Research shows prices in the United States are nearly double those in other well-off countries.Florida’s plan to save money by importing medications from Canada, authorized this month by the Food and Drug Administration, has renewed attention on the cost of prescription drugs in the United States.Research has consistently found that drug prices in America are significantly higher than those in other wealthy countries. In 2018, they were nearly double those in France and Britain, even when accounting for the discounts that can substantially reduce how much American health plans and employers pay.“The U.S. market is the bank for pharmaceutical companies,” said Ameet Sarpatwari, an expert in pharmaceutical policy at Harvard Medical School. “There’s a keen sense that the best place to try to extract profits is the U.S. because of its existing system and its dysfunction.”Here are six reasons drugs in the United States cost so much:1. There is no central negotiator willing to walk away.Other wealthy countries rely on a single negotiating body — usually the government — to decide whether to accept the price a pharmaceutical company wants to charge. In the United States, negotiations with drug makers are split among tens of thousands of health plans, resulting in far less bargaining muscle for the buyers.Other nations also conduct careful analyses of how much additional benefit a new drug presents over drugs already on the market — and at what cost. If the cost is too high and the benefit too small, those countries are more willing to say no to a new drug.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

The agency’s advisers cited concerns about the increased incidence of a rare but potentially serious blood clotting condition among those who received the company’s shot.The Centers for Disease Control and Prevention recommended on Thursday that Covid vaccines other than Johnson & Johnson’s should be preferred, after its advisers cited increasing evidence that the company’s shots can trigger a rare blood clotting disorder now linked to dozens of cases and at least nine deaths in the United States in the past year.The decision adopted a recommendation by an expert panel that effectively discouraged vaccine providers and adults from using Johnson & Johnson’s shot. New data showed that there was a higher risk for the blood clotting condition than previously known. The risk was greatest among women 30 to 49, estimated at 1 in 100,000 who had received the company’s shot.Johnson & Johnson’s vaccine is not being removed from the market. It will remain an option for people who are “unable or unwilling” to receive the more popular shots from Moderna or Pfizer-BioNTech, the agency said.The recommendation is the latest setback for a vaccine that has largely fallen out of favor in the United States. The company’s vaccine has not fulfilled its early promise as a traditional, one-and-done format that would be easy to deploy in more isolated or rural communities, or among people skittish about receiving two doses.Coronavirus Vaccine TrackerA look at all the vaccines that have reached trials in humans.About 16 million people in the United States have received the Johnson & Johnson vaccine as their primary immunization, compared with 73 million fully immunized with Moderna’s vaccine and 114 million with the Pfizer-BioNTech shots. Among Americans who have received a booster, just 1.6 percent chose Johnson & Johnson.This week, the Food and Drug Administration issued updated guidance on the risks of the blood clotting disorder linked to Johnson & Johnson’s vaccine, but reiterated that the benefits outweighed its risks.Dozens of countries have authorized Johnson & Johnson’s vaccine and have been using it as part of their immunization campaigns. But while it remains in high demand in some parts of the world, it has lost popularity in many countries because of safety concerns and its relative lower effectiveness against Covid.Some governments have already moved to put restrictions on Johnson & Johnson’s shot because of the blood clotting risk. Finland, Denmark and Slovenia stopped using it, and several other nations have ranked it lower for use than Pfizer-BioNTech’s and Moderna’s vaccines. Some countries also have advised doctors to counsel women under 50 of the potential risk.The C.D.C. panel’s recommendation lands in the middle of a surge in virus cases driven by the Delta coronavirus variant and Omicron, the latest version that has already become dominant in some countries and is spreading fast in Britain and the United States.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4A new U.S. surge.

