A Narrow View on a Big Topic

One of the Big Issues floating around the NZ political scene at the moment is the TPP (Trans Pacific Partnership). It’s a massive agreement between a dozen or so countries, and to be honest, I’d be lucky to understand half of it. A small fragment of an analysis about it, however, caught my eye.

The new TPP rules would see longer patent terms for drugs, increasing the time before cheaper generic drugs can enter the market. Other elements of the TPP would further extend patents should a new use for the drug be found. All of these mean further barriers to the creation of generic drugs which, in some cases, can reduce the costs of drugs by huge amounts.

In New Zealand this would mean that PHARMAC would have to spend more of its set budget on non-generic drugs. Currently PHARMAC’s role is to manage the funding that District Health Boards set aside for spending on community, cancer, vaccines and, eventually, hospital pharmaceuticals. New Zealand has decided to operate within a fixed medicines budget because of that, PHARMAC needs to make decisions between competing priorities to achieve the best health outcomes for New Zealanders.

If fewer generic options are available then PHARMAC will have to make decisions about which drugs are no longer subsidised. Keep that in mind when you hear NZ Minister of Trade Tim Groser say that Pharmac won’t change. No, it won’t, but it just won’t be nearly as effective.

So Pharmac will have to spend inordinate amounts of money on drugs on-patent, when they could have been buying them generically. This isn’t a problem this year or next year. It’s a problem five or ten years down the line, when drugs are budgeted to have gone off-patent don’t, and that makes a mess of Pharmac’s budget. Pharmac get a defined amount of money to spend each year, and these patent medicines will start eating into it. They’re going to have to make cuts somewhere.

And this is where it gets personal, for me and for many other mental health patients. Psych meds are split pretty neatly into two categories – generics that cost a couple of cents per pill, and brand names, which cost somewhere near NASA’s operating budget (but we don’t get to play with rockets). There are usually several drugs in each psych medication category, so if you’re looking to trim the budget of anti-psychotics, you can turf the stupidly expensive aripiprazole, because there are a dozen other medications in that category, most of which went generic years ago. This is possible over the entire funded spectrum of drugs, but psychiatric drugs are the ones I know most intimately.

I don’t know if this is true of all drug classes, or whether it’s just psych meds, but they’re a bit hit-and-miss. You can get no help from escitalopram, but find that fluoxetine really helps, and helps you back into the real world. Having a variety of drugs available is so important to psychiatry, because occasionally a patient will end up playing medication roulette until the right drug or combination is found. Pharmac makes it possible to try some newer drugs when the older drugs have failed.

I already pay $55/month for melatonin because it’s not funded under Pharmac. But if I had to pay for all of it (assuming I get Pharmac rates), the total is scary. I would be paying a few cents over $370 for everything, and the bulk comes from two drugs, lamotrigine and aripiprazole, which cost $290 between them. Lamotrigine has already come off patent, but it’s still expensive. There are other anti-epileptic and mood-stabilising drugs out there, and they could cut this from a cheaper option perhaps. It’s not very practical though, because it’s a fairly widely used drug, and weaning so many people off it is a difficult process. I like my chances there. Aripiprazole is a different story. Already a special authority medication, it’s still firmly on-patent. There are a dozen other anti-psychotics out there, and this one is very expensive. there aren’t too many people taking it. I think we’re on shaky ground here.

Aripiprazole has been a wonder drug for me. By the second day on it, I was up off the couch and doing things. I went from completely non-functional to able to cope with a few things. There might be other drugs that could do that, but I’m rather attached to the aripiprazole. I have something that works, and I don’t want to go back to the searching-for-the-right-drug roller coaster.

New drugs are expensive, very expensive, as the drug company tries to make as much as they can off it to offset the costs of development. The moment they go generic, Pharmac breathes a sigh of relief on their behalf. But then the drug companies can get sneaky. They can find a new indication for their drug – say, Drug X was marketed as an anxiolytic, but it was very sedating. That’s ok, before it goes off patent, it’s found that it’s very sedating, so it’s now used as a sedative or sleep aid. Then they can have a few more years of patent protection. And if that’s not enough, if they modify the drug (change its formulation or dosage) then they get another another patent, which may be in effect for as long as 20 years.

All this rambling has only a couple of points: the TPP is poised to screw over the Pharmac budget, and it’s putting anyone who needs medication at risk of having to change medications. And that’s not cool.

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