Drug prices: is the sky the limit?

DOI: 10.1590/S1679-45082016ED3620 Drug prices are established mostly by the Big Pharma companies in America and Europe, and those prices are transmitted, when they manage to do so, to other countries. New drugs for hepatitis C, monoclonal antibodies used in cancer therapy or new inhibitors of kinases also used for cancer treatment, are examples of very expensive drugs. High prices are even higher in Brazil because of our taxing system, described many times by our press as crazy: in Brazil 34% of total drug price is tax. Imported drugs (the majority of new resources for cancer treatment are not available in our internal market) do not pay importation tax and IPI, if a medicine is imported in the name of an individual based on norms of our National Health Surveillance Agency (ANVISA). Imported drugs authorized by ANVISA and available in our country pay all taxes and in this case almost 60% of the prices are taxes. There are tributary waivers for a good number of drugs for some taxes, like PIS and COFINS: states taxes as ICMS do not have waivers.(1) Some societies like the American College of Cardiology (ACC), Memorial Sloan Kettering Cancer Center (MSKCC) and the Institute for Clinical and Economic Review (ICER) try to evaluate what they call “the real value of a drug”. They elaborate tables comparing quality of life and survival years added when a drug is used, and check if the price of the drug correlates with those measures.(2) A recent paper published in the journal Cancer by physicians of our North American sister, MD Anderson Hospital, analyzed treatments for hematological malignancies and calculated the incremental cost/ effectiveness ratios by using US$ 50,000.00 per quality-adjusted life/year (QUALYS) as the breakpoint, which showed that tyrosine kinase inhibitors and monoclonal antibodies are over this mark. So, the costs of the majority of new treatments for hematological cancers are too high to be deemed cost/effective in the United States – this is their phrase entirely, and refers to United States’ costs.(3) Cancer treatment is getting more and more expensive and this trend does not show any evidence of abating, causing distress for patients.(4) The national health system of Great Britain has an Drug prices: is the sky the limit?