{"id":92992,"date":"2018-12-15T09:19:51","date_gmt":"2018-12-15T08:19:51","guid":{"rendered":"https:\/\/www.erasmusmagazine.nl\/en\/?p=92992"},"modified":"2025-12-19T11:23:10","modified_gmt":"2025-12-19T10:23:10","slug":"how-medications-are-slowly-becoming-a-little-more-affordable","status":"publish","type":"post","link":"https:\/\/www.erasmusmagazine.nl\/en\/2018\/12\/15\/how-medications-are-slowly-becoming-a-little-more-affordable\/","title":{"rendered":"How medications are slowly becoming a little more affordable"},"content":{"rendered":"

People have been quite upset with the high prices charged for medicines for a while. Now, though, pharmacists and AMCs are revolting against Big Pharma and the power it wields. Three Rotterdam-based experts are seeing a turn of the tide. \u201cMaximising your profits at the expense of patients is completely unethical.\u201d<\/p>\n

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\n\t\n\n<\/svg>\n<\/span>\n\tImage by:<\/span>\n\n\t\t\t\n\t\t\t\t\t\t\tEsther Dijkstra<\/a>\t\t\t\t\t<\/span>\n\t<\/p>\n<\/figcaption><\/figure>

Like Asterix\u2019 and Obelix\u2019 tiny village in Roman-occupied Gaul, the pharmacists of the Amsterdam Academic Medical Centre fought the Italian pharmaceutical company Leadiant this year. Leadiant had raised the price for a drug called CDCA, which is used to treat a rare metabolic disorder called CTX, making it 500 times more expensive than it used to be: 140 dollar per pill, up from 28 cents per pill. In response to the price hike, the Amsterdam-based pharmacists decided to start making the drug themselves, which they were allowed to do as compounding pharmacists. Initially, the Dutch Health Care Inspectorate seemed to disallow the practice, but by now, the Amsterdam AMC has been granted permission to start compounding the drug itself again, subject to certain conditions. Was 2018 the year in which society finally genuinely revolted against Big Pharma?<\/p>\n

Unethical<\/h2>\n\t
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\n\t\t\u2018We have to go to prices that are fair\u2019\n\t<\/blockquote>\n\n\t\t\t
\n\t\t\t\t\t\t\t–<\/span>\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\tCarin Uyl-de Groot\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/figcaption>\n\t<\/figure>\n\t\t<\/div>\n\t<\/div>\n

\u201cIt has become very clear this year that we can\u2019t go on this way,\u201d says Carin Uyl-de Groots, a Professor of Healthcare Evaluation at the EUR. \u201cSome new medications are practically unaffordable, even though patients are entitled to treatment. Maybe it\u2019s legal for prices to be set in a particular way, but maximising your profits at the expense of patients is completely unethical. We have to go to prices that are fair\u201d<\/p>\n

Earlier this year, Uyl-de Groot published a study in Nature Reviews Clinical Oncology<\/a><\/em>, <\/em>which showed that the great majority of cancer drugs are too expensive. She created an algorithm that calculates the cost price of medications. \u201cTake this ovarian cancer drug, for instance. Our algorithm says it should cost 15,000 euros. In actual fact, it costs 126,000 euros.\u201d She is seeking to have the calculation method applied to the pharmaceutical industry. \u201cTo this end, I\u2019m discussing the matter with the European Parliament, among other parties. Last year, the European Parliament passed a resolution requiring pharmaceutical companies to provide greater transparency on the prices they charge for medicines.\u201d<\/p>\n

Standing stronger together<\/h2>

Europe is where true breakthroughs must be brought about, Uyl-de Groot believes. \u201cAt present, countries are negotiating on an individual basis. As a result, they are not aware what kind of agreements pharmaceutical companies are entering into with other countries.\u201d Moreover, the Netherlands does not have much of a say on its own, since it only constitutes 2 per cent of the European market. Uyl-de Groot explains that a large country like Germany is more interesting to companies, meaning it gets medications sooner and at a cheaper rate. \u201cFor this reason, I\u2019m currently in talks with Beneluxai<\/a>, a group established by five countries that wish to negotiate with pharmaceutical companies together: Belgium, the Netherlands, Luxembourg, Austria and Ireland. Together we will stand stronger.\u201d<\/p>\n

If Uyl-de Groot had her way, a European agency would be established that was in charge of the price of medications, like EMA, the European Medicines Agency, which evaluates applications for European marketing authorisation for medicines. She feels this would be in pharmaceutical companies\u2019 interest, as well. \u201cTheir turnover would increase, because medicines will be marketed sooner and will be used by more patients due to their lower price point.\u201d For instance, in the example of the aforementioned ovarian cancer drug, her algorithm predicts that the pharmaceutical company\u2019s turnover would multiply five-fold (up to \u20ac700 million), despite the reduced selling price. Prof. Uyl-de Groot is at pains to emphasise that she is not at all against pharmaceutical companies. \u201cWe simply need those medicines.\u201d<\/p>\n

