I've just been hearing in the UK news about calls for reform in the UK rental housing market tenancy laws. Apparently people have become fed up being evicted without grounds by private landlords. Communities are being destabilised by the high turnover of tenants. Obviously not a desirable situation.
I remember 50 years ago when the opposite situation reigned. People could not by law be evicted at all except for the most flagrant breach of contract. As a poverty stricken student, I could hardly find a flat to rent and share with my pals for all the tea in China. Nobody wanted to rent their property if they might never be able to sell it in their lifetime and thus cash in on their investment. Who could blame them?
So the tenancy laws were changed, eviction without grounds became possible, and now we have a glut of buy-to-let properties and calls for the private tenancy laws to once again be reformed the opposite way to last time. What is more, I can't see this pendulum doing anything else than swing from one end to the other.
So what might change that? Well, you guys in the US have something that we don;t have much over here. You have the concept of large apartment blocks purpose built for the private rental market and professionally managed. They are like the middle ground. The profit on the rental price makes the business sustainable, people are generally not evicted so long as they fit in with the community rules, and the market determines the rent. I'm not saying it's perfect, but I can't count the number of times I have wished for such a system here in UK. A system where I could deal with a professional property management team, not an irate private owner who believes it is my fault because the central heating broke down in the middle of winter, or a lady who is hysterical because I don't want to use the brand of sink cleaner that she thinks her sink should be cleaned with.
Anyway, so what does all this have to do with the price of the hepC meds, Gilead, et al? It is the need for a middle ground. If developers don't have the incentive to produce new groundbreaking drugs then there won't be any. If the Big Greedy Pigs have it all their own way then surely there will be a change in the legislation sooner or later and the pendulum will swing the other way. As evidenced with the UK Property Rental Market, this will never stop.
So what would a middle ground look like? Well, the drugs would have to be affordable, as defined by what the particular market could stand for most people to be accommodated, governments, non-profit organisations and charities picking up the slack. At the same time, the price would have to be enough not to disincentivise developers from producing new drugs. Well, at current prices the developers would still be making a decent living at a fraction of the current cost of drugs so I don't think we have to worry about them deciding it wouldn't be worth their while. What, are they really going to decide that they'd rather go sling hamburgers than drop their prices?
Getting now to the prices. I think that if Gilead had pinned their prices around what the generic drugs are currently costing us in the high-income countries, ie. up to $1500 for 12 weeks Harvoni, then the market could have stood it. Not liked it but stood it. On that basis, they could have dropped their prices proportionately for middle and lower income countries. This might not be perfect for anybody but it would have a chance of working for everybody.
NSW Australia. Genotype 1b 30+ years, F0-F1, VL 91,000 Feb 2015 (740,000 in 2010), Tx naive.
Ordered Sof/Dac from Buyers Club 21 Sept, received 14 Oct.
Virus UNDETECTED at 3 weeks AND 12 weeks (EOT) AND SVR4 AND SVR12 AND SVR24.
A thousand thankyous to Dr James and the amazing FixHepC team.
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:
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.
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.
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.