Pill Prices Are Hiked Up All The Time In The Low-Income World

The price of drugs is making headlines this year. Turing Pharmaceuticals, the company founded by the now infamous Martin Shkreli, upped the price of Daraprim from $13 a pill to $750 — a 5,000 percent increase. The drug has been used for decades to treat malaria and toxoplasmosis, a parasitic infection that can affect HIV patients.

Aggressive pricing tactics are not new — and those affected most are the poorest in developing countries, says Judit Rius Sanjuan, an international law specialist and U.S. manager and legal policy adviser for Doctors Without Borders' Access Campaign. (The group is known by its French initials MSF, for Medecins Sans Frontiers.)

We asked Sanjuan how drug pricing affects the patients seen by MSF across the globe and what can be done about it.

How can a drug price for malaria/HIV infections go from $13.50 to $750 per tablet?

When [pharmaceutical companies] don't face competition, they price the drugs as they wish. Normally what they do is they raise the prices as high as they think the market can bear. It doesn't really matter to them if the product isn't going to be affordable and if only a small number of patients will have access. What they try to do is maximize profits. That is hugely problematic from a public health perspective, but it's not at all an exception.

It's an example of a ... failure in the current system where governments are not regulating or intervening to promote competition and set up limits on how high prices are being basically raised.

What impact does that have on the fight against diseases?

It means there is a huge negative impact on the lives of millions of people. If you raise the prices so high, you get substandard medical care. Patients are not really treated with the best medical tools that exist out there; they are treated with medical tools that are affordable. Or [there is] rationing of care. Sometimes it means that not all the patients that require treatment get treatment. Sometimes [only] the richest or the sickest receive access to medical treatments.

How is it possible to set prices that high?

If the supplier of the medicine or vaccine has a monopoly — either because of a patent or [another reason], they have the freedom to set prices as high as they want.

That must change if other companies are making the same medicine.

When competition reaches the market, then usually it has an impact on prices being lower and sometimes very significantly lower. That really is many times a game changer.

Do countries ever intervene?

Some countries have the capacity to regulate prices by setting up price controls. When the governments in developing countries use these tools, that usually has a positive impact and prices are lower.

Do outrageous jumps in drug prices go on all the time and we just don't hear about it?

Turing Pharmaceuticals is not an exception. It's a systematic problem we're facing in many countries that we work in. And the situation is getting worse as more monopolies are being created. We've seen prices rise across the board for TB drugs, for HIV drugs, for vaccines, for hepatitis C drugs.

What will the impact of the revelations about Martin Shkreli and his companies' practices be on global drug prices?

I [hope] it helps raise the issue that high prices are a problem. This is happening not just in the United States but all around the world. This is affecting the lives of millions of people in a very negative way and there are specific concrete actions that governments can take. I think it's an opportunity that should be seized to fix the current research development system for medicines and vaccines.

There are also reports that when a country moves from lower to middle income, prices for the drugs it needs go up. Is this problematic in fighting diseases?

When a country moves from low income to middle income, public health needs don't change. There is a huge amount of inequality in these countries. In fact, there are official estimates that more than 70 percent of the poorest people around the world no longer live in low-income economies but in fact live in middle-income economies. Companies are raising prices in countries considered middle income. They are charging higher prices than the prices they charge in low-income economies. That has a huge negative consequence for patients who are poor.

What changes does MSF think should be made, if any, to the pricing system?

[For] medical products that are used for neglected patients and neglected diseases that mostly affect poor patients, we don't think research and development costs should be recovered with high prices. We think there should be a different way for paying for innovation. We are co-funders of an initiative called Drugs for Neglected Diseases. DNDI is a public-private partnership that does research and development for neglected diseases. The products that come out of these efforts are patent-free. And we would like more of that kind of effort.

Innovation that's not affordable is meaningless to us because it means MSF cannot treat patients. What good does it do to have innovation if patients do not have access to it?