1.

What is the proper balance for pharmaceutical companies between delivering

the fiduciary obligation of earning a profit for owner and providing life-saving
or life-extending drugs to customers? How much profit is too much profit and
who determines the amount? How does that balance get achieved?

The issue of finding the proper balance for pharmaceutical companies between delivering the
fiduciary obligation of earning a profit for owners and providing life-saving or life-extending
drugs to customers is complex and difficult to break down. There is a point where there is too
much profit and it is difficult to say who actually should determine the amount and how to
achieve the balance. I am an advocate of small-government and would possibly like to see
executives can only make 10x what their lowest-wage employee earns. Any extra profits for the
company that become of this go toward more research and development to find cheaper products
and possibly supplement/distribution programs for the less fortunate.

The United States could consider other methods for controlling drug pricing, such as those used in
some European countries. There are ways the US could use market forces and incentives from
government programs to control drug prices. Patents are important for a period of time. If a
company has spent lots of money attempting to come up with a medication that works, that
company should be rewarded with exclusive rights or should take commissions for the use of the
patents. The proper balance of patent protection for costly research and development versus lack
of competition is that the patent-holding company should accept some form of compensation by
another company to develop that drug, or treat it like a public utility.

There should be a cap on the amount of money that can be charged for orphan drugs to combat
high costs without viable alternatives. Yes there should be cost restrictions. Yes there should be
patent restrictions. Taking decades-old medications that do not have competitors and are
purchased and prices raised exponentially should be against the law. The justification for treating
that case differently than the case where a drug, with patent protection, comes to market and is
priced for hundreds or thousands of dollars is that the new drug coming to market with patent
protection is recuperating lost funds to research and development and marketing. In cases like
Turing and Valeant Pharmaceuticals they are taking a drug that has been around for a long time
and then raising the price exponentially for absolutely no reason other than greed and profit.

The United States and other developed countries can stimulate greater research and development
of treatments for NTDs and offer those drugs at prices that are affordable by rolling out an
incentive program provided to pharmaceutical companies developing NTD treatments that would
include the expedited FDA review of a subsequent drug of the company’s choice, potentially
generating millions of dollars of added revenue due to the fact that the chosen drug would gain
market access earlier than would otherwise be the case. Some flexibility in redeeming this reward
could be introduced, including allowing the benefit to be sold to another company.