Global health advocates suggest alternatives when limited options + limited bargaining power = unlimited drug prices

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Around the time the price of Daraprim, a drug used to treat toxoplasmosis rose by 5000 percent last month, the panel that produces federally approved guidelines for prevention and treatment of opportunistic infections in people living with HIV issued a heads up to physicians in the United States. They might need to consider substitute options for patients who could tolerate them, the notice said, because a couple of months before the price increase, the drug had stopped being available in pharmacies, limited only to the distribution system owned by the company that now owned the drug. In addition, of course, the price of the drug by then was making American physicians weigh its use, and consider alternative medicines with less proven track records. While the pharmaceutical company CEO subsequently announced the drug price would be lowered, the new price, and its affordability remains a question. In the meantime, the price of cycloserine, a drug used to treat tuberculosis in people whose disease is resistant to other drugs, or who are unable to tolerate other drugs, had risen 2000 percent for U.S. patients, placing the drug out of reach for most of them. That drug price, under protest, also was lowered — to double its previous price. All of this followed the good news/bad news over the last couple years of sofosbuvir, a oral drug that can cure hepatitis C in 12 weeks, an attractive alternative to six to 12 months of weekly injections and side effects from standard treatments, but at an also out-of-reach price in the U.S. of about $84,000.

They are situations reminiscent of the days when prohibitive pricing for antiretroviral drugs put life-saving medicine out of the reach of millions of people who needed them in low income countries, with the result, as a recent report from Médecins Sans Frontières notes, that many died. The report, as well as a release from the global Stop TB Partnership, also note that it doesn’t have to be that way.

Even as the deal was being made that raised the price of cycloserine in the U.S. from $500 for 30 capsules to $10,800, the price of the TB drug was dropping once again, and now averages less than $6 in countries around the world getting the medicine through the Global Drug Facility, a drug procurement system that is part of the Stop TB Partnership. That’s how much of a difference pooling demand across more than 130 countries and negotiating prices can make, the partnership says.

The Médecins Sans Frontières report focuses on sofosbuvir, and points to the monopoly on the drug granted pharmaceutical company Gilead through its patent, even though, as the global health nonprofit Médecins du Monde argued in its opposition to the patent in Europe, “the improvement of quality of life that [Sovaldi] offers is a breakthrough, but the molecule that comprises the drug is not.” Countries that set more rigorous standards for patent protection open the way for generic competition and better public health, the report asserts.

The Médecins Sans Frontières report, in its quarterly newsletter Alert, also looks at issues in pharmaceutical development that hobbled development of Ebola treatment and prevention products until the West Africa outbreak brought the need into focus, and at obstacles to vaccine access.

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