A few months ago, my friend posted a link to an online crowd-funding page for his mom, who is battling cancer. The treatment that might save her life would cost her over $100,000 this year alone – and it might leave their family bankrupt. As a medical student, I have been told by ordinary people that they have split pills and skipped days just to make their medications last longer. Some have simply given up on filling prescriptions due to cost. The rising price of drugs is one of the most important problems we face every day. And while we see the obvious damage to our pocketbooks, it is hard to take a step back and understand how written laws and politics are intruding into exam rooms and making our problems worse.
A key upcoming trade agreement that will affect drug affordability (and that few people truly understand) is the Trans-Pacific Partnership (TPP). Hidden in its over 30 chapters and 2,000 pages of dense public policy material is an attempt by the pharmaceutical industry to maximize their profits on medications we use every day.
The TPP seeks to extend intellectual property rights and patents for drug companies, prolonging the time period that drugs can be priced at ranges too expensive for most people to afford. When it comes to biologics (drugs used to treat cancers and some immunologic conditions), the agreement contains provisions mandating every participating country to create a “new exclusivity period”. This is a period during which biologics manufacturers can set unaffordable prices in the name of “research and development”, which would result in an average cost of $190,000 per person per year, according to Public Citizen. Other TPP provisions would likely bring even longer exclusivity periods, extending the time period that patients would lack access to affordable alternatives to life-saving drugs. In addition, provisions involving “evergreening” (creating new patents on old drugs) and patent extensions will further delay the introduction of generics to the market. This agreement will only worsen the climate of price hikes and profit-seeking that we are already seeing.
The TPP also gives companies the right to intervene in government decision-making, which may undermine efforts to protect public health. One mechanism through which they can do this is an Investor-State Dispute Settlement (ISDS), which allows corporations to challenge sovereign states if they believe a country’s laws are interfering with their ability to do business. ISDS has been used in the past as a way for tobacco companies to challenge government plain packaging laws, which were intended to decrease smoking. The TPP contains many ISDS provisions that could lead to a variety of challenges from companies against the US or other countries. For example, pharmaceutical companies could potentially have influence in decisions regarding Medicare and Medicaid coverage of drugs and devices in the U.S.
In early February, President Obama, along with leaders from eleven other countries, signed the TPP in NewZealand, opening the door for the bill’s introduction to Congress and paving the way for an agreement that will undermine drug affordability around the world. Meanwhile, on home soil, “Pharma bro” Martin Shkreli pleaded the fifth, avoiding questions about his outrageous price hikes on HIV medications. Down the street, protesters gathered outside pharmaceutical companies offices where two cancer patients were arrested after refusing to leave the building, demanding that pharmaceutical companies be held responsible for the provisions within the TPP that will lengthen the time before new biologics drugs used to treat cancer become affordable. The outrage around drug pricing is clear, yet many do not realize how provisions within the TPP ingrain the mechanisms that make high drug prices and industry control possible.
The TPP sets a dangerous precedent that acts against access to medicines and public health. Patients already face high drug prices at the whim of pharmaceutical companies, and this agreement will only offer those companies more control. If you have ever needed medication, if you have ever had a loved one impacted by cancer, if you care about how we access medicine here in the US and around the world, please call your member of Congress and tell them to oppose the TPP. For the sake of our future patients, we will do the same.
Submitted by Hannah Keppler on behalf of AMSA (American Medical Student Association).
Hannah Keppler is the co-leader of the Just Medicine Campaign with the American Medical Student Association (AMSA). She is a third year medical student at Albert Einstein College of Medicine in the Bronx, NY.
The AMSA Just Medicine Campaign is an action campaign of AMSA which engages students around the country in ending conflicts of interest in medical education and promoting access to medicines.