E-DRUG: High cost of cancer medicines
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[This long article deals with the high prices of anti-cancer medicines
in the USA context. However, it touches on medicine pricing strategies,
ethical issues in pricing of medicines, value-based pricing, how the
current patent system doesn't work (with regard to access to medicines)
and how price affects access to medicines. For those countries that
include cancer medicines in their essential medicines list, it will have
a particular message. Some portions are copied below for your interest -
copied as Fair Use. DB]
http://nymag.com/news/features/cancer-drugs-2013-10/
By Stephen S. Hall Published Oct 20, 2013
The Cost of Living
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New drugs could extend cancer patients' lives by days. At a cost of
thousands and thousands of dollars. Prompting some doctors to refuse to
use them.
On August 3, 2012, the Food and Drug Administration approved a new
cancer drug called Zaltrap as a safe and effective treatment for
patients with advanced colon cancer. The approval was based on a
large-scale clinical trial that showed that Zaltrap, given in
combination with three previously approved drugs to patients who had
failed initial therapy, extended median overall survival by 42 days.
No one knew the price of Zaltrap at that point, but Leonard Saltz, who
heads the gastrointestinal oncology group at Memorial Sloan-Kettering
Cancer Center, had a sense of what was coming.
<snip>
The pharmacist e-mailed the numbers, and Saltz stared at the figures on
his computer screen. Zaltrap, the drug that was extremely similar to
Avastin, cost roughly $11,000 a month.
<snip>
The centerpiece of the 2009 article was a chart tracking the price of
every cancer drug approved by the FDA since 1965 (now regularly updated
by Bach and his colleague Geoffrey Schnorr). In preparing it, Bach
discovered several dirty secrets about drug pricing. The first is that
there is no fixed price. The 'sticker price' of a cancer drug is listed
in a compendium called the /Red Book//, /but no one pays that price,
according to experts. Drug companies can, and do, offer undisclosed
discounts to health-insurance companies, hospitals, and middlemen in the
health-care market. So prices vary widely. The Sloan-Kettering
compendium pegs its cancer-drug prices to Medicare reimbursements, which
give an indication of the real marketplace price (and the cost to
taxpayers). These prices are lower than those in the /Red Book, /but
still, according to Bach, are 'astronomical'
Second, the chart documents a recent sea change in pricing. It shows a
very slight uptick in prices until the mid-eighties, when the rise
becomes more substantial, and then bends sharply upward around 2000.
Beginning about twenty years ago, the graph also shows a series of dots
way above the curve of average prices, indicating drugs that, in effect,
have broken the sound barrier on price since the nineties.
<snip>
'There is a number in people's minds' he says. 'If you say to people,
-I have a drug that extends life by one day at a billion dollars;
shouldn't we as a society pay for it?,' I'm pretty confident most people
would say no. If I say, -I have a drug that extends life by three years
at a cost of $1.50, I'm pretty confident everybody would say, -Of
course!' Somewhere in there is a number, a tipping point, where we say,
- No, we can't. Right now, we're unwilling as a society to /explore/
where that point is. And I would argue that we have to. Wherever it may
be, we have to find it.'
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