The story of how Remicade became Canada’s most lucrative drug with sales topping $1.1-billion – told masterfully by Globe and Mail health reporter Kelly Grant – has many sick-making elements.
The drug’s maker, Janssen, among other things:
- Set up stand-alone infusion clinics, and sponsored infusion clinics in hospitals
- Mounted a massive PR blitz to undermine a competing drug, Inflectra, a biosimilar that is roughly half the price
- Wooed individual provinces with deep discounts to entice them away from a national alliance seeking to negotiate a lower price
- Offered the first doses of Remicade to hospitals for as little as a penny in a bid to get them to get new patients using it instead of Inflectra
- Created a support program to help patients get insurers, private and public, to pay for the drug
- Funded patient advocacy groups, but cut them off if they supported switching to biosimilars
After perusing that list, hating Big Pharma is easy.
But nothing done to promote Remicade was illegal or unethical. Nor are these practices unique to this company or this drug.
The fact that Remicade has captured more than 95 per cent of the market, despite the availability of a lower-priced alternative, and that Canada pays more for both the brand-name and biosimilar version of the drug than most countries, speaks not so much to the evils of capitalism as it does to the wide-ranging policy-making failure.
When it comes to prescription drugs, we regulate poorly, we negotiate badly, and we provide abysmal access and even worse support to consumers.
None of that is Big Pharma’s fault.
Biologics like Remicade are relatively new. They are expensive and can require infusion rather than taking a pill. Our health delivery and payment systems were not designed for those realities.
We have absurd rules, chief among them is that prescription drugs are covered by medicare when taken in a hospital, but not necessarily when taken outside of a hospital. Only when drug costs become “catastrophic” can patients apply for financial help.
Companies, such as Janssen, set up infusion clinics to satisfy a need that the plodding public-health system failed to meet. They funded clinics inside hospitals as a work-around to ridiculous rules.
It’s all well and good to be outraged that a for-profit pharma company is insinuating itself into our sacred publicly funded system.
But shouldn’t we be equally outraged at the fact that where these clinics don’t exist, patients go to the emergency department to get their infusions? How is that a sensible use of resources?
We can tsk-tsk at how Big Pharma is aggressively promoting its wares by creating patient-support programs but, again, the services provided are desperately needed and unavailable in the public system.
For example, BioAdvance, Janssen’s patient-support initiative, helps new patients fill out the paperwork to get their drugs funded. The alternative is trying to navigate a soul-crushing bureaucracy alone. Sure, the company urges them to seek Remicade instead of Inflectra, but the alternative for many would be extended waits for care, or even no treatment at all.
If we want biosimilars to be prescribed and funded instead of brand-name drugs, then we have to make those rules clear and enforce them, as many countries do. Not place the burden on individual practitioners and patients to decide.
If governments want cheaper prices for drugs, they have to negotiate them. That includes initiatives such as the pan-Canadian Pharmaceutical Alliance to negotiate a single national price.
When provinces abandon the common front at the drop of a hat and are willing to sign contracts where secrecy, not transparency, is the norm, they have no one to blame but themselves for higher prices.
The Patented Medicine Prices Review Board estimated that Canada would save between $91-million and $514-million a year on biologics. Those savings can be achieved by implementing policies similar to other countries, not by whinging about pharma companies’ desire to maximize its sales/profits.
More important than short-term savings is a change of philosophy: Talking about the price of drugs is very 20th century; in the 21st century, and the impending era of personalized medicine, what matters is the value treatments provide.
For drugs such as Remicade, we should be paying, and paying fairly, when the drug works, when it delivers on a specific treatment goal. We should not be concerning ourselves with trivialities such as where it’s administered and by whom, and whether or not a pharma company has hurt our feelings.