A committee of experts voted on a preference for the Moderna or Pfizer immunizations, citing the risk of blood clots linked to Johnson & Johnson’s product.An expert panel to the Centers for Disease Control and Prevention on Thursday voted to recommend that Covid vaccines other than Johnson & Johnson’s should be preferred, citing increasing evidence that the company’s shots can trigger a rare blood clot disorder now linked to dozens of cases and at least nine deaths in the United States in the last year.The panel’s vote effectively discourages vaccine providers and adults from using Johnson & Johnson’s shot. New data showed that there was a higher risk for the blood clotting condition than previously known. The risk was greatest among women aged 30 to 49, estimated at 1 in 100,000 who had received the company’s shot.Still, some panelists expressed hope that Johnson & Johnson’s vaccine could still be used by people who did not have access to the more popular shots from Moderna or Pfizer-BioNTech, or wanted the shot despite knowing of the elevated side effect risk.The recommendation, which the C.D.C. must still decide whether to accept, is the latest setback for a vaccine which has largely fallen out of favor in the United States. The company’s vaccine has not fulfilled its early promise as a traditional, one-and-done format that would be easy to deploy in more isolated or rural communities, and among people skittish about receiving two doses.About 16 million people in the United States have received the Johnson & Johnson vaccine as their primary immunization, compared to 73 million fully immunized with Moderna’s vaccine and 114 million with the Pfizer-BioNTech shots. Among Americans who have received a booster, just 1.6 percent chose Johnson & Johnson.Earlier this week, the Food and Drug Administration issued updated guidance on the risks of the blood-clotting disorder linked to Johnson & Johnson’s vaccine, but reiterated that the benefits outweighed its risks.Dozens of countries have authorized Johnson & Johnson’s vaccine and have been using it as part of their immunization campaigns. But while it remains in high demand in some parts of the world, it has lost popularity in many countries because of safety concerns and its relative lower effectiveness against Covid.Some governments have already moved to put restrictions on Johnson & Johnson’s shot because of the blood clotting risk. Finland, Denmark and Slovenia stopped using it, and several other nations have ranked it lower for use than Pfizer-BioNTech and Moderna’s vaccines. Some countries also have advised doctors to counsel women under 50 of the potential risk.The C.D.C. panel’s recommendation lands in the midst of a global surge in virus cases driven by the Delta coronavirus variant and Omicron, the latest version that has already begun spreading quickly in Britain and the United States.Several laboratory experiments suggest that a single dose of Johnson & Johnson’s shot may offer little defense against infection with Omicron. The company said late last month that it was testing blood samples from clinical trial participants who have received its shot as a booster to see how their vaccine-induced antibodies fare against Omicron.At Thursday’s meeting of the Advisory Committee on Immunization Practices, C.D.C. officials went into detail on the clotting-related syndrome identified in 54 people in the United States who received the Johnson & Johnson shot before the end of August. Overall, the rate of the condition was 3.8 cases per one million people given the vaccine.People who received a Johnson & Johnson shot months ago are not thought to be at risk for the clotting condition, since the onset of symptoms typically occurred about nine days after vaccination in the diagnosed cases.An increased risk for the condition, which is known as thrombosis with thrombocytopenia syndrome and can cause internal bleeding, has also been linked to the shot from AstraZeneca, which is not authorized in the United States. It has not been associated with the Moderna or Pfizer vaccines.One panelist, Dr. Pablo Sanchez, a pediatrician at Ohio State University, said he had steered families away from the Johnson & Johnson vaccine.Evidence has increasingly shown that one dose of Johnson & Johnson’s shot offers much less protection against infection than other vaccines. Federal health officials in October authorized boosters for people who had received a single shot of the company’s vaccine at least two months earlier. They allowed for a “mix and match” approach, allowing people to get a second shot of a Pfizer or Moderna vaccine.Coronavirus Vaccine TrackerA look at all the vaccines that have reached trials in humans.So far, most Johnson & Johnson recipients who have gotten a booster have turned to other shots, and hardly any people originally immunized with other shots have opted for Johnson & Johnson as a booster.Despite their recommendation, a number of panelists said it was important to keep Johnson & Johnson’s vaccine available as an option.“It’s really important, though, that we not completely eliminate this vaccine,” said Dr. Jason Goldman, an assistant professor of clinical biomedical science at Florida Atlantic University.Dr. Penny Heaton, a Johnson & Johnson executive, said the vaccine is making a “crucial difference” in the pandemic response. “We are confident in the positive benefit-risk profile of our vaccine. It is saving lives here in the U.S. today and on every continent around the globe,” she said.In April, soon after Johnson & Johnson’s vaccine started being administered in the United States, federal officials briefly halted use of the shot because of concerns about the risk of blood clots. Cases have continued to accumulate.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4A new U.S. surge.

In a meeting of its expert vaccine advisers on Thursday, the Centers for Disease Control and Prevention presented new details on concerning rates of a rare blood clotting condition linked to Johnson & Johnson’s Covid vaccine, including nine confirmed deaths.The new data set the stage for the experts to consider recommending new restrictions on use of the vaccine. The panel, the Advisory Committee on Immunization Practices, could advise doing nothing, that the vaccine be restricted to only older people, or that it not be used at all in the United States. The panel could also recommend that Pfizer-BioNTech and Moderna’s vaccines should be preferred over Johnson & Johnson’s shot, except in cases where people cannot access a different brand or who want it despite the risk.Earlier this week, the Food and Drug Administration issued updated guidance on the risks of the blood-clotting disorder, but said again that the benefits of the vaccine outweighed its risks.C.D.C. officials went into detail on the clotting-related syndrome identified in 54 people in the United States who received the shot before the end of August. Overall, the rate of the condition was 3.8 cases per one million people given the vaccine. That is higher than the rate had been previously thought to be.The risk for the condition, which is known as thrombosis with thrombocytopenia syndrome and can cause internal bleeding, was highest in women ages 30 to 49, showing up in about 1 in 100,000 recipients in that age group. The rate at which the condition would normally be expected in the general population is not known, said Dr. Isaac See, a C.D.C. official.Of all Johnson & Johnson vaccine recipients diagnosed with the condition, 36 were admitted to an intensive care unit and the longest hospital stay was 132 days. Eight of them died. Since September, a ninth person has died.“We’ve been struck from reviewing these cases by how rapidly the status deteriorates and results in death,” Dr. See said.The people who died ranged in age from 28 to 62. Seven were women, and all were white. Obesity was the most common underlying medical condition. Two of the people who died did not have known medical problems, Dr. See said.Dr. See said additional cases had been identified since earlier C.D.C. meetings because of lags in reporting and delays in identifying and confirming illnesses related to the vaccine.An increased risk for the condition has been linked to the Johnson & Johnson vaccine and the shot from AstraZeneca, which is not authorized in the United States. It has not been linked to the vaccines from Moderna or Pfizer.On Thursday, C.D.C. officials also reported on side effects among children aged 5 to 11 who have received the Pfizer vaccine in the last several weeks. With 7.1 million doses administered, the C.D.C. confirmed eight cases of myocarditis, or swelling of the heart muscle, and has an additional case under review.It was previously reported that males between 16 and 29 years had a heightened risk of developing myocarditis. Nearly 11 out of every 100,000 of them developed the condition a few days after being fully vaccinated. On balance, it was estimated that for boys 12 to 17, the shots would cause an estimated 70 myocarditis cases but prevent 5,700 infections, 215 hospitalizations and two deaths, the C.D.C. said. But most recovered within a short period of time.Among the six cases in younger children with known outcomes, five recovered from the symptoms. The eight confirmed cases were evenly split between males and females.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4U.S. surpasses 800,000 deaths.