A new study on the pricing of multiple sclerosis drugs--which found, essentially, that they're too expensive, at least in the U.S.--tags a few issues that people like to chat about casually. But what if they were seriously addressed? That would only raise all sorts of political, ethical and philosophical questions.
The Neurology study analyzed the cost-benefit data of four drugs using U.S. prices: Biogen Idec's Avonex, Teva Pharmaceutical's Copaxone, Bayer's Betaseron and Merck KGaA's Rebif. Although the numbers on each drug varied, the general conclusion was that it costs more than $800,000 for each patient to gain a year's worth of quality of life. That's way off the charts in the realm of cost-benefit analyses; a good value amounts to $100,000 to $150,000 per QALY.
Looking at the dry numbers, it's easy to simply conclude that the drugs are too expensive. And in the U.S., they might be. As Bloomberg points out, these MS meds cost some $34,000 per year, compared with about $13,000 per year in the U.K. "Simply reducing the price of these drugs to a level for what they're sold in the U.K. and Europe will bring the number to a much more acceptable level," Katia Noyes, lead author of the study, told the news service.
But the prices are going up, not down. Now that Novartis has introduced its MS pill Gilenya, makers of injected meds are expecting to lose prescriptions to the new, easier-to-administer drug. So, they've raised prices to help make up the difference. The price tag on Gilenya in the U.S. is about $48,000.
Why such a big discrepancy in price between the U.S. and elsewhere? That's a good question, often asked but never answered satisfactorily. True, the sticker price doesn't account for rebates and such, but those behind-the-scenes cuts still don't amount to the discounts given to governments that actually negotiate prices. And drugmakers can raise prices in the U.S. at will, but lack such pricing power in other places.
The companies that make these MS drugs defended their cost and utility, pointing to their assistance programs to show they're sensitive to patients' ability to afford the meds. Payers? That's a more private conversation. Complicating the discussion is that starting treatment with these MS drugs earlier--at the very beginning--makes them more cost-effective. First-line treatment could delay a patient's disability, presumably reducing other treatment costs. Comparing those two approaches, cost-wise, is another study entirely.
But will American society be able to look dispassionately at the cost-effectiveness of medical treatments, drug or otherwise? At what point do payers begin to say no in the U.S., if ever? If they did, would drugmakers cut prices to bring them back? And would innovation suffer then, as pharma is always promising? Not easy questions to answer, especially if most people prefer to ignore them.