Can A Surge In Activism Defeat American Big Pharma?

By Vinayak Bhardwaj

Not a day passes in America without news of a drug company raising prices on prescription drugs. Americans pay two to six times more for prescription drugs than those living in other developed countries, who earn the same income.

People with chronic or life-threatening diseases, for whom drug costs are unaffordable, often skip treatment altogether. One quarter of all cancer patients chose not to fill a prescription due to cost, according to a 2013 study in the journal Oncologist. This is as drug prices for these conditions have skyrocketed. Humira for example, a widely used best-selling drug for rheumatoid arthritis, is now $2,700 per course of treatment, nearly three times what it costs in Switzerland.

The vast majority of Americans support a wide range of measures to make drugs more affordable: 92% of Americans support laws allowing the federal government to negotiate lower prices for people on Medicare, the public welfare benefit scheme targeted at senior citizens. However, with two lobbyists per member of Congress and a lobbying services’ bill that oustrips every other industry, including defence, the odds are stacked against citizens in their fight against ‘big pharma’ over drug prices.

Dana Gill of I-MAK addresses the Affordable Meds Now conference in Washington DC.

Citizen Testimonies Shaping a Movement

Yet just over a month ago, at a meeting held at Georgetown University’s O’Neill Institute for Global Health Policy in Washington DC, citizens opened a new front in their efforts to lower drug prices. The gathering, convened by non-profit advocacy group Public Citizen, was held under the conference title “Affordable Meds Now”, brought together civil society activists, physicians, lawyers, patient groups and key senators and congressmen, to activate a new campaign for reforms in drug pricing.

Conference attendees shared testimonies of loved ones lost due to families being unable to afford treatment, in some cases even when the drug in question (such as insulin) had never been placed under patent in the first place. Other experiences shared by veterans of the fight for affordable HIV treatments, who brought the price of drugs from $10,000 per patient per year to $72 per patient per year, sought inspiration from international campaigns, that might inform the domestic fight to lower drug prices.

President Trump’s Blueprint to Lower Drug Prices: Politicians Respond

An animating theme throughout the conference, was the presidency of Donald Trump. His actions on immigrants, women, the judiciary, and on the rights of workers to organise were themselves rallying cries for the activists. But so too were his efforts to lower drug prices. During Donald Trump’s 2016 campaign for the presidency, he told Time Magazine in his Person of the Year interview in December 2016: “I’m going to bring down drug prices. I don’t like what has happened with drug prices.” Elsewhere during the campaign, he said, “They’re getting away with murder…. Pharma has a lot of lobbies and a lot of lobbyists and a lot of power.”

Yet his blueprint to lower drug prices, released a few weeks before the conference, was criticized for doing nothing to address the crisis he had spoken against during his campaign. Conference attendees pointed to the sharp rise in drug companies’ stock prices shortly after Trump announced his blueprint, as evidence that his efforts had failed even before they’d begun.

Rep. Lloyd Doggett (D-TX)

Lloyd Doggett (Democrat, Texas), a ranking member of the congressional Subcommittee on Human Resources and the Subcommittee on Trade, railed against the cabinet members Trump had appointed, who were hiking up the very drug prices Trump was supposedly against. He wanted ‘action not tweets’ from Trump and his administration. Doggett further decried the lack of evidence-based discussion among Republicans who, he said, had recently blocked presentation of proposals for Medicare to negotiate lower prices for drugs at the Ways and Means Committee of which Doggett is also a member.

Getting the government-funded Medicare, which is the largest buyer of health services, to negotiate lower prices for drugs has become a key advocacy goal among health care activists.

Speaking specifically of Trump’s blueprint to lower drug prices, like other Democratic Party politicians who spoke at the conference, Doggett identified the proposal to increase drug prices in other countries as a way to lower the price of drugs in the US as laughable. “Anyone who thinks this bizarre trickle down will help US citizens get lower drug prices … well, they need a prescription.”

Other policymakers who attended the conference, Senator Cory Booker (D-New Jersey) and Tina Smith (D-Minnesota), spoke in more broad terms about the challenges ahead, exhorting the organisers and activists in attendance to press an electoral victory for the Democrats in the mid-term elections scheduled for November this year, as a crucial way to change drug pricing policies.

Some Alternatives Proposed

Public funding for research leading to drug development at research universities should benefit the public, conference presenters from various organisations argued. As many as 210 drug molecules approved between 2010-2016 were developed at research universities, according to Universities Allied for Essential Medicine (UAEM), an activist group made up of university student researchers advocating for affordable drug prices. A separate analysis, by Stan Dorn of Families USA, a non-profit, nonpartisan group, showed that 89 percent of funding for development of these 210 drug molecules came from the National Institute of Health, at an amount of over $100 billion. This level of public funding for drug research should come with conditions, Dorn said.

Affordable Meds Now conference

Such conditions, Dorn explained, might include attaching conditions to funding which would explicitly include making affordable access to resulting pharmaceutical products; requiring manufacturers to enter into pricing or licensing agreements with the department of health in the US, potentially capping prices at those charged in other wealthy countries. Additionally, drugs developed with taxpayer support could be made ineligible for patent protection and be sold as generics. Publicly funded research data should be mandatorily disclosed, even if in de-identified form so as to prevent cherry-picked selective publication of favoured data, Dorn said.

US Pharmaceutical Industry’s ‘Extraordinary Profits’

“The normal average rate of profit is 4-9 percent for any industry that’s non pharmaceutical…. For pharmaceutical companies that rate of return is 20 percent,” Suraj Madoori of Treatment Action Group explained at the conference. he extraordinary profits achieved by the US drug industry is not often driven by value-added products being produced, he argued. Often there was a focus on ‘evergreening’ and making minor modifications to existing compounds, that could easily become patented, and further drive profits. Using the buying power of state-funded health insurance schemes could be one way of reducing prices of drugs, Madoori said. Additionally, he proposed introducing cost-effectiveness evaluations in price determination, as a way to work out whether the set price of a drug is actually worth it, pointing to examples of Australia and Britain, where these ways of targeting drug prices were routine.

The challenge ahead for the Affordable Meds Now conference participants will be to translate these policy goals into actionable campaigns, organisers said, as they concluded three days of galvanizing discussions.

Image Credits: Vinayak Bhardwaj