High prices – low evidence: Is the lack of transparency hindering the access to affordable medication?

High prices – low evidence: Is the lack of transparency hindering the access to affordable medication? – The case of Sofosbuvir.

Angela Uyen

One third of the world lacks access to medicines. During the last decades factors like Intellectual property and the increasing number of new technologies, have posed great challenges for governance in the pharmaceutical sector. The need of enhancing transparency has been addressed as a key aspect to improve access to medication. Access to medicines can be analysed from different perspectives: as a human right, an international goal, an investment to improve populations quality of life, or a political matter. For instance, Article 25 of the Universal Declaration of Human Rights claims, “Everyone has the right to a standard of living adequate for the health of himself and of his family”. Within this context, access to medication plays an important role in healthcare provision. However, the complexity of the topic touches different stakeholders, including the private sector, academia, the medical profession, and different government departments. These stakeholders perform in a delicate balance between the government’s duty and the open market economy. Moreover, most of the biggest pharmaceutical companies are based in the US and in Europe, pointing to components of hegemony and international trade involved in the field of access to medicine.

Access to essential medication has become an important goal of international agendas. For instance, the provision of pharmaceuticals has been included as an important part of the Millennium Development Goals. However, it also remains a political and economic problem. The World Health Organization has recognized some of the remaining challenges regarding the access to quality essential medical products. Within these various challenges, high prices are still a key issue, having its direct toll on governments, non-governmental organizations (NGO), and on the patient’s economy. International bodies have enforced various policies to deter the fixing of prices and enlist negotiation of medication with insurance companies. The inadequacy of transparency in approving and pricing medication is one of the leading causes of the exorbitant costs charged for medication. The concept of transparency as a goal and as a means, plays an important role in the agenda of international organizations concerning good governance. It is recognized that strengthening accountability and transparency are necessary elements to consolidate democracy. The lack of transparency in the pharmaceutical industry has been addressed in different stages of the research, manufacturing, and commercialization of medicines. This market is particularly vulnerable to corruption due to the large profits, the multiple processes involved and the complexity of financial and legal frame.

My Master´s thesis* explored the matter of transparency in the pharmaceutical sector, analysing the evidence behind the authorization and the pricing. To this end, the study explored the case of Sofosbuvir, one of the most expensive drugs globally, used to treat Hepatitis C.  The analysis of transparency is focused on the evidence behind the approval and use of Sofosbuvir, and the economic aspects and market features of the drug. The study shows how this case involves many uncertainties about the effectiveness, and the fairness, of pricing. Intellectual property and market conditions have allowed new drugs like Sofosbuvir to enter the market with historically high prices, raising concerns about the future of public health and access to medicines. Therefore, to address transparency in all the different steps of the value chain in the pharmaceutical sector is required to increase access to medicines and to promote sustainability of health systems. 

*Chevening Scholar, MA (c) International Relations, Queen Mary University of London. To obtain the full study, please contact Dr. Uyen via Linkedin.