Health, transatlantic trade, and President Trump's populism: what American Patients First has to do with Brexit and the NHS

Inadequate access to medicines is a huge burden for the large number of uninsured Americans and for those who are insured but cannot afford to pay for medicines out-of-pocket.2 Poor access causes real economic hardship and contributes to poor health outcomes.3 Similar drugs are often much cheaper in the UK (and even cheaper in other EU countries such as Belgium, Italy, Greece, and Spain) than they are in the USA.4 As a single payer, the UK Government negotiates with pharmaceutical companies to set prices via the Pharmaceutical Price Regulation Scheme. The Affordable Care Act, despite creating a government agency focused on comparative effectiveness research, actually prevents the agency and the Secretary of Health and Human Services (HHS) from basing decisions on cost per quality-adjusted life-year calculations.5 US drug pricing, transatlantic trade, and Brexit Since the 1970s, the UK has negotiated its international trade in concert with its EU partners. The USA promoted the removal of restrictions on direct-to-consumer advertising of medicines in trade agreements with Australia and South Korea, although both countries succeeded in maintaining some safeguards.8 US negotiators targeted New Zealand's Pharmaceutical Management Agency during talks on the Trans-Pacific Partnership Agreement, pressing to eliminate therapeutic reference pricing, add a mechanism to allow pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce complex disclosure provisions that would facilitate industry involvement in coverage and pricing decisions.9 Statements from the Trump Administration make clear connections between trade and pharmaceutical pricing. [...]recently, the UK did not have a fully functioning trade ministry that would be capable of complex negotiations with a high-capacity country like the USA.