A pharma industry war?

From an update of the Department of Health (DOH), the Philippines now has a total of 1,709 cases of confirmed Influenza A (H1N1) infection, including one death. Thus, the Philippines now ranks 7th worldwide and No. 1 in Southeast Asia in terms of “laboratory-confirmed cases” of H1N1 as reported to the World Health Organization.

Based on its worldwide monitoring, the WHO tallied a total of 77,201 cases of Influenza A (H1N1), with 332 deaths reported in 107 countries. As of late, however, the international pharmaceutical industry has yet to come up with large-scale production of anti-H1N1 vaccine for commercial distribution. The vaccine against common flu costs as much as P450 per shot. And because of the H1N1 scare, the anti-flu vaccine is running short in supply here.

Amid the H1N1 scare, the medical field is preoccupied over a raging “war” within the country’s pharmaceutical industry that is totally unrelated to swine flu. The apple of discord involves Norvasc, a medicine being prescribed as maintenance drug for patients with hypertension ailment.

And from what I have gathered, a discount card promotional scheme by a multinational pharmaceutical company is at the very center of this maelstrom. Whether or not the “war” would benefit many Filipinos — who clamor for more affordable medicines — is enough reason for us to take interest into this matter.

It all started when the Pharmaceutical and Healthcare Association of the Philippines (PHAP) parted ways with the controversial multinational pharma firm Pfizer while the debate on Cheaper Medicines bill was still raging then in Congress. The parting of ways, industry insiders told me, was far from cordial. It was reportedly due to Pfizer’s continuing promo scheme that features a discount card for its pricey anti-hypertensive drug.

Under the promo tack, a number of select hypertensive patients avail of a privileged 50 percent discount on Pfizer’s Norvasc tablets. The PHAP has reportedly strongly objected to the Pfizer promo come-on for several reasons. First, the Pfizer scheme appears to be a “direct-to-patient marketing” of a prescription drug or one that can only be dispensed with a doctor’s prescription.

The second PHAP objection is supposedly the requirement of Pfizer for patients to fill up a form which allegedly violates the industry’s ethics regarding “access to patient information.” From the PHAP standpoint, the Pfizer promo gives the multinational entity undue advantage by having in their data-bank these personal information that can be subsequently used for “cross selling.”

We do not know if this information is accurate, but “access to patient information” by pharmaceutical companies is likewise considered unethical in Pfizer’s headquarters in the United States. Why Pfizer indulges in the practice here is something that reportedly baffled PHAP which also has some other US-based multinationals as members.

PHAP’s other objection is that the Pfizer promo-scheme apparently “turns the medical community into one large marketing force” for the multinational’s drug products. As explained to me, the discount cards are channeled to doctors which is frowned upon in the medical profession. Secondly, the discount cards have bar codes and are swiped like credit cards. Many suspect these are used to monitor how Pfizer products perform as a result of the endorsement by a particular doctor.

The more ethical route would have been to let the drugstores distribute the discount cards since this is a marketing and promotional gimmick. Actually, this is reportedly also a volatile issue between Pfizer and the Drug Store Association of the Philippines (DSAP). But this is a different story altogether.

During those tumultuous days when the Cheaper Medicines bill was in Congress, PHAP stood by Pfizer when it was accused by several congressmen of allegedly mobilizing a phalanx of lobbyists to prevent the inclusion of provisions that could be inimical to its business. The alliance is apparently no longer there today, thanks to that discount card gimmick.

Does this pharma industry war promise to benefit Filipino patients suffering from hypertension and the aggravation caused by expensive prices of multinational drug companies for this ailment?

We can’t tell yet, but the controversy triggered by the discount card gimmick may have surfaced some very important issues that government health officials and lawmakers may want to step into. PHAP insiders point to two possible areas that are worth looking into — the 50 percent discount offered by the Pfizer card gimmick.

First, that Pfizer is giving out 50 percent discounts on Norvasc because it can actually afford to sell the pricey drug at 50 percent less than its current selling price. If that is the case, why doesn’t Pfizer just sell it at 50 percent less to all Filipino hypertensive patients? Why limit the privilege to a few select patients who have the goodwill of their doctors? Why limit the privilege to those whose names end up in Pfizer’s marketing data bank?

The other possibility is that the local Pfizer here is in no position to sell the pricey Norvasc at 50 percent less across the board. To do so would spell disaster to its bottom line performance. Thus, it could get them into trouble with their US headquarters.

Here is the interesting question: if Pfizer cannot afford to sell the product at 50 percent less, then who is subsidizing the losses it incurs with the discount card gimmick? PHAP insiders have an alarming insight on this.

Usually, the promo discount card is given to patients who regularly consult with doctors and who buy their medicines in bulk. That means the patients who are financially better off. Then, logically it could only mean that the less privileged patients who do not have discount cards end up subsidizing the discounts given to the privileged cardholders. Is this a case of the poor subsidizing the rich then?

We don’t know. But the mere fact that these issues have surfaced merely shows that the country can actually derive some benefits from this “price war” in the pharmaceutical industry.

Let’s keep watching. And let’s make sure we keep our blood pressure at normal levels. We can’t afford our blood pressure to shoot up. The cost of medicines, especially those manufactured by multinational drug companies are still beyond our reach.