Rabin Martin

Dr. Brian Drucker, the researcher who in the 1990’s identified imatinib’s potential and begged Novartis to develop it, was a co-signer of the recent Blood article on cancer drug prices.

That’s the question which continues to reverberate from the recent week article in the hematology journal Blood rejecting the high prices of treatments for CML (chronic myeloid leukemia), in particular imatinib, known as Gleevec in the U.S. and Glivec everywhere else.

The article, signed by more than 100 blood cancer experts from around the world, argues that the prices for these medications – which in the U.S. can top $90,000 per year – have become “unsustainable.”

“Advocating for lower drug prices,” the doctors argue, “is a necessity to save the lives of patients who cannot afford them.”

This is not the first time oncologists have agitated about the cost of medicines.  And while imatinib and its followers are truly life-saving, new drugs for other tumors have been criticized for offering too small a survival benefit at too high a cost.

Yet doctors, more than most, well understand that expensive cancer drugs are part of a well-established research and regulatory paradigm that has pushed the costs of creating new medicines past $1 billion.

In response, the Blood article calls for dialogue with industry about value versus benefit in cancer treatments, and about commercial models that leave much of the world – places where the cancer burden is rising – altogether off the table.

This conversation will be more productive by acknowledging that the price of medicines is only one factor – albeit important – in shaping access to innovative cancer care.  Costs for hospital stays, imaging and devices as well as doctor fees, for instance, are also part of this larger systemic issue.

To their credit, oncology companies have funded patient assistance programs in the U.S. and elsewhere to help close the gap.  Novartis, the manufacturer of imatinib, created a global access program that has reached more than 57,000 CML patients in 79 countries.

Donation programs, however, aren’t likely to meet the surging demand for cancer treatments.

Instead, market-based solutions that incentivize the continued development and wider distribution of medications will be essential to address the growing global burden of cancer, with some 70 percent of deaths in low- and middle-income countries.

At the same time, low prices alone will never get cancer drugs past the “last mile.”  As Felicia Knaul at the Harvard Global Equity Initiative has pointed out, 26 of the 29 drugs for the most common cancers are already off patent and priced affordably – yet still fail to reach many patients.

If cancer really is to become a chronic disease, health systems around the world will need to be strengthened in the areas of prevention, screening and treatment – use of  imatinib, for instance, requires regular molecular testing.

Stronger health systems would also create a larger market for oncology products, opening an important thread about potentially addressable patients in the coming dialogue with industry.

As the conversation begins, the parties should outline a broad agenda not limited to price and focus on new ways to achieve better outcomes for more people facing a cancer diagnosis.