Commentary: Making middle income countries pay full price for drugs is a big mistake

Radhakrishnan, Priti

doi:10.1136/bmj.h3757

Cited by 5 publications

(6 citation statements)

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“…There is specific need for policy action in UMICs since they are excluded from “access programs” that LICs enjoy. Furthermore, UMICs can suffer from trade pressure that HICs exercise to intensify intellectual property protection, and overall, these countries receive little international support to promote lower prices of medicines [ 93 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Moye-Holz

Vogler

2021

Appl Health Econ Health Policy

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Background There are concerns that high prices of cancer medicines may limit patient access. Since information on prices for cancer medicines and their impact on affordability is lacking for several countries, particularly for lower income countries, this study surveys prices of originator cancer medicines in Europe and Latin America and assesses their affordability. Methods For 19 cancer medicines, public procurement and ex-factory prices, as of 2017, were surveyed in five Latin American (LATAM) countries (Brazil, Chile, Colombia, Mexico, and Peru) and 11 European countries (Austria,

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Section: Discussionmentioning

confidence: 99%

Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Moye-Holz

Vogler

2021

Appl Health Econ Health Policy

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“…[ 79 ; 198 ] This means that the authorities recognize the drug patents, but are allowed to have local generic manufacturers produce the same drugs, without fearing claims of patent infringement, or they can import the drug from another generic manufacturer. [ 7 ; 56 ; 79 ; 81 ] This reduces the costs of a new drug dramatically,[ 171 ] though other options like international procurement seem to offer a better discount. Unfortunately, this approach is also administratively cumbersome, since in general, it applies to one drug at a time,[ 56 ] and could result in other innovators withdrawing their drug from the market.…”

Section: Drug Innovation Regulation and Pricing Interventionsmentioning

confidence: 99%

“…The price hike occurred despite the fact that research costs for the new indication were included in the initial price. [ 4 – 6 ] Also in the US, the list price of sofosbuvir (Sovaldi ® ) is $84,000 for a 12-week treatment, or $1,000 a pill,[ 7 ] which has caused health plans to refuse routine coverage of this drug for hepatitis C virus (HCV) infection. [ 5 ; 8 ] Sovaldi ® alone accounted for 64% of US HCV-related spending in 2014, which totaled $12.3 billion.…”

Section: Introductionmentioning

confidence: 99%

“…Governments and health insurers are struggling with the dramatic increase in costs of new medications. [ 7 ; 24 – 26 ] In December 2015, the US Senate issued a warning report on Sovaldi’s escalating drug price and its impact on the US health care system. The committee report said the Gilead Sciences pharmaceutical company had set the price as a benchmark to “raise the price floor” for its future hepatitis C-drugs like Harvoni, thus knowingly reducing the number of eligible patients for these superior treatments to cure HCV.…”

Section: Introductionmentioning

confidence: 99%

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Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks

2017

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ContextRecent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines.MethodA systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines.FindingsChanges in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered.ConclusionA fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines.

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“…Ultimately, the origin of the problem is the unexplained high price of orphan medicines [9,[31][32][33]. Pharmaceutical companies should not only clarify pricing of orphan medicines but also share a responsibility to come up with solutions that allows the incorporation of innovative medicines in realistic healthcare budgets [34,35].…”

Section: Discussionmentioning

confidence: 99%

The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy

Scheijmans

Zomers

Fadaei

et al. 2022

BMC Health Serv Res

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Background The reimbursement for expensive medicines poses a growing challenge to healthcare worldwide. In order to increase its control over the costs of medicines, the Dutch government introduced the Coverage Lock (CL) policy in 2015. The CL postpones decisions regarding reimbursement of expensive medicines until detailed advice on i.e., cost-effectiveness has been given. The CL has been in place for six years, has raised many questions and concerns, but currently, no evaluation is known to the authors. A better understanding of the effects of the CL on all stakeholders involved may contribute to reflections on the CL process and help find ways to improve it. An evaluation of Dutch policy will also be relevant for other countries that aim to optimize reimbursement procedures for expensive treatments. To perform this evaluation, we focused on the CL procedure for the medicine nusinersen. Nusinersen is the first treatment for spinal muscular atrophy (SMA). Following EMA approval in May 2017, it was placed in the CL. The analysis of cost-effectiveness and added therapeutic value resulted in an advice for reimbursement limited to children younger than 9.5 years at the start of treatment; this was implemented from August 2018 onwards. Methods Qualitative stakeholder perspective analysis of the CL procedure focusing on nusinersen with 15 stakeholders. Results Stakeholders raised key issues of the CL based on their experience with nusinersen: emotional impact of the CL, duration of the CL procedure, appropriateness of the CL procedure for different types of medicines, transparency of the CL, a wish for patient-centred decision-making and the lack of uniformity of access to expensive treatments. Discussion Stakeholders supported measures to control healthcare expenses and to ensure reasonable pricing. They considered the delay in access to therapies and lack of procedural transparency to be the main challenges to the CL. Stakeholders also agreed that the interests of patients deserve more attention in the practical implementation of the reimbursement decision. Stakeholders suggested a number of adjustments to improve the CL, such as a faster start with conditional reimbursement programs to ensure access and intensify European collaboration to speed up the assessment of the medicine.

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Commentary: Making middle income countries pay full price for drugs is a big mistake

Cited by 5 publications

References 1 publication

Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Comparison of Prices and Affordability of Cancer Medicines in 16 Countries in Europe and Latin America

Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks

The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy

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