Drug Pricing Transparency: The New Retail Revolution

Drug pricing and transparency in Europe and the United States: what is it and how does it work?

INTRODUCTION

As drug prices are viewed to be opaque, there have been increasing societal demands on policy and decision makers to implement initiatives that promote drug price transparency.

AREAS COVERED

This Perspective discusses what drug price transparency is and how it works in theory and in practice.

EXPERT OPINION

Transparency on drug prices may target payers, patients and health care professionals; and may relate to prices at each stage in a drug's distribution system. Although proponents claim that drug price transparency will reduce prices and increase patient access, others expect the opposite effect. Nevertheless, a number of international organizations, countries and consumer groups have taken steps to enhance drug price transparency. This has occurred despite a lack of theoretical clarity and of evidence about its likely impact. Policy and decision makers need to consider how payers and pharmaceutical companies are likely to react to drug price transparency and need to be aware that transparency may produce different effects depending on the country to which it is applied. Even though we believe that full drug price transparency is elusive, various incremental measures can be taken to move toward it.

Consumers' Knowledge, Attitudes, and Practices Toward Medicine Price Transparency at Private Healthcare Setting in Malaysia

Background: Medicine price transparency refers to the practice of making prices available to consumers for them to identify, compare, and select the medicine that provides the desired value. This study aimed to evaluate consumer knowledge, attitudes, and practices regarding Malaysia's medicine price transparency initiative, as well as factors that may influence related good consumer practices in private healthcare settings.

Methods: A cross-sectional, self-administered survey was conducted between May and July 2019 among consumers attending private healthcare institutions in Malaysia. The self-developed and validated survey consisted of four sections on the following: respondents' demographics, and 28 close-ended and graded Likert scale answer options on knowledge, attitudes, and practices toward medicine price transparency. Factors influencing good consumer practices toward the transparency initiative were modeled using binary logistic regression.

Results: A total of 679 respondents were part of the study. The mean age of respondents was 38 ± 13.3, with the majority (n = 420, 61.9%) being female. The respondents' mean score of knowledge and attitudes toward the price transparency initiative was 5.6 ± 1.5 of the total score of 8 and 31.9 ± 4.0 of the total score of 40, respectively. The respondents had the lowest score in the practice of price transparency, with a mean score of 31.5 ± 5.6 of the total score of 60. Male gender, Chinese ethnicity, high score on knowledge and attitudes, and high expenses on medicines influenced respondents' good practices of medicine price transparency.

Conclusion: Respondents had good knowledge and attitudes, but their usage and implementation of the medicine price transparency initiative was still inadequate. A number of factors influence this inadequacy, including gender, race, consumers' out-of-pocket spending on medication, and knowledge of and attitudes toward price transparency practices. Consumer-driven market price control would be impossible to achieve without the good consumer practices of medicine price transparency.

Determinants of drug prices: a systematic review of comparison studies

OBJECTIVE

In this systematic review on drug price comparison studies, we report on recent determinants of drug prices in a national and international context to facilitate regulation of drug prices by purchasers and policymakers worldwide. Determinants of drug prices were divided into non-modifiable and modifiable and were categorised as pertaining to a country's income level, pharmaceutical market system and its policies and government.

PRIMARY OUTCOME

Determinants of drug prices or price variance.

DESIGN

We systematically searched PubMed, EMBASE, Web of Science and Cochrane Library for peer-reviewed articles published between 2004 and 22 July 2020 that reported an association of the primary outcome with one or more determinants. We performed a best-evidence synthesis of these associations for determinants covered in at least three studies.

RESULTS

31 publications were included. Only one publication described net drug prices and 30 described retail drug prices. Five modifiable determinants were associated with lower retail prices: generic market portion, discounts, tendering policies, central (governmental) purchasing and pricing regulation schemes. The originators market portion and a system in which mark-ups are common were associated with higher retail prices. Retail prices were highest in the USA, even compared with other high-income countries. A positive association between national income level and drug retail prices could not be established among middle-income and high-income countries. Retail prices were highest in low-income countries when adjusted for purchasing power parity.

