The cross : What is an innovative medicine?
Sophie Crozier: Medicines that represent a real novelty in terms of treatment, efficacy, either because they allow the treatment of rare diseases for which there was no treatment, for example, or because they are real ” breakthrough ”in terms of process, in particular manufacturing… Some of these therapies are set to develop and their indications to expand, as is the case in oncology, and will therefore concern more and more people in the coming months and years. patients.
What ethical questions do these treatments pose?
SC: The prices are exorbitant! CCNE took up the subject in 2016, following the marketing of Soldavi, a treatment against hepatitis C, the initial price of which was over € 40,000. In 2020, this treatment is offered at a price of € 25,000 for a 12-week cure… If it were offered to all patients in need (approximately 128,000), this would represent more than € 3 billion for a single disease. Some gene therapies cost 2 million euros for a single patient, which imposes choices among patients.
→ READ the opinion 135. “Access to therapeutic innovations: ethical issues”
The price of these drugs therefore raises two main ethical questions: how to allow access to these very expensive treatments to all, in the name of equity, without compromising the sustainability of the French health insurance system, based on solidarity, and while preserving an incentive for therapeutic innovation?
What justifies such prices?
SC: This is precisely one of the problems that we put forward. There is a lack of transparency in pricing. Of course, innovation comes at a price, that of research and development and the cost of production, but there is an opacity that we encourage to remove because it concerns public expenditure. Medicines are not like any other product. In addition, the pharmaceutical industry largely benefits from research tax credit and public solidarity, while at the same time, we are witnessing a financialization of the pharmaceutical industry which is generating profits equivalent to those of the luxury sector. Such expenditure for the health system could lead to making choices, favoring certain treatments to the detriment of others, or even having to “triage” patients.
These very high prices also question the value of life: what price are we willing to pay to save a life? While some countries, such as the UK, have chosen to limit access to treatment on a cost-effective basis, this is not the model for our health insurance system. It is therefore essential to be able to obtain, in the collective interest, effective treatments, at a fair price that is bearable by the community. We must be able to continue to promote therapeutic innovation, but at reasonable prices. Dividends are private, health is public.
But how can a fairer price be obtained?
SC: In the opinion, we publish a list of recommendations, of which transparency is the first ethical and democratic requirement. We also invite the strengthening of the skills of the public authorities for negotiations with manufacturers. For example, we suggest strengthening the bodies that prepare and lead negotiations with the laboratories, by calling on public researchers and academics, in particular for carrying out medico-economic analyzes.
The creation of an autonomous public medicine pole to set up public (or mixed) non-profit production entities for innovative medicines is also one of our recommendations. But it is clear that these recommendations alone will not be sufficient if there is not a real political will for transparency and cooperation at European and even global level, to continue promoting therapeutic innovation without contributing to continuous speculation. . Faced with such complexity, CCNE calls for a “Medicines Segur” which would bring all the players around the same table. The price of innovative drugs is a major public health issue. It concerns us all as citizens.