Fighting for affordable medicines

WE have doubts over the preliminary findings of the Cost-Benefit Assessment (CBA) 2.0 on the impact of the Medicines Price Regulation (MPR) policy, which were opened for public consultation recently (Nov 29 and Dec 6).

Although the study summary stated that patient advocacy groups had been approached for “expert views”, none of our societies were invited.

We are very disappointed with how the study was conducted, as it primarily chose to overlook the impact on the most affected stakeholders, namely patients and their families, and was too biased towards the private healthcare industry.

CBA 2.0 was framed as if it would take away the profit margin of the private primary care sector and threaten their survival.

We want to focus on expensive cancer drugs that are not free or even subsidised in the government sector.

According to the National Cancer Registry Report 2012-2016, males and females in this country have a lifetime cancer risk of 1:10 and 1:9 respectively.

In 2019, public and private hospitals treated 123,848 and 49,364 cancer patients, and recorded 7,031 and 1,166 deaths respectively (Health Indicators 2020).

A significant number of patients in the community must have cancer drugs every day to stay alive.

According to the Medicine Prices Monitoring Report 2017, cancer drugs were among the most expensive treatments by disease category.

For example, a patient needs to spend RM8,870 every three weeks for Her2 drug TDM1 (Kadcyla) alone to treat her Stage 4 Her2 type breast cancer. The patient, a Together Against Cancer (TAC) committee member, has spent RM168,503 on TDM1 (Kadcyla) alone for 19 cycles so far, and she also has to pay for other medicines, doctor’s consultation, nursing fee, and etc.

How many Malaysian households could afford such costs?

The patient chose to continue treatment in the private sector because the cost of the innovator drug is similar in public hospitals.

Prostate Cancer Society Malaysia (PCSM) recognises that the price could be flexible among drug manufacturers, especially for drugs that have been in the market for a while but enjoy monopoly due to patents or only one or two generic suppliers.

Also, there are equally efficacious generics elsewhere in the world that could be obtained through limited supply personal imports.

For example, there is an efficacious drug called Abiraterone acetate to treat prostate cancer.

PCSM fought hard for years to get cheaper generics, and one was finally obtained two years ago.

But since it was a monopoly market, it was still very pricey, and eight times the cost in India.

PCSM appealed to the Health Ministry to get a second generic and negotiated directly with the manufacturer, who agreed to bring down the market price to a more affordable level exclusively for PCSM members.

The lesson here is that patient advocacy organisations such as TAC and PCSM play a vital role in safeguarding the interest of patients. Reducing the wholesalers and retailers’ mark-ups and generic competition are keys to making medicines more affordable.

Only prescription drugs with a single registration holder in the Malaysian market (about 600 drugs) will be subjected to Phase One of the MRP, as single- sourced medications are usually the most expensive due to market monopoly. Phase 1 will be monitored and reviewed before proceeding to the next phase.

We, therefore, call on the government to implement the first phase of the MPR as soon as possible.

We, the cancer patients, are very hopeful that cancer drugs can be made more affordable.

TOGETHER AGAINST CANCER

PROSTATE CANCER SOCIETY MALAYSIA

ACADEMY OF MEDICINE MALAYSIA

BREAST CANCER WELFARE ASSOCIATION

CANCER SURVIVORS MALAYSIA

CANCER SURVIVOR SUPPORT GROUP

COLORECTAL CANCER SURVIVORSHIP SOCIETY MALAYSIA KANWORK

MAJLIS KANSER NASIONAL

MALAYSIAN SOCIETY OF HAEMATOLOGY

NATIONAL CANCER SOCIETY MALAYSIA

PERSATUAN SUKARELAWAN KANSER NEGERI KEDAH

PINK RIBBON WELLNESS (L) FOUNDATION

SOCIETY FOR CANCER ADVOCACY & AWARENESS KUCHING

THE MAX FOUNDATION WAR ON CANCER