[Ip-health] Health Policy Watch: WHO-led Fair Pricing Forum Gathers Diverse Groups To Improve Drug Access

Thiru Balasubramaniam thiru at keionline.org
Thu Apr 11 19:42:07 PDT 2019


WHO-led Fair Pricing Forum Gathers Diverse Groups To Improve Drug Access
by Elaine Ruth Fletcher

A diverse group of civil society, industry and government representatives
convened today at the WHO-led 2nd Fair Pricing Forum in Johannesburg, South
Africa, in the quest for new solutions that can unlock people’s access to
desperately needed drugs at more affordable prices.

The two-day meeting, co-sponsored with South Africa and involving some 30
countries and 40 industry and nonprofit groups, comes at a time when the
debate over drug access has become increasingly polarised.

Civil society organizations have become increasingly strident about the
need for a major overhaul in the system. They say that the old formulas of
voluntary industry concessions coupled with large-scale public- and
donor-funded procurement, which helped get billions of people access to
vital drugs for HIV/AIDS, TB and malaria a generation ago, is cracking.

Demand for treatments for cancers, cardiovascular disease, diabetes,
asthma, and other non-communicable diseases is soaring in rich and poor
countries alike. There is also an unmet need in low- and middle-income
countries for new, life-saving treatments or vaccines for infectious
diseases such as pneumonia and Hepatitis C.

In his opening address at the Forum, South Africa’s Minister of Health
Aaron Motsoaledi said that the first steps towards fixing the system should
include broader uptake of a series of recommendations from a UN High Level
Panel that “place the right of people to access medicines ahead of the
private interests of pharmaceutical companies.”

These should include “transparency on a global level on the pricing of
medicines” he added, as well as a WHO-maintained international database of
prices of patented and generic medicines and biosimilars in the private and
public sectors of all countries where they are registered.

Transparency has also become the clarion call of leading civil society
groups such as Oxfam, Médicins Sans Frontières (Doctors Without
Borders/MSF) and others for full public disclosure, globally and
nationally, of the costs of new drug development and prices of bulk drug
sales to national health systems. They were among the organisers of a side
event on the Forum’s opening day under the theme “No Fair Price without

The NGOs said that they would urge countries to line up behind the new
Italian government resolution to establish a WHO price database, which is
to be tabled at the upcoming World Health Assembly in May.

“Transparency is not only a matter of fairness, but also a factor for
better governance of pharmaceutical markets. It is also at the core of the
resolution proposed by Italy and seconded by a number of countries in the
run up to the WHA. Member States have a chance to make a difference by
showing support for the resolution, and must not waste it,” said Jaume
Vidal of Health Action International (HAI) in a press release.

“For every significant reform of incentives, pricing or access,
transparency and reliable data is important. The current asymmetry in
knowledge of R&D costs, sales, pricing, know-how and access does not serve
patients, taxpayers or employers. Transparency is a public good and a
challenge that benefits from collective action,” added James Love of
Knowledge Ecology International (KEI), another one of the event organisers,
in the HAI press release.

“The issue of transparency is really key – the fact that prices are
negotiated in secrecy is not acceptable,” Gaelle Krikorian, Head of Policy
at MSF’s Access Campaign, told Health Policy Watch in an interview. “The
way it works now is that no one can share information about the real price.
Listed prices are usually over the roof, and then there are agreements on a
‘rebate’ that looks better, but still is excessive and unjustified;
countries agree to this price which was not published.”

Advancing the transparency agenda with governments attending at the Pricing
Forum will thus be a key objective for MSF, Krikorian added. She said that
the time is ripe for change, because rich countries are now grappling with
higher drug prices – underlining fundamental flaws in the current system
that have beset low- and middle-income countries for many years.

“Over the past few years, access to medicine and excessive pricing also
became a problem in western countries. In France, for instance, the Social
Security system raised the alarm in 2015, noting concerns that the national
budget would not be able to accommodate the extreme prices of some of the
new life-saving medicines, and ensure access to all,” Krikorian observed.

