Jacalyn Duffin is a hematologist and historian who holds the Hannah Chair in the History of Medicine at Queen’s University
The sixth full year of the global generic drug shortage has drawn to a close. We Canadians can look back and marvel at how little we still know about the problem. Generic drug shortages do not get anything like the attention paid to the fraught relationship between the federal government and the provinces over a renewed health accord. They are also obscured by concerns over brand-name, on-patent pharmaceuticals, such as the shocking price hikes that occurred overnight last February when Martin Shkreli raised the price of Daraprim from $13.50 to $750, or when Valeant upped the price for a month’s supply of two drugs for Wilson’s disease to more than $25,000. Yet, looking back over 2016, Canada has reported shortages of reliable generic drugs for epilepsy, bladder cancer, psychosis, syphilis, asthma, and kits for treating overdose.
The extraordinary shortages of ‘old’ generics run parallel to high costs of new biological anti-inflammatories and expensive wonder drugs for Hepatitis C. Drug pricing is one important factor in access to health care. Little wonder that India has been reporting severe shortages of drugs for Wilson’s Disease since last August. The media of such countries describes shortages with anger over failure to provide, pathos for “victims,” moaning over the declining purchasing power of currencies, and suspicion of government corruption.
We feel the effects in Canada too. We have seen an arbitrary price hike and shortage of Epipen last October. High prices hit both uninsured patients and private insurers hard; they spill over to employers confronted with higher premiums. Some speculate that they have prompted a boon in the number of retail pharmacies in Canada.
When Health Minister Jane Philpott received the report of her Patent Medicine Review Board (PMPRB) last August, she learned that Canada pays more than most developed nations, that expenditures are increasing, and that the commitments to research and development are not being met. She announced a close study of patent drug prices.
But pricing is only one factor in access. Drugs must not only be affordable, they must also exist. Both factors are vulnerable to unfair manipulation when there is only one manufacturer, as is frequently the case for generics. But generics fall outside the purview of the PMPRB. Nevertheless, some reports suggest that we pay more than other countries for generics too, a factoid that is extrapolated into the conclusion that we pay too much. What is the right price? And are some of these drugs no longer being made because it is difficult to make a profit? In other words, one explanation for drug shortages might be that generic prices are simply too low.
Few people connect the dots. Why do we not know the answers to these reasonable questions? Why is it that doctors are unaware or don’t care? And why do we not even try to measure the problem?
Let’s make a New Year’s resolution to mine this problem and find some answers.
If one of the reasons why Canada is experiencing a shortage of generic drugs is because our prices are too low then that would imply that shortages would be even worse in countries such as New Zealand where generic prices are only a fraction of what they are in Canada. Is that the case? Is there any data to support or refute the idea that shortages are more severe in countries with lower generic prices? It might make intuitive sense but it would be interesting to get hard data difficult as that might be.