Increases in drug prices puts pressure on European healthcare

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Increases in cancer medicine prices in the UK, despite many medicines going off-patent, suggest that in many cases NHS price negotiations are failing to lower or even stabilise drug prices, found a UK study.

European prices for some off-patent cancer drugs have risen by more than 100% in the past five years, with two cases of hikes exceeding 1,000%, Reuters Health reports that data has found.

Similar price rises for old drugs have sparked outrage in the US, where former hedge fund manager Martin Shkreli was pilloried in 2015 for increasing the cost of an anti-parasitic medicine by more than 5,000%. The new analysis by British academics suggests Europe is not immune to such unexplained cost increases, although absolute prices typically remain a lot lower than in the US.

“It seems to be happening quite frequently across Europe,” said Andrew Hill of the University of Liverpool, who presented the data with a colleague from the London School of Hygiene and Tropical Medicine at the European Cancer Congress in Amsterdam. “Prices aren’t as high as in the US but these are generic drugs and, as such, they should be available at close to the cost of production.”

The report says Hill’s analysis showed the British list price of busulfan, an old drug for leukaemia, had increased by 1,227% between 2011 and 2016, while one generic version of tamoxifen, used for breast cancer, rose by 1,079%.

There were also massive increases for some cancer treatments in other European countries, including Italy, where Aspen Pharmacare was fined €5m ($5.3m) last year after hiking the price of a chemotherapy drug by 1,540%. Aspen is appealing the decision.

Industry critics argue some companies take over supply of certain generic drugs and then raise prices progressively to maximize profits. The report says the generics industry says this is a skewed picture, since in some cases prices need to rise from unrealistically low levels to keep production viable, especially when companies are supplying only a small number of patients.

South Africa-based Aspen said that while the percentage increases appeared large, they were “from a very low and unsustainable price base, having not been increased over decades”.

Warwick Smith, director general of the British Generic Manufacturers Association, said in many cases competitive tendering systems imposed by European healthcare systems also resulted in very substantial discounts from the prices cited. “In the case of generic medicines used in hospitals, it is important to distinguish between the actual price paid and the much higher list prices often quoted,” he said.

The report says the issue is gaining increased attention from authorities in several European countries, with Britain last month fining Pfizer a record $106m for its role in ramping up the cost of an old epilepsy drug by as much as 2,600%. Pfizer is appealing.

The report says the British government is also introducing new legislation designed to secure better value for money for the National Health Service from its spend on medicines.

The European Consumer Organisation BEUC, meanwhile, wrote to European commissioner for competition Margrethe Vestager in October asking her investigate potential cases of unfair generic drug prices across the EU, the report says.

Background: Cancer medicine prices continue to strain healthcare systems. In the UK, the Cancer Drugs Fund is being overhauled under pressure from high prices. Drug prices typically fall as patents expire and the market opens to competition from generics, which are available at high quality and low cost from countries such as India.
Methods: NHS indicative prices in 2011 and 2016 were collected from the British National Formulary (BNF) for all medicines with cancer-related indications. The lowest available price was recorded if multiple suppliers were listed. 2016 Indian prices were collected from the online database Price per one cycle or 28 days, as applicable, was calculated based on the dosage regimen of a common indication.
Results: Of the 190 formulations of 89 medicines included in the survey, 28 formulations of 21 medicines showed price increases in the UK from 2011 to 2016 (Table). The largest increases were seen for treosulfan 250 mg (+1201%), busulfan 2 mg (+1107%), and tamoxifen 10 mg (+972%) tablets. Price increases were seen despite generic market availability: 17/21 medicines with price increases 2011–2016 were generic in 2016. BNF 2016 prices were median 2308% above current Indian prices.
Conclusions: Increases in cancer medicine prices in the UK, despite many medicines going off-patent, suggest that in many cases NHS price negotiations are failing to lower or even stabilize drug prices. High quality generic versions of drugs like imatinib are available from India at prices far lower than the current UK levels, showing the potential for future price reductions.

A Hill, M Barber

Reuters Health report
European Cancer Congress abstract

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