China can­cer pa­tients gam­ble on grey mar­ket

Kuwait Times - - ANALYSIS -

When her fa­ther’s lung can­cer wors­ened, Yin Min, a 51-year-old financial bro­ker from Shang­hai, faced a choice: pay nearly $3,000 a month for an ap­proved drug or pay a frac­tion of the price for a generic drug not ap­proved for use in China. Yin, like many fam­i­lies in China, turned to the in­creas­ingly pop­u­lar, un­reg­u­lated mar­ket of on­line phar­ma­cies, agents and peer groups for drugs. She bought a generic ver­sion of Iressa, not ap­proved for use in China, di­rectly from a man­u­fac­turer in In­dia. “With this sort of mis­for­tune, it’s hard to put into words the financial pres­sure you feel,”Yin told Reuters.

Of 30 can­cer pa­tients in­ter­viewed by Reuters over the past year, two thirds took routes sim­i­lar to Yin’s, pushed by China’s high drug prices and a lack of ac­cess to newer drugs. The pa­tients were aged be­tween 32 and 81, had vary­ing in­come lev­els and suf­fered from a va­ri­ety of can­cers. There is no of­fi­cial data on how many can­cer pa­tients in China turn to un­reg­u­lated chan­nels, but re­search in­di­cates an in­crease glob­ally in the use of grey and coun­ter­feit mar­kets.

Liu Xue­mei, a 61-year-old car­ci­noma pa­tient from Beijing, said she went through a phar­macy agent to get a cheaper al­ter­na­tive to the ap­proved Zadaxin, while Zhao Xiao­hua, who has lung can­cer, said he found a cheaper treat­ment through a pa­tients group rec­om­mended by his doc­tor. Pa­tients Reuters spoke to said doc­tors of­ten turn a blind eye to them ac­cess­ing drugs through the grey mar­ket, and some ac­tively help them do this. Medicines bought through un­of­fi­cial chan­nels are not nec­es­sar­ily harm­ful, and some of the In­dian gener­ics avail­able on­line are ap­proved for use in other mar­kets.

But they can in­clude drugs that are in­ef­fec­tive or fake. The rea­son pa­tients in China turn to these un­reg­u­lated chan­nels are largely financial. Low av­er­age salaries, a chasm be­tween ur­ban and ru­ral wealth, and creak­ing state re­im­burse­ment schemes mean se­ri­ous dis­ease is among the lead­ing causes of poverty, cre­at­ing a ma­jor social bur­den and ris­ing debt.

In Yin’s case, the generic drug she bought was 13 times less ex­pen­sive than the China-ap­proved branded Tarceva. But Chi­nese also turn to un­of­fi­cial chan­nels be­cause of bot­tle­necks in China’s drug ap­provals, which phar­ma­ceu­ti­cal ex­ec­u­tives say can mean drugs lag mar­kets like the United States by 5-10 years. China re­quires all new drugs to be tested and ap­proved in the coun­try, but has a short­age of spe­cial­ists for this work.

The na­tional drug re­im­burse­ment list, the main cat­a­log of medicines cov­ered by state health in­sur­ance, is be­ing up­dated for the first time since 2009. That means even if a drug has been ap­proved, pa­tients can of­ten only ac­cess it if they pay for it them­selves.

China’s health ministry did not re­spond to Reuters’ ques­tions about pa­tients turn­ing to un­reg­u­lated chan­nels to buy medicines, or the lack of ac­cess to new drugs. The high cost of drugs is not con­fined to China, and there has been a jump glob­ally in so-called ‘buy­ers clubs’ - in­for­mal pa­tient groups sourc­ing drugs via the grey mar­ket to help those with HIV and hep­ati­tis ac­cess drugs at more af­ford­able prices.

Lim­ited Op­tions

China last year had four mil­lion new can­cer cases, ac­cord­ing to of­fi­cial data, and the na­tion’s per­sonal health­care bill is set to soar al­most four­fold to 12.7 tril­lion yuan ($1.84 tril­lion) by 2025, ac­cord­ing to Bos­ton Con­sult­ing Group. For many Chi­nese, be­ing left out­side the health sys­tem at a time of need is in sharp con­trast to the ‘iron rice bowl’ con­cept of state ben­e­fits and guar­an­tees for life. “If we can’t buy the drug in China or we can’t af­ford to buy it, then what other op­tions do we have?” asked Duan Guang­ping, a banker in Chongqing, whose mother got lung can­cer in 2011. He bought a drug for her from Bangladesh. China has sought to in­crease in­sur­ance cov­er­age for se­ri­ous dis­eases, and en­cour­age drug mak­ers to lower their prices to gain bet­ter mar­ket ac­cess. It has also tried to speed up the reg­u­la­tory ap­proval process by thin­ning out the waiting list, forc­ing man­u­fac­tur­ers to with­draw new drugs where trial data isn’t strong enough.

But change has been slow. “A lot of new on­col­ogy drugs were ap­proved in the US and UK, but in China there’s a 5-7 year de­lay,” said Li Tiantian, a for­mer doc­tor and founder of med­i­cal plat­form DXY.com. “A lot of pa­tients with can­cer can­not wait.” The over­all 5-year sur­vival rate for can­cer in China is just over 30 per­cent, less than half the level in the United States, ac­cord­ing to Deutsche Bank.

Le­gal Risk

Turn­ing to un­of­fi­cial chan­nels can also carry a le­gal risk. Leukemia pa­tient Lu Yong, a prom­i­nent mem­ber of a lo­cal ‘buy­ers club’, was ar­rested last year and charged with sell­ing un­ap­proved drugs and credit card fraud. He was later re­leased af­ter a pub­lic out­cry. In 2004, af­ter buy­ing a generic ver­sion of Iressa from In­dia, Lu helped set up an on­line group for leukemia pa­tients, who wanted the same drugs he was get­ting at a frac­tion of the price of the ap­proved drug in China.

The generic started at around 3,000 yuan ($435) and the price slowly dropped over the years, Lu said - to a long way be­low the price of the ap­proved drug from As­traZeneca.

“There was no other op­tion, so we took this path even though what we were do­ing was against the law,” Lu told Reuters be­fore his ar­rest. Lu de­clined to com­ment to Reuters af­ter his re­lease, but in his ear­lier in­ter­view he said he never prof­ited from the trans­ac­tions and only helped other pa­tients to make the com­pli­cated over­seas pay­ments. “It’s be­cause of prob­lems with China’s pub­lic health in­sur­ance sys­tem that so many se­ri­ously ill pa­tients aren’t able to sur­vive,” he said then. — Reuters

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