Despite compulsory licensing, generic cancer drug too costly for the poor

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, Last Updated: Apr 23, 2013 at 4:46 PM

Generic drugs

Despite the ruling earlier this week that allowed Natco, an Indian pharmacy to copy Bayer’s Nexavar, a blockbuster cancer drug that will bring down the price by 97%, the  generic cancer drug is still too costly for most people.  The generic version of the drug, German drug-maker Bayer’s Nexavar, will be produced under what is known as a compulsory license, an option available to developing nations to issue where life-saving treatments are unaffordable. Although the price has been brought down from Rs 2.8 lakhs to Rs 8,800 per month, it is still too costly for most people. The only way it can work is if the government can add this drug to its list of generic drugs that it proposed to give for free at public healthcare facilities.

Award winning Indian oncologist Dr M. Krishnan Nair felt that the only solution is for the government to take cancer seriously and increase healthcare funding. The government’s allocation for health care is a meagre Rs 30,702 cr which considering a population of about 1.7 billion amounts to approximately Rs 262 per person. This at least 1/6th the amount spent on defence alone and just over 2% of the total GDP. With around 40 percent of the population living below the poverty line (recently lowered to Rs 28.35 and Rs 22.42 daily spending in urban and rural areas respectively), healthcare remains an upper middle-class luxury. This is attested by the fact that Indians spend four times more in private hospitals than government ones. Poor patients usually camp outside government hospitals begging for treatment. 

As chairman of a committee tasked with formulating India’s cancer strategy in the five years to 2012, Nair advocated Rs 2300 cr ($460 million) for cancer control but only Rs 200 cr was eventually spent. Campaigners for cheaper access to drugs hailed the decision, which was taken after the country’s patent office concluded that Bayer’s Nexavar was not “reasonably affordably priced”. But the ruling has not gone down well with global pharmas like Pfizer, GlaxoSmithKline and Novartis who presumed rapid growth in developing economies like India and are worried about intellectual property rights.

However the people in the know aren’t really convinced. “The compulsory license system might not really work because poor people cannot even afford the discounted price,” said G. Balachandhran, former head of the National Pharmaceutical Pricing Authority (NPPA), India’s drug price watchdog regulator. “Instead of dealing on a case-to-case basis, India needs to have a policy that will bring more and more people under medical cover … we need to increase the health insurance penetration, so that even poor people can afford treatment,” he added. Only 15 percent of India’s 1.2 billion are covered by health insurance, according to business lobby group the Federation of Indian Chambers Commerce & Industry, meaning even at the cut price Nexavar will be out of reach for most people.

Pravin Anand, managing partner at Indian law firm Anand and Anand believes that compulsory licenses should primarily be granted in the case of pandemics, suggesting that affordability is a tricky gauge of necessity. ”Affordability is not an absolute concept; therefore something that is affordable for one individual might not be so for others,” said Anand. 

First Published: Mar 21, 2012 at 9:18 AM

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    Top health stories of 2012 | ListenHealth.Com December 19, 2012 at 10:11 am

    [...] Despite compulsory licencing generic drugs too costly for the poor [...]

    Reply
    Nita Kulkarni April 18, 2012 at 2:32 pm

    Even more important is to find out how effective this costly chemotherapy is. Research studies have shown that these drugs prolong life for a few years at best, and the patient is miserable! Unless ofcourse the cancer is caught early.

    Reply
    Stuti March 22, 2012 at 12:19 pm

    I think this is stretching the concepts too far. At least give some credit to the big companies for the huge amounts they put in for the research on these drugs. Or if these drugs are really provided for free, then there must be more than just- enough funding by the Government for the research.

    Reply
    tmaster March 21, 2012 at 11:55 am

    Why do they ignore that there are a significant number of people between those living on 30+lpa and those on Rs 30/day

    sure, your maid may not be able to afford the drug, but now, probably those working as electricians can stretch their budgets and afford it, those in call centers may be able to afford it, those just starting off jobs at Infy,TCS,etc can afford it. (the last category alone has almost a lakh people annually)

    Just because the move didnt make it accessible to the poorest of poor, doesnt mean its useless

    Reply
    naimish March 21, 2012 at 10:39 am

    What we expect?Pharma cos are not here for charity.Who will bear the operational costs?Let the govt come forward with a concrete strategy so that such so called “Costly” drugs can be distributed free of cost.We think 1000 times before spending on our health but we are happy to spend on movies and entertainment.Pity.Nothing can be done overnight as no funding is encouraged for research in India.The quality of research here is far too low to compare with other country.Needless to say we lag far behind by turning a blind eye and always beleive in copycat versions.

    Reply
    aBHIJIT March 20, 2012 at 1:54 pm

    Doctors must be barred by law to prescribe generics by brandname. There should be stirct punishment like fine of Rs1lakh. Doctors must write generic names…. like Paracetamol 500mg and not Calpol 500. The paitent should be free to choose based on his purchasing power and brand. Doctors should not be allowed to force the paitent by partcular brand.

    Reply
    Amol March 20, 2012 at 1:41 pm

    Cancer is deadliest disease. Even middle class people suffers economically while fighting with Cancer as the drugs are so costly. If this is not the worst see the success rate of treatments which is minimum. At the end of the day family loose both money and person. Surely its governments duty to provide affordable medicines to the cancer Patient and there is need to curb the increasing deaths because of Cancer.

    Reply
    supi March 20, 2012 at 12:55 pm

    we are spending so much for research on cancer and still we are unable to get good drugs from our own country when they can formulate why can’t we and also government is providing so many facilities and funds and the result is zero and millions are suffering and we ahead in publishing papers .

    Reply