The scandal of generic drug pricing: drug regulation policies need review
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j947 (Published 23 February 2017) Cite this as: BMJ 2017;356:j947
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The NHS is a big enough purchaser to save moneyon manufacturing many generics in house. If the department of health genuinely wanted to reduce payment to for-profit companies this would have happened years ago. Now ther will be a test of political will!
I hope Professor Meeran and Imperial will use their entrepreneurial skills to do so. It should be able to undercut the prices of for-profit foreign companies.
Competing interests: No competing interests
Despite ongoing recession and implementation of strict austerity measures, prices of generics in Greece are still high, sometimes up to 880% higher than the same generics in Sweden! [1]
Even so, generics in Greece are prescribed only in 20% of patients. [2][3]
References
[1] http://neoskosmos.com/news/en/generic-drug-prices-sky-high
[2] http://gabi-journal.net/news/measures-to-increase-generics-use-in-greece
[3] https://www.ihs.com/country-industry-forecasting.html?ID=10659107152
Competing interests: No competing interests
According to Meeran et al., it is scandalous that the generic drug maker Actavis asks around £100 for a month’s supply of hydrocortisone, by comparing it to the monthly price in Spain (£3.12/month). I question whether the price of highly effective corticosteroid therapy is really that unjustified or immoral.
Evidence is paramount that increased regulations for local pharmacy manufacturing and repeated tendering by healthcare payers to generic drug manufacturers is a morbid cocktail for the availability of essential drugs. In the Netherlands, acute shortages of levothyroxine, dexamphetamine and many others (1) are currently giving policy makers headaches. It is no longer interesting for drug manufacturers to produce these drugs, and local pharmacies have been pushed out of manufacturing as they are not allowed to scale up. I agree that extreme price peaks of some old drug products are clearly undesirable. However, governments and insurance companies should realize that they have created this problem themselves. By pushing the price of generics, many of which very valuable therapies, to the limit, and by short-term contracting of generic manufacturers, generics lost their essential profitability to manufacturers (2).
So, policy makers and healthcare payers should create a system in which production of generic drugs is sufficiently rewarding, and go for sustainable contracts. Furthermore, R&D costs do not factor in to the eventual drug price, regardless . The value of drugs should be determined by the medical need they cover, not by whether the original development costs have been covered.
1. https://farmanco.knmp.nl/tekortgeneesmiddelen Webpage (in Dutch); last visited on 3 March 2017.
2. M.E. Markowski, "Drug Shortages: The Problem of Inadequate Profits" (April 2012).
Competing interests: No competing interests
'Generic' NHS manufactured Blood Glucose Monitoring Strips
I agree with the principle that the NHS should be free to safely manufacture generic drugs where this represents cost saving.
I also wonder whether it would be possible for the NHS to manufacture its own Blood Glucose Monitoring Systems.
There are many different testing kits on the market currently. Meter reading devices are often sold at a discount by pharmacies - a 'loss leader' that will more than recoup its costs through the subsequent NHS prescriptions of testing strips.
Primary care organisations are frequently tasked with the role of sticking to whichever testing system is currently deemed cost effective. These can then rapidly become no longer the most cost effective.
I do not know the true cost of manufacturing testing strips, but my suspicion is that they are likely to be very cheap once a suitable economy of scale has been achieved.
If the NHS had its own prescribable/issuable systems they could then become the only ones that are prescribed throughout primary and secondary care. The potential cost savings could be massive.
Competing interests: No competing interests