By Ryan Abbott
A few days ago, a group of more than 100 experts in chronic myeloid leukemia (CML) published an article in the medical journal Blood to draw attention to the prices of anti-cancer drugs and the effects of these prices on individual patients.
The authors note that three new drugs were approved by the FDA for CML in 2012, all of which were priced at “astronomical levels.” Of the 12 anti-cancer drugs approved by the FDA last year, 11 were priced above $100,000. This represents a doubling of prices from a decade ago. The authors claim that these prices “are too high, unsustainable, may compromise access of needy patients to highly effective therapy, and are harmful to the sustainability of our national healthcare systems.”
The cost of medicines is a controversial issue. Proponents of allowing the pharmaceutical industry to set its own prices argue that high prices are needed to incentivize new drug development. According to PhRMA, the cost of new drug approval is around $1.2 billion, although some independent experts put that price as low as $75 million. Yet, whatever the benefits of high prices, it is clear that high prices create a barrier to patient access to medicines.
This has long been an issue in the developing world, as illustrated by the series of posts I wrote earlier this month about the Glivec patent case in India (Part I, Part II, Part III). That case involved India’s high court denying Novartis a patent for a variation on the drug Glivec. In the U.S., Glivec was initially priced at nearly $30,000 when it was released in 2001, and its price has steadily increased to $92,000 a year in 2012. For perspective, the per capital income in India is $1,500 a year.
But the problem of high drug costs isn’t restricted to developing countries. While most U.S. citizens have access to life-saving medicines, the high cost of these drugs is contributing to a financial health care crisis. U.S. health care spending was $2.7 trillion in 2011, or 18% of the GDP, compared with 6–9% in Europe. This discrepancy is partially due to the fact that European nations often negotiate drug prices in the public market—something the U.S. government is prevented from doing by law (with some exceptions). Despite spending more on health care, the U.S. does worse than most European countries with regards to public health outcomes such as life expectancy.
So why are high drug prices a problem for doctors? Because high drug prices are a problem for patients. The cost of medicines may be the single most common reason for patient noncompliance. Patients need advocates who can help them navigate the enormous complexity of the health care system. That isn’t something doctors have been trained to do—doctors are taught how to prescribe, not how to procure. But knowing when a drug is indicated is of little use to a patient who lacks access. Patients need doctors with a more holistic approach to care.
It is unfortunate that physicians have mostly stayed out of the debate over research, pricing, and access. Doctors are in a unique position to act as patient advocates; pricing and access should be core issues for health care professionals seeking to help individuals cope with disease. Physicians have been leaders in integrating treatment development in other areas; for example, physicians develop new surgical procedures and make them widely available. There is no reason doctors can’t play a similar role in advocating change to the drug development paradigm. To be sure, there are some doctors who already do this (think Médecins Sans Frontières), but this has been limited to a relatively small portion of the medical community.
The article in Blood concluded with a very modest proposal, “We propose to begin the dialogue by organizing regular meetings, involving all parties concerned, to address the reasons behind high cancer drug prices and offer solutions to reduce them. For CML, and for other cancers, we believe drug prices should reflect objective measures of benefit. . .”
What more could doctors do? There are alternatives to giving the problem to multinational corporations and having them take responsibility for the entire process. Doctors might directly play a role in helping to more efficiently design or participate in clinical trial programs, or expand research on generic drugs for new indications. Doctors could encourage drug pricing based on value, or more ambitiously recommend alternatives to patent protection to incentivize new drug development such as prize systems.
The cost of medicines cannot continue to escalate indefinitely. Physicians should recognize this is a crucial opportunity for professional leadership. That is why the article in Blood is promising. Perhaps this is a step toward a new standard of physician advocacy.