CONCLUSIONS

Literature on determinants of net drug prices is extremely sparse. Various healthcare system interventions, market-specific and governmental regulations are consistently associated with lower retail prices. Some interventions are easily implementable in developing or middle-income countries, such as tendering, central purchasing and fixed pricing regulation schemes. Net drug price comparison studies are needed to overcome the lack of price transparency and to quantify the effectiveness of policy measures on net drug prices.

Identification and characterization of citalopram new metabolites with the use of UHPLC-Q-TOF technique: In silico toxicity assessment of the identified transformation products

In this study the metabolite profiling of citalopram with the use of human liver microsomes as well as the complementary photocatalytic method were established. This strategy allowed the detection of five metabolites of citalopram including 3-hydroxycitalopram and 3-oxocitalopram which were found as a new and not previously described metabolites of this drug The photocatalytic simulation of metabolism was carried out using tungsten (VI) oxide nanopowders with the different particle sizes, which allowed to examine the effect of this photocatalyst parameter on the mapping of metabolic processes. The accurate characterization of all observed structures was possible due to the use of ultra-high-pressure liquid chromatography and high-resolution mass spectrometry combined system as a highly useful technique in drug metabolism studies. In order to perform the toxicity prediction of citalopram and its metabolites, the acute toxicity to rodents, as well as genotoxicity, carcinogenicity, developmental toxicity and receptor-mediated toxicity was calculated basing on the in silico tools.

Multi stakeholders of health and industries perspectives on medicine price transparency initiative in private health care settings in Malaysia

Introduction

Medicine price transparency initiatives provide public or government on information about the product's prices and the components that may influence the prices, such as volume and product quality. In Malaysia, medicine price transparency has become part of the government's strategies in ensuring adequate, continuous and equitable access to quality, safe, effective and affordable medicines. Since the effect of medicine price transparency depend critically on how prices are presented, this study aims to evaluate the stakeholders' perspective of medicine price transparency practice in the private healthcare system in Malaysia.

Methods

This study was conducted as face-to-face, semi-structured interview. Respondents from private pharmaceutical industries, community pharmacists, general practitioners, private hospital pharmacists, governments, academicians and senior pharmacist were recruited using purposive sampling. Using phenomenological study approach, interviews were conducted, and audio recorded with their consent. Data were transcribed verbatim and analysed using thematic analysis with Atlas.ti 8 software and categorised as strengths, weaknesses, opportunities and threats (SWOT).

Results

A total of 28 respondents were interviewed. There was a mixed perception regarding the price transparency implementation in Malaysia's private healthcare settings. The potential strengths include it will provide price standardization, reduce price manipulation and competition, hence allowing the industry players to focus more on patient-care services. Moreover, the private stakeholders were concerned that the practice may affect stakeholders' business and marketing strategy, reduce profit margin, increase general practitioner's consultation fees and causing impact on geographical discrepancies. The practice was viewed as an opportunity to disseminate the truth price information to consumer and strengthen collaboration between healthcare industries and Ministry of Health although this may become a threat that affect the business survival.

Conclusion

Price transparency initiatives would benefit the pharmaceutical industries, consumer and countries, but it needs to be implemented appropriately to prevent price manipulation, market monopoly, and business closure. Future study may want to evaluate the impact of the initiatives on the business in the industry.

Value and affordability of CAR T-cell therapy in the United States

In the United States the increasing number of Food and Drug Administration (FDA)-approved, innovative, and potentially effective commercial cancer therapies pose a significant financial burden on public and private payers. Chimeric antigen receptor (CAR) T cells are prototypical of this challenge. In 2017 and 2018, tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite) were approved by the FDA for use after showing groundbreaking results in relapsed/refractory B-cell malignancies. In 2020 and 2021, four further submissions to the FDA are expected for CAR T-cell therapies for indolent and aggressive B-cell malignancies and plasma cell myeloma. Yet, with marketed prices of over $350,000 per infusion for the two FDA-approved therapies and similar price tags expected for the coming products, serious concerns are raised over value and affordability. In this review we summarize recent, peer-reviewed cost-effectiveness studies of tisagenlecleucel and axicabtagene ciloleucel in the United States; discuss key issues concerning the health plan budget impact of CAR T-cell therapy; and review policy, payment and scientific approaches that may improve the value and affordability of CAR T-cell therapy.