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Rx for healthcare: cheaper, available drugs
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A steroid drug needed to treat an eight-month-old baby suffering infantile spasms, or West syndrome, in the Xiaoshan District was simply unavailable anywhere in Hangzhou, the distraught parents discovered.
They mounted a nationwide search for the drug, known as ATCH (adrenocorticotropic hormone), via the Internet and eventually found the medication with the help of netizens and doctors. The medication is considered an “orphan drug” because it is specifically developed to treat a rare medical condition and thus is often hard to come by.
Indeed, not every victim of infantile spasms is as lucky as the baby in Hangzhou. According to a report in the Beijing Morning Post, a Guangdong infant is still waiting for ACTH treatment after the parents of a fellow sufferer snapped up the only dose readily available.
The incident involving the Xiaoshan infant sparked considerable discussion in cyberspace and highlighted problems of drug cost and availability in China’s healthcare system. Netizens asked why a lifesaving drug that is relatively cheap to make should be so hard to come by.
The central, provincial and municipal governments are trying to address the issues.
Infantile spasms is a rare form of epilepsy that causes seizures in babies. It occurs in two or three of every 10,000 births, and can cause delays in the development of a child. Those with spasms related to an underlying developmental brain disorder or injury have a higher likelihood of moderate to severe delay.
Many doctors believe that the quicker the seizures are controlled, the better the results will be.
ATCH, which is considered the most effective drug to treat infantile spasms, costs little through legal channels, when available, but it can sell for as much as 8,000 yuan (US$1,260) on the black market.
The Children’s Hospital of Zhejiang University School of Medicine told Shanghai Daily that it ran out of the ATCH quite some time ago.
According to a report in the Jinling Evening News, Shanghai No. 1 Biochemical & Pharmaceutical Co is the only drug manufacturer still making ATCH. The company mainly supplies hospitals in Shanghai and Beijing and doesn’t sell to individuals.
According to a survey by the China Food and Drug Administration last year, 342 drugs that treat uncommon diseases were in short supply across the country.
Generally, these medicines have unstable market demand and are considered low-profit by pharmaceutical companies. The profit motive hasn’t been helped by government controls on price rises for certain medicines. As a result, fewer and fewer companies are willing to continue producing orphan drugs. In some cases, production relies on only one drug company, leaving patients at its mercy.
In order to increase profits, some pharmaceutical makers have figured out a way to “upgrade” the medicines.
“Some companies discontinue the production of the cheaper medicines and come out with so-called new drugs, which in fact are the original medication in new packaging,” said Dr Liu Huan of Jiaxing No. 1 People’s Hospital in northern Zhejiang Province.
At the same time, medicine sales often provide up to half of a hospital’s revenue, prodding doctors to prescribe the most expensive drugs available for patients. Hospitals account for 85 percent of drug purchases, so pharmaceutical companies cater to their financial considerations.
“Pharmaceutical companies don’t want to produce cheap medicine, agents don’t want to sell them and hospitals don’t want to prescribe them,” Niu Zhengqian, vice president of Chinese Pharmaceutical Enterprises Association, told Guangzhou Daily. “Those factors determine the availability of cheaper drugs.”
The healthcare system problems are not confined to sufferers of rare disorders. Cancer patients have available medicines but cannot afford them. The cancer drug Glivec, for example, costs 24,000 yuan a month for treatment.
Zhejiang Province has come to the rescue, adding 15 cancer-fighting drugs to government medical insurance coverage. The drugs include Glivec, produced by Novartis Pharma Schweiz AG, Alimta, produced by Eli Lilly & Co, and Herceptin made by Genentech Inc.
The insurance coverage is expected to save patients up to 400 million yuan a year in Zhejiang.
The Hangzhou government has initiated the Public Hospital Comprehensive Reform Pilot Plan, which is expected to lower the proportion of hospitals’ revenue from sales of medicine to 30 percent in 2017.
And in June, the central government removed 2,700 drugs from its pricing system, which means drugmakers can charge according to market demand. Since then, some hard-to-find drugs have begun reappearing on the market. The government is expected to expand the list of drugs exempt from controls.
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