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Understanding of the factors that contribute to policies diverging from neoliberal norms and accounting for situations when social movement activists prevail over the interests of more powerful opponents requires an analytical framework specifying the dimensions of interest. The case of Brazil’s pharmaceutical policies, especially those dealing with HIV/AIDS, is considered.

To understand the space and limits for progressive agency amidst contemporary globalization, previous articulations of dependent development and global capitalism require conceptual space with insights from social movement theory and normative framing.

Control over technology, political alliances, and normative appeals have changed since the concept of dependent development to today’s contemporary neoliberal globalization for understanding cases of progressive agency. Technology is based more on intangible knowledge, activism across the state-society boundary is more likely, and human rights has become the dominant idiom for naming and shaming more powerful opponents.

The analytic framework developed informs our understanding of pharmaceutical autonomy – the ability of a country to provide for the prescription drug needs of its population – in the case of Brazil. Further research of other situations requires the application of the framework to determine its merits.

A focus on technology, alliances, and norms provides a useful starting point for exploring situations of development autonomy that prevails over the interests of corporate power.

This chapter looks at the past, present and future of international cannabis control required by the UN drug control conventions in the post-2016 United Nations General Assembly Special Session era with an eye on the next High Level Ministerial Segment (HLMS) at the UN Commission on Narcotic Drugs in 2019, and beyond. From a policy analysis perspective, the author meanders through the increasing tendency to legally regulate recreational cannabis markets notwithstanding the obligation enshrined in the UN drug control conventions to limit cannabis exclusively for ‘medical and scientific’ purposes. Taking into account relevant national and international developments, the chapter describes how the growing discomfort with the status of cannabis and the prohibitive and punitive approach stemming from the international drug control regime went through a process from soft to hard defections of the treaty obligations. The case of the Netherlands demonstrates the difficulty faced by reform-minded states in reconciling their wish for a different cannabis control mechanism with their obligations under international law, resulting in an incomplete regulation of its coffee-shop system, where small amounts of cannabis are tolerated for sale, but where the illicit supply to the shops remained unregulated. Subsequent more wide-ranging reforms to regulate cannabis from seed to sale in Uruguay, several US States and – in 2018 – in Canada, are clearly violating the obligations of the UN drug control conventions. Nevertheless, the HLMS will likely leave the elephant in the room untouched. The emerging paradigm shift regarding cannabis shows that a modernisation of the UN drug control regime is long overdue. This chapter discusses some of the options available.

This chapter examines representations of gender in online modafinil markets. While gender has often been absent from scholarship on online drug markets, our analysis demonstrates the ubiquity of gender in representations of modafinil users and sellers. The analysis draws on visual images, blogs, and marketing emails relating to three websites selling modafinil, discussed pseudonymously. We describe the range of ways that notions of gender are represented in advertising. Although women represent around 40% of that buying modafinil online, websites and communications tended not to feature women. Although sexist stereotypes of women were rarely present (in contrast to direct-to-consumer pharmaceutical advertising), the ways that modafinil was imagined tended to focus narrowly on corporate spheres of work and productivity. We contrast this narrow imaginary with female journalists’ own accounts of using modafinil to manage illness and enhance creativity. Thus, we conclude that the ways that modafinil has been imagined reflects working assumptions as to who is considered the ‘normal’ participant in online modafinil markets.

The relationship between patents and the pharmaceutical industry is both complex and important. While many believe that patents are manipulated by the pharmaceutical industry for its own economic ends, a historical approach to the utilization of patents combined with an analysis of current patent issues places this relationship in its proper context. Though patents were created long before the pharmaceutical industry reached its current status as a major industry in the United States, a historical, analytic approach shows that the pharmaceutical industry has adjusted to constantly evolving legislation enacted to provide the most effective and efficient system by which to research, invent, regulate and patent new medicines.

