Every time I return from our local pharmacy after refilling a prescription for one of my autistic son‘s medications, I am grateful that we have health insurance. “Med’ cine” (as Charlie pronounces the word) helps him function with and in spite of severe anxiety and abnormal brain activity. I’m always shocked to see how much our co-payment is versus the full cost of the medicine.
Charlie’s medications are hardly the most expensive. Some drugs for treating cancer can cost in the six figures for a year’s supply. Gleevec, a drug for treating chronic myeloid leukemia (CML) made $4.7 billion for Novartis in 2012. Of the estimated 1.2 million to 1.5 million people in the world with chronic myeloid leukemia, only a minority are using this or a similar drug. In recognition of this, an international group of 120 leading cancer physicians has written an article in Blood, the journal of the American Society of Hematology, asserting that the all too often astronomical costs for some drugs are “immoral.”
The physicians’ article touches on a number of dilemmas: is there a “just price” for medications? How can governments craft policies that ensure such drugs are acquirable for all and not only the wealthy? Are pharmaceutical companies obligated to keep costs low or only low enough? These are fine fodder for medical ethicists and academic debate, but as one of the article’s lead authors, Dr. Hagop M. Kantarjian, chairman of the leukemia department at the MD Anderson Cancer Center in Houston, says, high prices mean real consequences.
Life-saving Drugs Could Cost You Your Life Savings
A close relative has prostate cancer that worsened even after surgery and radiation treatment. Then his doctor started him on Zytiga, a recently developed drug made by Johnson & Johnson and, to our eternal gratification, he started to improve. Zytiga costs around $5,500 per month, about $66,000 for a full year; you can bet he’s more than thankful for solid health insurance benefits in retirement. A similar drug, Xtandi, costs $7,450 per month, about $89,400 for twelve months.
Another drug that treats CML, Bosiluf, was just introduced by Pfizer in September. When Novartis’ Gleevec was introduced in 2001, its price tag was $30,000 for a year. But a year’s trial of Bosiluf is $98,000. Pfizer says that it helps “financially eligible patients get their prescriptions for free or at a savings, and insured patients pay no more than $50 a month.” But what might a supply of this medicine cost in a year, in two years?
The physicians note that the survival rate for patients in the United States seems to be less than it should be, perhaps in no small part because costs are forcing patients to not take the medicine they need. Prices for many drugs are twice as high in the U.S. as in many other countries, where government pressure or price controls keep drug costs down. Even if people have relative low out-of-pocket costs, the health system must still pay for the medications, driving up their costs.
What Matters Most: Patients’ Lives or Profits?
Drug companies, as you may expect, say they need to make a profit. Not only is it not an easy feat to develop effective drugs; companies factor in the costs of everything including marketing in their prices. It’s after the first billon dollars earned that a drug starts making profit, the physicians write.
Physicians and scientists have often played a role in research and clinical trials to develop drugs and, in some cases, profited themselves (and even served as “key opinion leaders” for some drug companies). In fact, some of the 120 or so doctors who co-authored the article have worked in partnership with, and been paid by, drug companies. Dr. Kantarjian has himself worked with Novartis and anticipates that his penning the article will have repercussions that could hurt his research career and, potentially, patients in need of his knowledge to develop new treatments.
The Hippocratic Oath to primum non nocere (“first do no harm”) drives the physicians’ protest against high prices. They are not yet taking any direct action, rather calling for “dialogue” with drug companies about pricing, the New York Times points out. Some of the doctors note they were inspired by physicians at the Memorial Sloan-Kettering Cancer Center in New York who, last fall, refused to use a new colon cancer drug, Zaltrap, because it cost twice the price of another drug without being more effective. The drug maker, Sanofi, cut the price in half after the physicians published an op-ed in the New York Times.
But what if physicians, backed by the government, took a firm stand against drug companies and insisted they do the right thing?
Government regulations setting limits on drug prices are needed, even in the face of a chorus of legislators wanting to protect business interests and not hamper the free market. What if researchers like Dr. Kantarjian stipulated to companies that they cannot help to develop new treatments unless costs are kept down?
It is far more profitable for companies to develop certain types of drugs — those for diabetes or high cholesterol that must be taken daily throughout someone’s lifetime — so new antibiotics or vaccines are not given priority. What if there were incentives for companies to develop the drugs that are most needed?
When there’s a choice between preserving capitalism’s freedoms and saving lives, the outcome doesn’t have to be a foregone conclusion. If we can create medicines to save people’s lives, surely we can figure out a way to provide these to everyone who needs them, too.
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