The US regulatory agency, the Food and
Drug Administration (FDA), approved 27
new molecular entities in 2013, down from
39 in 2012. Many of these approvals marked
the first approval of the medicine in any market.
A number of experimental medicines had
their development and review expedited
under the ‘breakthrough therapy designation’
programme, as a result of the 2012 Safety
and Innovation Act. This Act was designed
to speed up the approvals process for
medicines intended to treat serious or life
threatening conditions, and is enabling
medicines to reach patients sooner (see
Figure 4 Expedited development).
In the USA, there are no government price
controls on private sector purchases.
However, pharmaceutical manufacturers
are required by federal law to provide rebates
to the government on certain medicines in
order to qualify for reimbursement under
various healthcare programmes. These
rebates are shared between the states and
the federal government to offset the overall
cost of prescription drugs provided through
the Medicaid insurance programme for lowincome
Americans. Rebates were increased
and expanded through the Affordable Care
Act (ACA). Although the increase means
additional costs for pharmaceutical
manufacturers, it is also allowing Medicaid
to provide greater access for patients to
prescription medicines.
This expansion of the Medicaid programme,
together with new health insurance
marketplaces and a financial penalty for
certain Americans who choose not to purchase
insurance, which launched on 1 January 2014,
caused a great deal of uncertainty in the
insurance market through 2013.