Patients’ rights being sacrificed for cheap drugs
One hematology and oncology doctor confided that when it came time to settle the bill of a Chinese cancer patient seeking out-of-pocket radiation therapy in Taiwan, the patient was astounded to find that the price for target drugs was only one-third of that in China.
“The patient said he didn’t want to leave, and even asked if he could buy some drugs to take back with him to China,” the oncology specialist said.
Tainted Dietary Oil Fears
Not only are high-end medicines relatively inexpensive in Taiwan, popular drugs also cost less per unit than a bottle of water or a chocolate bar, even going for less than NT$1 (about three cents in U.S. dollar terms).
For instance, one tablet of the major international painkiller brand Panadol typically sells for NT$13.5, and members of the public must buy it at their own expense. However, in order to grab the market of hospitals and clinics using locally made analgesic pain relievers, some suppliers have slashed prices to less than NT$0.2 per tablet.
One physician admits that when he gets a cold, instead of using the Panadol tablet that he can get at his own hospital for just a few cents per dose, he prefers to head to a pharmacy and pay over 10 times higher the price for a brand he trusts.
At a meeting of the Legislative Yuan’s Social Welfare and Envi- ronmental Hygiene Committee, Legislator Lin Shu-fen questioned whether pharmaceutical manufacturers could source inexpensive and sub-par raw materials because the price of drugs is too low to profit otherwise. Lin’s line of questioning resulted in Food and Drug Administration Director-General Chiang Yu-mei promising to undertake an audit of low-cost drugs. When cheap is the rule, whether drug safety follows food safety and leads to the uncovering of a series of troublesome issues is a palpable fear hanging over the health care field.
“Will the health care field have its version of tainted cooking oil?” worries Jay C. J. Jeng, Director of the International Medical Service Center at Kaohsiung Medical University Hospital. Low drug prices could not only drive major international drug makers away and leave the Taiwanese public without decent drugs, he warns, it could even force drug makers to use substandard raw materials or cut corners.
Ten Times the Price Low drug prices have resulted in medical suppliers ceasing manufacturing or no longer importing certain drugs, resulting in shortages, so that the NHIA has even been forced to pay more for some drugs, such as long-acting penicillin.
One doctor of i nfectious disease at a medical center in Northern Taiwan relates that this drug is the first treatment option for syphilis, and is also used as a preventative drug for breast and cervical cancer patients to guard against cellulitis caused by post-operative lymphedema.
In the past, National Health Insurance paid NT$ 79 for a dose of penicillin, but medical suppliers stopped importing it after several rounds of price cuts by the NHIA, resulting in an island- wide shortage.
But patients still need medicine, and the NHIA eventually arranged a special order for suppliers to import penicillin at over 10 times the price, paying out NT$800 per dose.
“The Control Yuan should conduct an investigation!” the doctor says.
Moreover, the front-line penicillin shortage forced doctors to resort to treating patients with back-line antibiotics like cephalosporin. “Won’t this raise the risk of bacterial resistance, so that a super bacterium could show up in Taiwan? What a crazy policy!” another doctor said, shaking his head.
Taiwan’s generic drug makers are also concerned about medicine shortages.
In an effort to i nstitute drug regulation at the source, Taiwan’s Food and Drug Administration has mandated that allopathic pharmaceuticals manufactured domestically must be produced from GMP-approved raw materials (the active ingredient used in manufacturing drugs).
However well-intentioned the policy may be, international GMP drug suppliers have recently hiked prices en masse, and with the prices the NHIA pays for medicine remaining low, some local pharmaceutical suppliers have given up on some drugs due to cost considerations.
“According to the prevailing ground rules, drug shortages will only continue to get worse, becoming a trend,” relates Chi Sheng Chemical Corporation chairman Tung-mao Su.
Apart from the NHIA, hospitals have also been keeping a watchful eye on costs, aiding and abetting low drug prices. A seasoned observer of the pharmaceutical industry and former director of the Department of Health’s Pharmaceutical Affairs Bureau, professor Weng-foung Huang points out that Taiwan has never had a real pharmaceutical policy, only a drug pricing policy, which is like losing sight of the forest for the trees. “The Ministry of Health and Welfare, National Health Insurance Administration, medical community, and pharmaceutical industry are all in on it,” he charges.
And patients’ rights are being sacrificed. Translated from the Chinese by David Toman Additional reading selections can be found at http:// english. cw. com. tw