives and Competition

PORTAL researchers study how incentives in drug and medical device markets can be better aligned to promote meaningful innovation and ensure timely competition.

Innovation Incentives & Competition

Differential Legal Protections for Biologics vs Small-Molecule Drugs in the US

Wouters OJ, Vogel M, Feldman WB, Beall RF, Kesselheim AS, Tu SS | JAMA (2024)

The authors explore the validity of various justifications for the greater legal protections given to biologics over small-molecule drugs in the US. Across development times, clinical trial success rates, research and development costs, patent protection, market exclusivity periods, revenues, and treatment costs, the study found no evidence supporting differential treatment. The authors conclude that US law overly rewards the development of biologics relative to small-molecule drugs.

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Recent Work in Innovation Incentives & Competition

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Early Generic Semaglutide in Canada—Implications for US Patients and Policy

Tu SS, Kesselheim AS, Tadrous M, Beall RF - JAMA Internal Medicine

  • Innovation Incentives and Competition
  • Price, Value, and Access
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When Constitutional Theory Collides With Health Care Accountability—The False Claims Act at a Crossroads

Tu SS, Kesselheim AS - JAMA Health Forum

  • Innovation Incentives and Competition
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Orphan Designation for Drugs Approved in the United States and European Union: A Comparative Analysis

Costa E, Ross JS, Kesselheim AS - Clinical Pharmacology & Therapeutics

  • Innovation Incentives and Competition
  • Regulation and Clinical Evidence
The US Orphan Drug Act and EU Orphan Regulation both offer incentives to develop rare disease treatments, but of 344 rare disease drug indications approved from 2011 to 2020, 97.7% received FDA Orphan Drug designation versus only 40.4% from the EMA, with the agencies aligning most on advanced therapies and genetic diseases but diverging on cancer subsets and pediatric indications of common diseases like HIV. These differences reflect the broader US indication-based framework versus the EU’s narrower focus on distinct conditions, suggesting policymakers should target incentives toward truly rare diseases rather than subsets of common conditions like cancer.
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