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.

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Taking back control... in the workplace

It’s time to reboot dignity and respect at work, says Frances O’Grady, general secretary of the TUC

Jess* lives in a small town in the north-west and is on a zero-hours contract. Some weeks she could work up to 50 hours, but others she works as few as 30. And when she got ill, her company refused to pay her sick pay. Sarah* is 38 and lives in a big city. She is employed through an agency and although she has worked more than 12 weeks for the same employer, she feels like she’ll never get the same status as permanent staff. She told the TUC: “I feel frustrated at the lack of permanent jobs in the market and how little control you have as an agency worker. Everything in my life feels temporary at the moment. My experience of agency working is that you are on the bottom rung. You can’t speak out or you won’t get work.”

Wherever you go in the UK, the story is the same. Too many working people are stuck in jobs that don’t offer enough pay or enough security to build a life on – in short, there’s not enough control. Working for the TUC, I hear these stories every week. Stories of workers who don’t know from one day to the next whether they’ll work that day. Working people in all sorts of jobs who can’t raise problems at work, because on today’s “flexible” contracts: the boss doesn’t need to sack you, he can just take away next week’s hours. Delivery drivers who have found themselves deactivated without warning. Warehouse pickers red-flagged by a gadget that decides they are too slow. And stories from careworkers whose work lives are governed by the ping of an app – but who never get enough time to meet their elderly clients’ needs.

This is the reality of work for too many people now. Isolated from colleagues and at the beck and call of their boss. Without the small measure of security granted by a permanent contract and some basic employment rights. It all leaves hard-working people with precious little dignity or control. The time is ripe for a new deal for working people – and that’s what must be on offer at this election. For a start, as we leave the European Union, every party must guarantee that our rights at work don’t go backwards. Hard-won rights such as holiday pay and protection from pregnancy discrimination came from the EU. We can’t afford to lose these rights after we leave – and we need to know that they can’t be watered down on the quiet by judges or by parliament.

And in the years to come we have to make sure that hard-working Brits won’t miss out on new protections that Dutch, Spanish and German workers get. That’s why the final Brexit deal has to include a level playing field on workers’ rights – making sure they will always be as good as or better than what’s on offer to the rest of the EU. Second, the rules to protect working people haven’t kept up with how working lives have changed. One in ten workers is already in insecure work – and if nothing changes, 290,000 more people will join them by the next general election in 2022. That’s the equivalent of 13 extra Sports Directs, or the entire working population of Sheffield.

These jobs don’t pay enough and they push all the risks on to the workers. Paying rent and bills can be a nightmare when you don’t know how much you’ve got coming in each month. Britain’s 900,000 zero-hours contract workers earn a third less per hour than the average worker. And every worker pushed into false self-employment loses their rights to sick pay and paid holiday. If Britain aspires to become a high-skill, high-productivity economy, the next government must drag the rules about work into the 21st century. Promising a review isn’t enough; every party must make real commitments to crack down on zero-hours contracts and bogus self-employment, and make sure agency workers always get the going rate for the job.

And Britain still needs a pay rise. Rising inflation and slow wage growth means a new living standards crisis is coming. And we’re still in the longest pay squeeze since Victorian times: workers are on average over £1,000 worse off each year in real terms than they were in 2008. Over the coming parliament, the minimum wage needs a serious boost, so that it reaches £10 per hour as soon  as possible. We need to get more people covered by collective bargaining agreements that raise wages and skill levels. And it’s time for the government to stop artificially holding down public servants’ pay. By 2020, midwives and nurses will have seen their real pay fall by over £3,000 – scarcely the right reward for years of dedicated public service.

Of course, the best way to raise wages is to bring great jobs to every corner of the country. In both 2014 and 2015, London’s growth was double that of the average across the rest of the UK. We still lag behind our competitors on the infrastructure we need to help the whole country – such as modern transport links and fast broadband. And our investment in infrastructure is the lowest in the OECD. More than ever we need an industrial strategy that delivers good jobs to the parts of the UK where they’re needed most. Improving the lives of ordinary working people and giving them back control of their rights – that’s what all of the major parties should be prioritising this election.

** Names have been altered to protect people’s anonymity.

Frances O'Grady is the General Secretary of the TUC. 

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