Race to the bottom

Pricing policies threaten pharmaceutical makers.

One of the biggest threats to the pharmaceutical industry in the years ahead will be pricing pressure, which is coming from all directions. In the United States, big pharmaceutical companies have already agreed to certain cost control measures as part of the healthcare reform legislation known as Obamacare.. The companies apparently agreed to these measures in return for the promise of new patients, but a few short years after the law’s passage and before all of the provisions have even taken effect, politicians in Washington have already begun discussing further price control measures. Meanwhile, Indian regulators have caused a fuss by granting a compulsory license to generics maker Natco Pharmaceuticals for permission to manufacture a generic version of Bayer’s lucrative cancer drug Nexavar. Indian authorities argued that the license was necessitated by the high cost of branded Nexavar, which keeps Indian patients from accessing this life saving treatment. Bayer, meanwhile, made the well-worn but true contention that pharmaceutical advancement depends on companies’ ability to charge premium prices for innovative treatments.

Lately the debate about proper pricing for pharmaceuticals has shifted to Europe, where drug makers’ profits are under attack from multiple angles. As part of the ongoing debate concerning the best way to rein in spending, many countries are looking at cutting drug prices as a source of savings in government budgets. In no country will these new price controls have more effect than in Germany; as much for the country’s leading role in the European economy as for the lost revenue. Due mostly to its economic strength, Germany has maintained pharmaceutical prices that were relatively robust when compared with its European neighbors. After years of debate, though, Germany has begun switching from a policy that mostly allowed free pricing towards implementation of a new regime that weighs the costs and benefits of each drug, similar to that of the UK’s National Institute for Health and Clinical Excellence (NICE).

In addition to looking at the potential clinical benefit of any new medicine, German regulators will also consider the price for each drug in neighboring countries. Germany’s great wealth means that most of its neighbors have weaker economies, making them a poor benchmark for prices. Indeed, many of these countries look to their larger neighbor to take the lead on pharmaceutical pricing. These ingredients could quickly lead to a race-to-the-bottom for drug prices as countries push each other lower and lower. Germany’s new pricing policies have already claimed at least one victim – diabetes patients in Germany will not have access to a promising diabetes treatment. Wary of the threat of price controls, and deterred by rules for defining the proper comparator, Eli Lilly and its German partner Boehringer Ingelheim decided not to launch their new drug Tradjenta (linagliptin) in the German market. While regulators are working out bugs that may lead to more straightforward pricing in Germany, the overall effect will be the same – consistent lowering of prices.

The race to the bottom in pharmaceutical prices has already caused unintended consequences, spawning an army of carry-trade speculators trying to buy drugs cheaply in one country for sale in another.In the UK, for example, regulators have a reputation for insisting on drug prices that are lower than in neighboring countries. This has led to export of drugs from the UK into neighboring countries where they are sold at premium prices. This practice has already led to shortages of some important drugs in the country, prompting the All-Party Pharmacy Group (APPG), a trade organization, to urge the government to take action. Although the dire drug shortages cited by the APPG are disputed, the potential clearly exists for patients to be denied life-saving medicines. The same problem is manifesting for different reasons in Greece. Due to the slow-motion collapse of the Greek economy, pharmaceutical prices have been slashed dramatically. This has been done to allow people to keep access to their medicines without further bankrupting the government. The unfortunate and unintended consequence of the price cuts is a very lucrative carry trade for pharmaceutical wholesalers.

Amid the clear need for national governments to control healthcare spending, it is unfortunate that wholesalers and distributors are siphoning off pharmaceutical profits. While pharmaceutical companies can justify their high prices with the need to conduct expensive research, the carry trade directly detracts from this goal. Society tends to hold healthcare providers to a higher standard than most capitalists, making the bald taking of profits from unhealthy people somewhat unpalatable. As a result, the European Commission has announced the beginning of an investigation into pharmaceutical parallel trade. Considering these factors, it appears that international pricing pressure and its consequences will be a major area of concern for pharmaceutical companies into the foreseeable future.

Dr. Jerry Isaacson is head of GlobalData healthcare industry dynamics.

Photograph: Getty Images

Dr. Jerry Isaacson is head of GlobalData healthcare industry dynamics.

Show Hide image

Work with us: Wellcome Scholarship at the New Statesman

Be one of our 2016 science interns.

Britain needs more great science writers – particularly from backgrounds which have been traditionally under-represented in the media.

To address this, the New Statesman and Wellcome Trust, in partnership with Creative Access, have come together to offer annual placements to student or graduates from an ethnic minority background*.

The final 2016 placement will take place this Autumn/Winter (the exact date is flexible) and will last for four weeks.

Over the course of the placement, the successful applicants will:

  • Work alongside the New Statesman web and magazine team, learning about the editorial and production process, and how articles are conceived, written, edited and laid out;
  • Undertake a data-driven journalism research project on a scientific topic, which will be published on the New Statesman website
  • Visit Parliament and learn about how science-based legislation is developed and debated in the select committee system
  • Have an opportunity to interview a leading scientist or policy-maker
  • Write a regular bylined science blog on the New Statesman website
  • Receive regular feedback and editing from the editorial team
  • Meet journalists at other titles in the sector (previous Wellcome Scholars have met writers for the Atlantic, and presenters for the BBC)

Over the course of the placement, you will be paid London living wage.

To apply for the placement, follow the steps below and apply direct to the New Statesman. 

Please write an 800-word blogpost on a recent or upcoming scientific development which you feel has the potential to change lives significantly, explaining clearly and concisely what stage the research is at, and how it is likely to proceed. It should be written as if for the NS audience - interested, intelligent laypeople.

Please also write up to 200 words on why you are right for this placement and what you would hope to get out of it. You don't need to send a CV.

Please only use Word files, or paste your text into the body of an email. 

Send your application by email to Helen Lewis (Helen @ newstatesman co uk) with the subject line “Wellcome Scholarship 2016”. 

Applications close on 30 September 2016. Interviews will take place soon after.

This is a positive action scheme under the Race Relations Act.