However, industry representatives present at the meeting argue that
transparency could boomerang, undermining access to medicines in poorer

“For on-patent medicines, increasing transparency of net prices would lead
to price convergence, undermining access to medicines in poorer countries
by preventing differential pricing,” said a spokesperson for the
International Federation of Pharmaceutical Manufacturers and Associations
(IFPMA). She referred to a new report by a London-based think tank, Office
of Health Economics, that concluded: “The biggest single problem is the
possibility that some HICs [high-income countries] and higher income MICs
[middle-income countries] will seek to exploit price transparency by
insisting on paying the prices offered to poorer population groups”
(M.Berdud et al 2019).

Calls for transparency around the R&D costs of new drugs going on the
market could also create “perverse incentives” – rewarding more inefficient
and therefore costly R&D processes, IFPMA contends. Finally, in practical
terms, the IFPMA says that it is virtually “impossible to identify specific
R&D costs per product, and certainly not per country.”

In terms of proactive solutions to access barriers, voluntary pricing
agreements with industry that are mediated by WHO, product development
partnerships or civil society, are better options, the spokesperson said.

“Medicines Patent Pool is a great example of constructive collaboration
when civil society and industry come together to work toward a common
goal,” she said, referring to the Geneva-based nonprofit that forged
historic agreements with industry on new Hepatitis C drugs while they were
still under patent, and is now expanding its approach to other drugs on
WHO’s Essential Medicines list.

WHO is generally supportive of the principle of price transparency, said
Andrew Rintoul, who is the Organization’s lead organizer of the
Johannesburg Forum.

“Transparency has a lot of benefits,” Rintoul said, “not only in reducing
the high cost of “innovative” drugs, but so you can look at what people are
paying for generics. Transparency supports good governance in your
procurement processes, and it informs consumers of what they should be
paying when they purchase drugs on the private market as well.”

At the same time, he dismissed the notion that the system as a whole is
broken. “Industry is playing an important role. They are the ones doing the
innovation and taking the risks.”

Ultimately, he added, the common goal of everyone should be to get the
“right medicine to the right person at the right price.”

The Johannesburg Forum, which follows the first Fair Pricing Forum in
Amsterdam in 2017, is an example of WHO wielding its convening power to get
everyone in the room together to talk about diverse approaches to advance
this goal, he noted.

He said that the Forum would consider lessons gleaned from the early days
of the HIV/AIDS epidemic in the 1990s, when new anti-retroviral drugs were
initially unaffordable to millions of people in Africa, Latin America and
Asia, but later became widely accessible. Among the Forum speakers, South
Africa’s long-time Director General of Health Malebona Precious Matsoso and
WHO Assistant Director Mariangela Simao will describe how countries like
Brazil and South Africa broke through the access barriers in that period,
helping to lead transformational change.

“Today, non-communicable diseases are a current big challenge,” Rintoul
observed, referring to the drugs for cancer treatment, cardiovascular
diseases, diabetes and asthma, which are often unavailable or unaffordable
in low- and middle-income countries.

“I don’t think we will end up with the big funding mechanisms that we
created for HIV, TB and malaria.  But in fact, most of the NCD medicines on
the WHO Essential Medicines List are now generic. “As for some of the newer
cancer medicines, which are biological products, like trastuzumab
(Herceptin®), we still don’t have sufficient production of biosimilar
medicines on the market. We believe that more production of such biosimilar
products will be important in reducing prices,” he said. Biosimilar
products are compounds that have a similar health effect, even if they are
not biologically identical, and thus function in the marketplace like
“generic” brands of chemical drug formulations.

One very fundamental issue the Forum also will consider is how “Fair
Pricing” may best be defined.

“In Friday’s plenary session we will discuss what this really means,”
Rintoul said. “What is fair pricing versus affordable prices? Can we come
up with a definition of fair pricing? This is difficult to do, and we may
not come to a final conclusion on this in South Africa, but discussing it
would be a step forward.”

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

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