[Ip-health] Health Policy Watch: Several Ministers Of Health Speak Up For Drug Market Transparency, Lower Prices At WHA Side Event

Thiru Balasubramaniam thiru at keionline.org
Mon May 20 11:06:01 PDT 2019


Several Ministers Of Health Speak Up For Drug Market Transparency, Lower
Prices At WHA Side Event
20/05/2019 by Catherine Saez

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The room holding the high-level side event on transparency of
pharmaceutical product markets was overflowing today – with dozens of
people standing to hear the speakers – many of them ministers of health,
reflecting the importance of the topic at the 72nd World Health Assembly.

Member state organisers and co-sponsors of the event, representing diverse
levels of economic development, all made a call for a change of game, more
transparency in the pharmaceutical market, and the end of forced
confidentiality of price negotiations between countries and drug companies.

The side event, “Access to medicines, vaccines and health products: A
multi-dimensional approach for ensuring transparency of markets, affordable
and quality products to achieve Universal Health Coverage,” was organised
by Italy and South Korea, and co-sponsored by Costa-Rica, Greece,
Indonesia, Italy, Mexico, Mongolia, Netherlands, Portugal, Republic of
Korea, Saudi Arabia, Spain, and Vietnam. It was held on the first day of
the 72nd World Health Assembly (WHA), taking place from 20-28 May.

The topic is controversial and is the subject of a draft resolution
proposed by Italy, Greece, Malaysia, Portugal, Serbia, Slovenia, South
Africa, Spain, Turkey, and Uganda. The draft resolution has not yet been
tabled. Civil society groups drew attention to alleged efforts by some
developed countries to bar the resolution.

Intense discussions between WHO member states have been ongoing prior to
the WHA. Knowledge Ecology International provided a comparison between the
original proposal from 29 April, and the ones from 7 and 10 May.

Speakers at the side event underlined high prices, the secrecy around
research and development costs, and the negotiated prices obtained by
countries. They all called for a collaborative efforts to tackle those

Differential Pricing: Cyprus Denounces “Unethical Practices”

A representative of the Cyprus Ministry of Health in the audience gave a
vibrant account of what he described as “unethical practices” by the
pharmaceutical industry. He gave two examples where he said Cyprus, with no
negotiating power, and a small population of 800,000, was being asked to
pay prices vastly superior to those awarded to other countries. He gave the
example of a medicine to treat an orphan neurological condition, for which
800,000 euros per patient was the price set by the manufacturer of the

According to him, a study conducted in Cyprus examined all products
approved by the European Medical Agency (EMA) since 2011, and showed that
industry mostly waits about four years before releasing newly EMA-approved
products in Cyprus, reserving those products to richer northern European
countries first.

Lucas Li Bassi, director of the Italian Medicines Agency, said it would be
interesting to see whether differential pricing is actually occurring
according to countries’ gross domestic product (GDP), giving the example of
a pneumococcal vaccine which was charged twice as much in Lebanon as in
Greece. He called for better information leading to better policy
decisions. Countries are the biggest investors of the pharmaceutical
industry, he said and “should be able to shape the market.”

Valuable New Treatments Unaffordable, Older Ones Unavailable

Treatments for previously untreatable or fatal conditions have become
available, however due to some pharmaceutical monopolies driving high
prices, people are prevented from accessing those medicines, said Neunghoo
Park, Minister of Health and Welfare of South Korea. He called for
collaboration among countries and noted that the promotion of better health
should be central, and the ultimate goal of pursuing innovation in drugs.

Armando Bartolazzi, Italy’s Undersecretary for Health also remarked on the
increasing number of valuable, but unaffordable, medicines. Transparency,
he said, is recognised as a solution to address this challenge. The lack of
information does not allow public actors to know if resources are allocated
in the best way, he said, adding that tax payers currently pay multiple
times for products when research has been conducted with public funds. He
explained that “few clinical trials are in line with European Union law,”
which requests that clinical trials be registered before they start and
that summary results be reported within specific timelines. It also
requires that results should be disclosed regardless of the fact that they
might be negative, neutral or inconclusive. This disclosure would help
further research and avoid the duplication of trials, he said.

Bartolazzi also commented on new products and said that not all products
“are truly innovative,” but simply serve to preserve market exclusivity.

Bruno Bruins, Minister of Health, Welfare and Sport of the Netherlands
talked about shortages of previously accessible medicines. Some
antibiotics, he said, are manufactured in a single manufacturing site,
calling the situation “worrying.” He, too, reflected on the expensive
prices of new medicines, and called for increased collaboration between
countries. A joint approach would improve health technology assessment,
prices, and negotiating power, he said. Countries should be more
transparent on the price they are willing to pay, he added, and innovation
should be encouraged and rewarded, “but not at any cost,” he said.

Marta Temido, Minister of Health of Portugal, argued that the spread of
chronic diseases and an aging population will drive up healthcare
expenditure in the years to come. As health systems are “pressured to adopt
new drugs,” she said, the need for evidence-based decisions and
transparency are key.

For Sarangeral Davaajantsan, Mongolian Minister of Health, the price of
medicines would decrease if transparency was legalised, as it might create
competition between suppliers.

“We cannot continue business as usual,” said Faustino Blanco, Secretary
General for Health and Consumer Affairs at the Ministry of Health of Spain.
Countries have a justified concern about the inequality of the price of
medicines and the true value added of new products, he said, underlining
the essential role of a dynamic competition.

Strategies to Tackle High Prices Fall Short, Non-Disclosure Clauses Harmful

Soonman Kwon Seoul of the National University of Public Health of Korea
also underlined the lack of bargaining power of many countries and the lack
of information on R&D costs. High prices, he said, represent a “huge
impediment” for universal coverage, even in high income country settings,
threatening the sustainability of many health systems.

Multinational pharmaceutical companies, he said, threaten to withdraw some
products from the market as a strategy to increase prices. He listed
different ways governments tried to address the issue of high prices,
including managed entry agreements, health technology assessments, external
reference pricing, pooled procurement, and compulsory licensing.

Confidential rebates and discounts keep the list prices high, he said,
impairing the effectiveness of external reference pricing.

Giannis Baskozos, secretary general of Public Health at the Ministry of
Health of Greece said the issue of affordability and transparency should
remain high on the political agenda.

For Nikolaos Raptis, advisor to the Minister of Health of Greece, the
non-disclosure clauses that countries have to sign is a way for the
pharmaceutical industry to “divide and conquer.”

In the audience, a speaker from South Africa called countries to follow the
South African example. The country enforced a law preventing those
non-disclosure contracts, and requiring some compulsory information from
pharmaceutical companies, such as the price of the active ingredients in
their formulation. Transparency does not mean the information has to be
disclosed to the public, he added.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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