The World Health Organization estimated that in 1999 roughly one-third of the world's population lacked access to essential medicines that would have saved or improved their lives. Our analysis focuses on how pharmaceutical product patents restrict access to essential medicines in developing countries. It is well established that pharmaceutical product patents provide little incentive for pharmaceutical companies to develop new medicines designed to treat diseases prevalent in developing countries or to market in developing countries those patented medicines developed to treat diseases prevalent in developed countries. Economists have developed theoretical models showing that these incentives could be changed if (1) developing countries provided intellectual property protection for new pharmaceutical innovations and (2) an international regulatory framework were established to facilitate pharmaceutical companies setting lower prices in developing countries and higher prices in developed countries for patented medicines. We develop an index of property rights in pharmaceutical innovations covering 129 countries from 1960 to 2005. It shows that in 1960 only a handful of countries provided significant protection for pharmaceutical innovations, but by 2005 over 95 percent of countries in our sample provided significant statutory protections. However, an international framework to allow pharmaceutical companies to price discriminate has not been put in place. We conclude that international price discrimination mechanisms, compulsory patent licenses, and regional patent buyouts are not viable mechanisms for providing access to essential medicines to patients in developing countries. Global patent buyouts are more likely to achieve this goal, as they are not founded on an impractical separation of pharmaceutical markets in developing and developed countries and they provide critical incentives to develop new essential medicines.

With expenditures totaling $227 billion in 2007, prescription drug purchases are a growing portion of the total medical expenditure, and as this industry continues to grow, prescription drugs will continue to be a critical part of the larger health care industry. This chapter presents a survey on the economics of the US pharmaceutical industry, with a focus on the role of R&D and marketing, the determinants (and complications) of prescription drug pricing, and various aspects of consumer behavior specific to this industry, such as prescription drug regulation, the patient's interaction with the physician, and insurance coverage. This chapter also provides background in areas not often considered in the economics literature, such as the role of pharmacy benefit managers in prescription drug prices and the differentiation between alternative measures of prescription drug prices.

The existence of parallel imports (PI) raises a number of interesting policy and strategic questions, which are the subject of this survey article. For example, parallel trade is essentially arbitrage within policy-integrated markets of IPR-protected goods, which may have different prices across countries. Thus, we analyze fully two types of price differences that give rise to such arbitrage. First is simple retail-level trade in horizontal markets because consumer prices may differ. Second is the deeper, and more strategic, issue of vertical pricing within the common distribution organization of an original manufacturer selling its goods through wholesale distributors in different markets. This vertical price control problem presents the IPR-holding firm a menu of strategic choices regarding how to compete with PI. Another strategic question is how the existence of PI might affect incentives of IPR holders to invest in research and development (R&D). The global research-based pharmaceutical firms, for example, strongly oppose any relaxation of restrictions against PI of drugs into the United States, arguing that the potential reduction in profits would diminish their ability to innovate. There is a close linkage here with price controls for medicines, which are a key component of national health policies but can give rise to arbitrage through PI. We also discuss the complex economic relationships between PI and other forms of competition policy, or attempts to limit the abuse of market power offered by patents and copyrights. Finally, we review the emerging literature on how policies governing PI may affect international trade agreements.

Purpose – This study examines the effect of price regulation and competition on launch timing and pricing of new drugs.

Methods – Our data cover launch experience in 15 countries from 1992 to 2003 for drugs in 12 major therapeutic classes. We estimate a two-equation model of launch hazard and launch price of new drugs.

Findings – We find that launch timing and prices of new drugs are related to a country's average prices of established products in a class. Thus to the extent that price regulation reduces price levels, such regulation directly contributes to launch delay in the regulating country. Regulation by external referencing, whereby high-price countries reference low-price countries, also has indirect or spillover effects, contributing to launch delay and higher launch prices in low-price referenced countries.

Implications – Referencing policies adopted in high-price countries indirectly impose welfare loss on low-price countries. These findings have implications for US proposals to constrain pharmaceutical prices through external referencing and drug importation.