Danzon et al


Reviewed by Raffaella Ravinetto

Patricia Danzon has been promoting for a while the principle of differential prices as the best way to promote access to medicines, while discharging the usefulness of other measures promoted by NGOs and other representatives of the civil society, namely compulsory licenses. In this paper, the same line is followed: differential pricing is seen as the best way to achieve equitable access to medicines in different contexts, and ways to enable such differential prices are investigated and proposed, leaving other options behind. However, while broadly discussing the role of pharmaceutical manufacturers and of patients, this paper hardly or never mentions the national regulatory authorities (RA), which should in our view play a fundamental role in defining medicines’ prices and reimbursement’s mechanisms, based on objective elements that include among others:

– The characteristics of the medicines (essential, life-saving, truly innovative…)

– The actual research and development costs (often overestimated. See for instance http://www.prescrire.org/editoriaux/EDI22918.pdf)

– Evidence-based efficacy and safety data, coming  from clinical trials and post-marketing surveillance.

Regulatory authorities’ are key to ensure that prices are defined in a fair and independent way and that decisions are made based on public health priorities. When under-resourced, Southern regulatory authorities should be strengthened in order to allow them to play this role, also learning from the experience of international organizations that have been successful in negotiating the price of innovators and of WHO pre-qualified generics.

It is noteworthy that the authors of this paper acknowledge the fact that most patients in poor countries have to pay for medicines, including for essential and life-saving ones and that they don’t questioned this, either from a theoretical approach (universal right to health) or looking at its practical consequences (avoidable morbidity or mortality in poorer groups).


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