The need to make cancer drugs affordable Premium

With the Rajya Sabha Standing Committee on Health expressing concern over the high cost of cancer treatment, the Government invoking Section 100 of the Patents Act is a way forward

The subject of the spiralling costs of cancer medicines and their implications that have frequently been highlighted the world over were dwelled on in a recent report (“Cancer Care Plan and Management”) by the Rajya Sabha’s Standing Committee on Health. Alluding to the implications of the high cost of cancer care, the Committee noted that “about 40% of cancer hospitalization cases are financed mainly through borrowings, sale of assets and contributions from friends and relatives”. This situation has arisen, according to the Committee, because “even average out of pocket spending on cancer care is too high” and that “spending for cancer care in private facilities is about three times that of public facilities”. The Committee has, thus, highlighted the seriousness of problems concerning the treatment of cancer, the estimated incidence of which in India was nearly 1.4 million in 2020.

The catastrophic treatment cost has seriously impacted survival rates in developing countries. In breast cancer, while the five-year survival rates in India and South Africa are estimated to be 65% and 45%, respectively, in contrast, in high-income countries, it is nearly 90%. In its explanation of this dismal situation, a World Health Organization (WHO) report on pricing of cancer medicines and its impacts had stated that the cost of a course of standard treatment for early stage HER2 (human epidermal growth factor receptor) positive breast cancer would be equivalent to about 10 years of average annual wages in India and South Africa and 1.7 years in the United States.

According to WHO, the costs associated with other medical care and interventions (such as surgical interventions and radiotherapy) and supportive care would make overall care even more unaffordable.

In the treatment protocol for breast cancer, CDK (cyclin-dependent kinase) inhibitors constitute a major therapeutic tool, especially for metastatic breast cancer. Three drugs, Ribociclib, Palbociclib and Abemaciclib, belong to this therapeutic class, which help in slowing the spread of cancer cells in the body. A month’s treatment using these drugs could range between ₹48,000 and ₹95,000 and the patient is expected to take one of these medicines for the rest of her life.

If one can tabulate the use of cancer drugs and the approximate price for a month’s treatment one has: Ribociclib (Novartis) ₹64,455; Palbociclib (Pfizer) ₹87,000; Abemaciclib (Elli Lilly) between ₹47,752 and ₹95,000 (Sources: www.1mg.com; pharmeasy.in/).

Excessive costs of breast cancer medicines can be explained by the interplay of two related factors. The first is the argument advanced by the large pharmaceutical companies — that they spend over $3 billion in bringing a new molecule to the market, which they must recoup in order to remain in the market for innovation. However, the WHO report mentioned above observed that spending on research and development may bear little or no relationship to how pharmaceutical companies set cancer medicine prices. Companies set prices with an eye to maximise profits, thus denying patients from taking advantage of medical breakthroughs.

A second factor that allows the companies to sustain their high profit margins is intellectual property protection. Over the past three decades, pharma companies in the developed world have successfully persuaded their governments to strengthen the rights that they derive from patents and other forms of intellectual property rights by which they can exercise monopoly control over their products. Moreover, the scope and the power of these monopolies can become nearly absolute due to several factors, of which two are as follows.