UP FRONT
Guest Column
U.S. Medicine Prices: Watching from
Europe with Trembling Knees
By Peter Hokland, MD, DMedSci
Peter Hokland, MD, DMedSci
orking at the DanaFarber Cancer
Institute (then the
Sidney Farber) in
the Division of Tumor Immunology led
by Stuart Schlossman, MD, in the early
1980s was a great experience for my wife
and me – and perhaps an even greater
one for our two young kids. The concept
of Halloween, for one, was completely
new to them and completely tantalizing.
They can still remember being escorted
around Needham for trick-or-treating,
filling up their buckets with candy.
I could have sworn these traditions
would never cross the pond to Europe,
where we celebrate All Saints’ Day – the
remembrance of the ones departed during the preceding year – on November
1. During the last decade, however,
Halloween snuck into my country, too.
Pumpkins, gory masks, and, indeed,
festive candy are now amply available
at the local supermarket – somewhat to
my dismay.
My fellow European doctors and I
follow the trends in medication pricing in
the United States with similar trepidation,
hoping that this is one U.S. custom that
will not be “exported” to us.
Drug Pricing Decisions:
Lost in Translation
Naturally, we realize that pharmaceutical
companies develop new drugs at great
expense. Consequently, these new drugs
have hefty price tags both to cover the
costs of their discovery and to fund the
research to develop future drugs. However, some of the pricing decisions have
been difficult to rationalize.
When authors from the Memorial
Sloan-Kettering Cancer Center published
an editorial in The New York Times in
2012 standing up against the pricing of
a new colorectal cancer agent, they were
rightly lauded.1 The editorial and ensuing
publicity, in fact, led to the company halving the drug’s original price.
This reduction was, unfortunately, the
exception to the rule.
As in the United States, the prices of
new drugs in Europe are largely unregulated. In my country, the pharmaceutical
industry notifies the Danish Health Board
(the Danish equivalent of the U.S. Food
and Drug Administration) of changes in
ASHClinicalNews.org
medicine prices every two weeks merely
as a matter of announcement. The Danish
Health Board is obliged by law to then
communicate the pricing changes to all
pharmacies which are, in turn, also bound
by law to follow them.
Each new medication’s indication is
determined by a system of boards created
by a central organ under the Danish Regions. (Denmark is divided into five such
committees.) Once an already registered
drug has been approved by a committee, all costs of the drug to the patient are
covered by the public health service.
Typically, a new drug is dispensed by a
University Hospital, with reimbursement
to that hospital from the regional budget.
The regional health budget is determined
by the government as part of once yearly
negotiations. The most recent ones left the
Regions with a deficit of 0.5 billion DKr,
or $75 million, in a country with 5.6 million inhabitants. Such deficits have already
threatened staff reductions throughout
the country and, interestingly, the most
recent deficit was more or less the amount
needed to treat 200 children and teenagers
with a new drug against cystic fibrosis.
If this trend continues – and there
is every reason to think it will, with the
panoply of new drugs being developed
– the coming years will be a constant
struggle to get new medicines to our
patients while retaining the quality of
our health-care systems.
The situation in other European countries is essentially the same as in Denmark. For example, in Great Britain, the
National Institute for Clinical Excellence
(NICE) has been managing a Cancer
Drugs Fund which, despite an increasing
allotment of money for new drugs over
the past three years, became overwhelmed
in August, resulting in newspaper headlines such as “Up to 10,000 Patients Face
Being Stripped of Cancer Drugs.”2 The
Daily Mail also reported that closed-door
meetings would determine which drugs
would receive reduced funding.
If this were the only issue, it could be
solved by instituting stringent indications
restricting the use of new expensive drugs.
coverage of this phenomenon.
The New York Times and The New
Yorker have excoriated drug companies and their CEOs for the despicable
practice of buying other companies while
increasing prices of their portfolios of
drugs over 50-fold, simply by exploiting loopholes in the current American
system. Take the anti-toxoplasmosis drug
pyrimethamine (marketed as Daraprim®)
as an example. When there is a de facto
monopoly price-setting becomes a seller’s
market, even if the seller is “greedy and
indifferent,” according to The New Yorker
Financial Page coverage.3
As hematologists we have an obligation to secure the best treatments for our
patients, and this is heightened by the
fact that our field is a front-runner in the
development of new, paradigm-shifting
drug discoveries.
Most EU countries operate within a
national health-care service system, and
the doctors in these countries are fortunate enough to not have to bother with
insurance companies in the same ways
our American colleagues have to.
The recent deficits are deeply disturbing because they could destabilize the
fabric of most European health systems
– threatening to decrease the quality of
care simply because expenditures on
novel (and older) drugs are spiraling out
of control. In the United States, initiatives
from the Obama administration to institute formal reviews of medicine prices
by the FDA appear unlikely to succeed in
the present Congress, in part due to the
strong drug lobby (another phenomenon
not generally encountered in Europe).
Consequently, in Europe, we await
the importation of U.S. medicine prices,
with considerably more trepidation than
American Halloween customs! ●
REFERENCES
1. Bach PB, Saltz LB, Wittes RE. “In Cancer Care, Cost Matters.” The
New York Times, October 14, 2012.
2. Borland S. “Up to 10,000 patients face ‘being stripped of cancer
drugs’: Secret plans to slash lifesaving fund by £40million.” Daily
Mail, August 3, 2015.
3. Surowiecki J. “Taking on the Drug Profiteers.” The