Trade agreement threatens access to affordable medicines

20 September 2013

Access to affordable medicines is threatened by the proposed Trans Pacific Partnership Agreement, according to the New Zealand-based leader of the Global Asthma Network, Professor Innes Asher.

The US-driven trade agreement is designed to promote the interests of the pharmaceutical industry to the great detriment of public health, says Professor Asher from the University of Auckland.

“A lobby group influenced by the pharmaceutical industry is seeking to eliminate therapeutic reference pricing and introduce appeals processes that will allow pharmaceutical companies to challenge formulary listing and pricing decisions”, says Professor Asher. “It is also trying to introduce onerous disclosure and “transparency” provisions that will facilitate industry involvement in domestic decision-making around coverage, reimbursement and pricing of medicines and medical devices.”

Professor Asher was referring to a paper published recently in the journal “Health Policy” * in which the authors describe how these proposed TPPA provisions are likely to affect New Zealand’s Pharmaceutical Management Agency (PHARMAC).

“PHARMAC has been highly successful in facilitating affordable access to medicines for its population through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money,” she says.

“The TPPA will most likely increase costs and reduce access to affordable medicines for New Zealanders. In turn, this would exacerbate inequities in access to medicines in New Zealand, and disproportionately affect disadvantaged population groups, especially Māori and Pacific peoples.”

The Global Asthma Network (GAN) strongly opposes a TPPA that would allow pharmaceutical and medical device industries to override national health policy-making and invalidate policies and mechanisms that have been put in place to improve access to affordable medicines, says Professor Asher.

GAN also warns that such a TPPA would cause harm not only to populations in the eleven countries currently involved in the agreement, but it would set a dangerous precedent, opening the way for further international trade treaties to target low-income and middle-income countries. Many of those countries have weaker policy environments, governance and have vulnerable and marginalised populations, she says.

“The Millennium Development Goals acknowledges the need to improve the availability of affordable medicines for the world’s poor (Target 8e). Indeed, any country that aims to improve the health, well-being and development of its population needs to ensure equitable access to affordable medicines for all,” says Professor Asher.

Asthma causes disabling symptoms in millions of people who struggle to breathe, making ordinary activities extraordinarily difficult, with huge social and economic costs. About 235 million people in the world suffer from asthma and the number is increasing.

Professor Asher says, asthma is a neglected epidemic, especially in low- and middle-income countries. Underpinning optimal asthma treatment is ready access to quality–assured essential asthma medicines (a reliever such as salbutamol and a preventer inhaled corticosteroid such as beclometasone).

“Many countries in the world do not have these medicines readily available. Even where these medicines are available, their cost may be beyond the reach of many of the asthma sufferers,” she says. “In line with the Millennium Development Goals, the global community should be focusing efforts on making essential medicines affordable, and building policies, partnerships and mechanisms that will reduce inequities in health care across all the countries of the world.”

Advocacy is urgently required to ensure no trade agreements are allowed to counteract these efforts, says Professor Asher.

*Gleeson, D, Lopert, R, Reid, P. (2013) How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. Health Policy (in press, published online).