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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Delisting of Pharmaceutical Patents Challenged by the Federal Trade Commission

Leon J, Tu SS, Kesselheim AS, Feldman WB - JAMA Internal Medicine

  • Innovation Incentives and Competition
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Op-Ed: Congress Must Repair USPTO’s Inter Partes Review Process

Tu SS, Rai AK, Kesselheim AS - Law360

  • Innovation Incentives and Competition
Recent administrative changes at the USPTO, including centralized institution authority, unexplained discretionary denials, and non-merits-based decision criteria, have sharply constrained access to inter partes review and are now spreading to ex parte reexamination, leaving fewer viable mechanisms to challenge potentially invalid patents. Congress should enact legislation requiring written explanations for all denials, subjecting those decisions to judicial review under the Administrative Procedure Act’s arbitrary and capricious standard, and reestablishing IPR’s core function of removing erroneously granted patents to protect competition and the public interest.
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Simple graphic of magnifying glass examining papers to signify reviewing research publications.

Prescription Drugs Affected by an Expanded Rare Disease Carve-Out from Medicare Price Negotiation

Rome BN, Mooney H, Kesselheim AS - Journal of General Internal Medicine

  • Innovation Incentives and Competition
  • Price, Value, and Access
The One Big Beautiful Bill Act (OBBBA) expanded exemptions from Medicare drug price negotiation to include drugs approved for multiple rare diseases and delayed negotiation timelines for drugs first approved for a rare disease. The authors identified 22 drugs, collectively accounting for $18 billion in 2023 Medicare spending, that would be exempted or delayed from negotiation under these new provisions. Congress should consider more targeted approaches, such as setting a higher spending eligibility threshold for rare disease drugs, to preserve savings while maintaining protections for rare disease products.
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