November 19, 2018 09:30
Photo : rawpixel
In the United States, the cost of a drug from gene therapy to cure a rare disease, degeneration, inherited retinal, amounted to 425 000 $ per eye, so $ 850,000 for the two eyes. This is not a unique case…
The Glyberma, other medication gene to treat genetic diseases, can cost $ 1 million. The price of two other medicines, to treat muscle atrophy and a rare disease of the kidney is approximately $750,000.
The question arises already in 2018. The private and public plans they are able to bear these costs and what will be the limits that they will be able to pay in the future ?
The situation in Quebec
All the insurers, hospitals, governments and pharmacists are aware that we are heading towards an explosion in the cost of certain classes of innovative drugs, including gene therapies which involve the penetration of genes in cells or tissues of an individual to treat a disease.
How to deal with this catastrophe that could possibly endanger certain plans ? Without having all the answers, solutions, concerns were raised during a conference presented on November 15 in Quebec in the framework of the congress of theAssociation québécoise des pharmaciens propriétaires (AQPP). The Journal of insurance was present.
“The gene therapy, it’s going to cost,” said its president, Jean Thiffault, who moderated the debate and pharmacoeconomics. This type of treatment involves the penetration of genes in cells or tissues of an individual to treat a disease.
The issue is also social and ethical. It was thought of interest to allow a treatment to be very expensive to extend for a few months in the life of an elderly person 83 years old, but can we deny a mother of two young children who was only 35 years old ?
Jean Thiffault | Photo : Denis Méthot
Thousands of molecules in development
The pharmaceutical industry around the world is in turmoil. Not less than 7 000 molecules are currently in development, said Stéphane Lassignardie, general manager ofAbbvie Canada and chairman of the committee, Quebec of innovative Drugs Canada at the conference. All will not succeed on the market in the form of medication. But in his eyes, the promises that suggests the pharmaceutical industry are extraordinary. This figure of 7 000 molecules shows that the prospects are immense.
Mr. Lassignardie however, does not seem too look at the invoice. He deplored the fact that one has an approach too much carrying cost of drugs. His arguments ? Some drugs are going to cost a lot, certainly, but how much will they save by days of hospitalization, new exams, he asks ? How much will they allow to reduce sick leave in the long term, to return early to work, to become again a contributor to society, and reduce the burden of caregivers who are at risk of exhaustion ? “It’s part of the value of the medicine “, he commented.
Stéphane Lassignardie | Photo : Denis Méthot
Generics and biosimilars
Another speaker, Jean-Guy Goulet was on the contrary very interested to talk about figures, because he is the chief operating officer of Pharmascience, a large canadian manufacturer of generic drugs. The quebec ministry of Health has achieved significant savings in the cost of the generic. Despite these declines, Mr. Goulet claims that it still leaves billions of dollars in savings on the table by not using enough to generic drugs, even if the insurers often require the substitution. In his eyes, the generics are part of the way or solutions to reduce the cost of the medication.
Another class of drugs that is not yet exploited to its full capability could reduce the bill, it is the biosimilar products. These are larger molecules and complex that the drugs obtained by chemical synthesis. Biosimilars are entering the market at the expiry of the patent and the protection of the reference biologic drug. They are indicated in the treatment of various chronic conditions, including ankylosing spondylitis, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, diabetes type 1 or type 2, the growth hormone deficiency and cancers of advanced stage.
The biosimilar is seen as a more economic alternative than the reference biologic drug, but their adoption depends on several factors, including the acceptance of patients and health care providers, their cost, coverage, and guidelines for use of payers as well as the policies of substitution of drugs.
Jean-Guy Goulet | Photo : Denis Méthot
Other factors reducing costs
Other reduction factors were discussed by the participants at the conference. First, the responsibility of patients themselves and their treatment adherence. A drug that is not taken according to the dosage, or which is abandoned will not have the desired therapeutic effect, and will represent a waste of resources and money. Pharmacists, doctors and the health system have a role to play to ensure the optimal use of medications.
In another aspect, the freedom of physicians to choose drugs and treatments of their choice, without too much regard for its cost. When they prescribe medicines of exception, they must justify to the RAMQ. Some stakeholders expressed the wish that physicians were more rigorous when they are choosing a medication. They remind on a variety of forums, old drugs are still very effective, and the new molecule newer more expensive does not always a great clinical value added.
Then, should there be more mentoring of the freedom of prescription of physicians ? It is an avenue in which did not want to sink the president of the AQPP…