LAWS – The drug war. The Secret Pricing System: Deals Imposed by Big Pharma
In January 2023, in Estonia, the patient’s hopes Kadri Tennosaar they were fading. After four chemotherapy sessions, the cancer continued to grow. And treatment with Enhertu, the new drug that could have helped her, cost 20,000 euros for three months. An expense that the Estonian government would not have paid and that Tennosaar, former manager of a sports field in Tallinn, could not support. Investigate Europe (IE) reveals how drugs capable of saving or extending life are not available in the same way to the inhabitants of the European Union. In six EU countries (Hungary, Cyprus, Malta, Lithuania, Latvia and Estonia), a quarter of the 32 drugs that the German research institute IQWiG believes have a significant benefit over existing therapies are not reimbursed or marketed. In the absence of purchasing agreements between countries and companies, health authorities must resort to other expensive methods to obtain a drug, or cannot access it at all.
The situation is dramatic in Hungary, where 25 drugs out of 32 on the list are generally not reimbursed; in Malta and Cyprus, 19 and 15 respectively are not available. In Cyprus and Hungary, patients can obtain some drugs by applying for individual access, but often at exorbitant costs for the State. In the Baltic States and Romania, a large number of important medicines are also unavailable. In the EU, only Germany and Austria have access to all 32 drugs, while in Italy, one of the drugs on the list, Pluvitco, is not reimbursed. This is because the negotiation phase, which began in March 2023, is still ongoing. According to the latest report from the European Federation of Pharmaceutical Associations and Industries, Italy is in second place in Europe, after Germany, in terms of the percentage of medicines reimbursed (80 percent). A figure that places Italy well above the European average (45 percent).
“We have a first, a second and third class of European citizens when it comes to access: it’s a scandal,” he explains Clemens Auer, who was director general of the Austrian Ministry of Health until 2018. This is because companies choose the countries where it is most profitable to launch their drugs, going for those that guarantee higher market volumes and profits. “Pharmaceutical companies make it clear that the largest markets are the most important to them. And they wouldn’t want to give a discount to a small state like ours,” said a former Irish health official. “In principle, everyone in the EU should benefit from the single market,” adds the lawyer Ellen ‘t Hoen, which fights for fair access to medicines. “But medicines are not equally accessible to everyone in the single market.”
Thus in Latvia, cancer patients are forced to tell their lives on platforms crowdfunding in the hope of receiving donations. Viola, who needs the drug Enhertu for his treatment, writes that he “just wants to live one more year.” Anonymous donors have so far contributed 590 euros of the 45,212 euros needed for the therapy.
In other countries, patients go to even greater lengths to access a drug. In the Romanian city of Lugoj, Andreea Crăciun, a breast cancer patient, had to take her healthcare system to court when she discovered that the state would not pay for her treatment with the drug she needed, Keytruda. Many EU countries cover the cost of the drug for breast cancer patients, but not Romania. “At that point I didn’t know what to do,” recalls Crăciun. Desperate, the mother of two turned to a lawyer. On February 2 this year, her lawyer filed a lawsuit against the Romanian state. Ten days later, the court ruled in her favor: today the national health fund pays for her treatment. In other countries, charities try to fill the void left by pharmaceutical companies reluctant to market drugs in countries with limited purchasing power. In Estonia, the Kingitud Ule association has helped more than 2,000 patients since it was founded 10 years ago.
Thanks to this association, in March last year, Kadri Tennosaar took for the first time the drug that could have saved her life. “It was a small miracle,” Tennosaar says today. The drug worked and the cancer regressed.
*Investigate Europe