More effective and cheaper, too<\/h2>
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\n\t\n\n<\/svg>\n<\/span>\n\tImage by:<\/span>\n\n\t\t\t\n\t\t\t\t\t\t\tEsther Dijkstra<\/a>\t\t\t\t\t<\/span>\n\t<\/p>\n<\/figcaption><\/figure>

Pauline Meurs, too, is in favour of countries jointly entering into agreements on the prices they are going to pay. Meurs, a Professor of Healthcare Management, hopes that the pressure engendered by such a coordinated action will make pharmaceutical companies more innovative. Pharmaceutical companies currently have a business model based on failure, or so Meurs recently told Bruno Bruins, the Minister for Health Care, in a recommendation issued by the Public Health and Society Council (RVS). Meurs chairs this independent advisory body that issues recommendations to the Ministry of Health, Welfare and Sport. \u201cOnly 10 per cent of all medications being tested end up being marketed. That is a ridiculously low percentage. It\u2019s high time we looked at pharmaceutical companies\u2019 cost efficiency.\u201d<\/p>\n

She feels that the success rate of pharmaceutical research should be able to be raised, and that prices will benefit from this. \u201cPharmaceutical companies really aren\u2019t that innovative. They all conduct standard randomised controlled trials, to determine the efficacy of medications in large groups of patients.\u201d Many potential medicines are not rejected until these expensive and labour-intensive studies, called \u2018phase-3 studies\u2019.<\/p>\n

Therefore, Meurs and RVS are in favour of more efficient phase-2 studies, in which the efficacy of a drug and its potential side-effects are established. \u201cIf you examine not only middle-aged men, as is the case at the moment, but also women and the elderly, it is easier to assess whether a drug will survive the expensive phase-3 trials.\u201d<\/p>\n

Pharma bashing<\/h2>\n\t
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\n\t\t\u2018Biopharmaceutical start-ups can act like a gadfly to major companies\u2019\n\t<\/blockquote>\n\n\t\t\t
\n\t\t\t\t\t\t\t–<\/span>\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\tPauline Meurs\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/figcaption>\n\t<\/figure>\n\t\t<\/div>\n\t<\/div>\n

Meurs does see innovative methods being used at small biopharmaceutical start-ups. She thinks the Ministry of Economic Affairs should do more to support these small companies. \u201cLet them act like a gadfly to major companies. Give them incentives to keep doing so, instead of telling them the market must be allowed to run its own course. It\u2019s all about protecting the public interest: affordable medicines.\u201d<\/p>\n

Meurs\u2019 proposal played right into the hands of Hans B\u00fcller, who served as the Chairman of Erasmus MC\u2019s Board until 2013 and has been the Managing Director of FairMedicine<\/a> for the last two years. This organisation seeks to develop medications at an acceptable price point, by creating coalitions between all stakeholders, i.e., knowledge institutions, doctors, patients and, yes, pharmaceutical companies. \u201cI\u2019m not in favour of \u2018pharma bashing\u2019. However, I do think it\u2019s better if multiple parties market a medicine together, rather than having pharmaceutical companies dictate the whole process.\u201d<\/p>\n

Rare disorders<\/h2>

FairMedicine\u2019s methods are as follows. If someone working at a knowledge institution discovers a potential medication, FairMedicine will seek partners that will help him or her develop and market the medicine. A coalition made up of knowledge institutions, pharmaceutical companies, doctors and patients will perform the clinical trials and set prices, based on actual costs, with a \u2018socially acceptable\u2019 profit margin not exceeding 15 per cent.<\/p>\n

The former paediatrician believes FairMedicine\u2019s model will prove attractive to universities\u2019 pharmaceutical spin-offs. They, being more socially engaged than profit-hungry, tend to focus on rare disorders that major pharmaceutical companies do not think are worth their while. \u201cThey have a completely different attitude to the matter than the real \u2018crooks\u2019 whose only intention is to obtain a monopoly on certain medicines because they can then charge a hundred times as much.\u201d<\/p>\n

Medicines slowly becoming more affordable<\/h2>\n\t
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\n\t\t\u2018This was a year in which it became abundantly obvious that things really have to change\u2019\n\t<\/blockquote>\n\n\t\t\t
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However, B\u00fcller knows that it is hard for such small companies to actually obtain marketing authorisation for interesting drugs. \u201cThe drugs must be evaluated in expensive clinical trials. And banks don\u2019t give loans to such small companies that employ, say, twelve people. So then we\u2019re looking at a buy-out by a larger company that can<\/em> finance the trial. It\u2019s even become a bit of a business model for these start-ups. But it does mean they are no longer in charge of the product and the price charged for it.\u201d<\/p>\n

FairMedicine hopes to market its first medicine in mid-2019. B\u00fcller does not yet wish to announce what kind of drug it is. It seems that medicines are slowly getting more affordable. B\u00fcller agrees with Meurs and Uyl-de Groot that \u2018this was a year in which it became abundantly obvious that things really have to change\u2019. But, he adds, \u201ca lot of things will still have to change for us to get where we wish to be\u201d.<\/p>\n\n\t\n\t

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De redactie<\/h2>\n\t\t\n\t\t
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