Michael White: driving down the cost of drug deals

The company wants its much costlier Lucentis used instead.

How sorry should we feel for Big Pharma at a time when most people are struggling and every pound of public expenditure should be spent as effectively as possible? Not much, is still probably the right answer – it’s certainly what elected politicians instinctively feel. There’s an £84m saving here, although it’s also worth remembering that the drugs industry has problems, too.

Ministers in successive governments have struggled to keep a lid on excessive pricing and profits and the National Institute for Clinical and Health Excellence does its best to keep cost-inefficient products off the NHS’s books. It still gets taken to task for its gallant pains by patients desperate for any sort of hope, and by heart-over-head tabloids which are never skinflint when they hear the words “reader’s cancer”.

As for Parliament, the last time the Commons health committee reported on the industry, so far as I can tell, was in 2004-05 (Labour’s David Hinchliffe was still in the chair, Simon Burns a member) when it warned against excessive reliance on medicines, especially ones which later proved harmful, and called for an end to “lax oversight” of the industry, whose interests are not always the NHS’s.

Last year’s Rawlins report for the Academy of Medical Sciences called – yet again – for better, more transparent and coordinated regulation of what remains a major UK industry. Professor Timothy Evans made a similar plea in HSJ on 29 March. Only the other day the trade itself reported that 5 per cent of GPs’ prescriptions contain errors, hardly encouraging for our GP commissioning future. So bad is many GPs’ handwriting that an order to “clean that hospital” could easily be misread as “close” it.

Just kidding! Flip the perspective, however, and you see why Novartis might want to risk wasting its money suing the Southampton, Hampshire, Isle of Wight and Portsmouth PCT cluster for using £60 a shot Avastin (where do they get these silly Latin names?) instead of £750 Lucentis (Roche owns both, but Novartis markets the former) when treating wet age-related macular degeneration (AMD).

We’ve all been hearing for years that patents on some of the modern era’s greatest drug inventions – seven of the top 20, with £200m worth of global sales, by some reckonings – are due to expire by the end of this year. Blood pressure, depression, asthma, diabetes and HIV drugs will be some of the big money-spinners open to generic copies.

Since brand name drugs cost on average twice the price of generics, that’s excellent news for patients and finance directors. Yes, but there’s a downside. Patents registered by Big Pharma have fallen sharply away, even in the inventive US as lower-hanging medical fruit gets harder to pick. Big-earning drugs are pharma’s answer to JK Rowling – they subsidise research and more obscure-but-worthy drugs. Hence the merger of so many big firms, hence too the closure of Pfizer’s major EU research plant at Sandwich in Kent. Shareholders want quick results and dividends: AMD is not the only form of blindness.

Alas, when Novartis’s spokesman tried to plead patient safety (Avastin has not been submitted for AMD use, let alone approved by NICE) Evan Davis swatted him with reassuring academic reports: it’s safe, it’s an £84m no-brainer, he said. Do I hear echoes here of aspirin vs warfarin debate? Both thinned the blood, but one also thinned the NHS wallet.