Hi Joy,

In principle I agree. And proposals are certainly needed in order for sustainable deals to be made which work for everybody.
For this plan I make the following comments:
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What if the manufacturer decides not to tier their pricing? Tiered pricing only works for them if they can price gouge first world countries. So there’s a problem with how to set the market price that the PBS will pay. Not an insurmountable problem though.
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I love the concept of a Super Pharma profits tax however – The way things stand at the moment, Gilead could simply refuse to sell to the PBS and carry on with price gouging in more compliant countries. What is needed, and has been needed from the start, is for ALL countries to get together and form a united front. Either Gilead makes a deal that suits everybody or there is no deal on offer = the Gilead drug is blacklisted by the international community.
This of course raises the moral dilemma of people dying while deals are not getting made. Do you play hardball now in order to obtain better pricing for the many later, or do you deal now to save the lives of the critical cases and accept rationing later for the many? I’m glad I don’t have to sit in the seat that makes that decision.
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I can’t comment on New Zealand’s methodology except to say that if it is working for them then it sounds like it’s a viable solution. I just wonder how it works when there is only one breakthrough drug on offer with no competitors.

dt