Who puts the price on the medicine?

The price of medicines is not a cold number stuck on a pharmacy shelf. The price of a drug includes research, patents, risk, business, the bargaining force of states, sea lanes, oil, war and ultimately the patient’s own body. And the price determines which market a drug will reach before and for whom it will actually be available; it is not the same to have treatment as to be able to pay for treatment, including the public sector.

In Spain, the new drug law is on the table, which aims to reorganize prices, supply and use of generics. The objective, at least on paper, is clear: not to treat medicines as luxury products, but as social goods. But beware: being cheaper is not always being more accessible. If the price is too tight, the producer can leave. The pharmacy shelf will be cheap, but empty.

The factor that most influences the price of medicines is the patent. The patent is a temporary monopoly. A company obtains the exclusive right to produce and sell a particular medicine for a number of years, during which no one else can trade generics without their consent. The system’s promise is well-known: reward innovation, recover investment and promote new medicines. When the patent expires, magic happens. Not artistic magic, but economic magic: the possibility of producing medicines protected by the first patent opens up and prices drop. The same drug, the same therapeutic effect, but much cheaper. Then we realize that a large part of the high price did not reside in the molecule itself, but in the absence of competition.

And that's where Ormuz came in. At first glance, it seems to be a matter limited to oil - the closure of a strait, the increase in oil prices, the nervousness of the markets - but drugs also depend on these channels. By sea and air, they move in cold chains; chemical raw materials, active ingredients, packaging and logistics are also part of the drug. With the growing weight of the Gulf countries in pharmaceutical production and strategic distribution centers, a supply chain cut is not just economic news; it is also a public health alert.

In the US, too, the drug price game board is moving. The “most favored nation” model seeks to lower U.S. prices by comparing them with lower prices in other rich countries. This can create a domino effect: pharmacists can delay launches, penalize cheap countries or mask discounts. Lowering the price is good, not losing access.

The question, therefore, is not only whether medicines should be sold cheaper or more expensive, but how to pay for innovation without harming patients. In my opinion, the path is threefold: more transparent prices, more strategic public production and supply, and more rigorous use of patents to reward real innovation, not tricks to extend the monopoly.

After all, the price of a drug is not the sacred secret of the market. It's a social pact. And in social pacts, citizens have the right to ask: how much is health worth and who sends the bill?