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Expensive medication

Some medication is too expensive. Other medications aren’t available. Pharmacists have taken to making medication themselves. What causes these shortages, and why is medication so expensive? What can we do about it? And what are the principles behind healthcare?
By Christine Dirkse

Judith Gout

Researcher of health economics

‘Medication shortages are usually caused by the manufacturers of the raw materials, in Asia. The competition there is fierce. Reasons for companies temporarily being unable to supply these materials are bankruptcy, moving, or a merger.

We could prevent this by paying a higher price for raw materials, but then the medication would become more expensive as well. Or we should ensure more stock for pharmacies. But then we run the risk of medication becoming redundant when a new version becomes the preference. So I’m not sure pharmacists would agree to that.

Why some medication is too expensive is a complex issue. Prices can go up because a company buys a license to sell medication from another company. And if the patent is only valid for a few years, the company has very little time to earn their money back. So that’s an understandable reason for a price increase. But there is so little transparency at those companies that we can never know for sure what’s going on, and that means we can’t judge it either.

It’s a shame that people mistrust pharmaceutical companies so much. They do a lot of good. They produce free vaccines for countries that need it, and they they’ve been trying to curtail the prices of medication, by linking the price to the result of the medication (value-based healthcare). But very few people know this.’

Job van Boven

Assistant professor of health economics

‘People are working on getting healthcare costs down, including the cost of medication. In Europe several small countries, including the Netherlands and Belgium, are trying to get the discussion going. But because the pharmaceutical industry, and therefore its interests, is located in the larger countries, I’m not sure if that will help.

In the Netherlands some pharmacists have taken to making the medications themselves, in spite of the patents on the medication. They’re allowed to do this for individual patients, but I’m not sure they should be doing it on this large a scale. But this only works for a small number of people and isn’t a structural solution.

Health insurance companies should starting thinking long term if they want to keep costs down. Cheap medication can also lead to healthcare costs. Forcing people to switch or excessive side effects can lead to people not taking their medication. This lack of medication compliance can lead to complications and expensive hospital stays. Slightly more expensive medication that people take every day will be cheaper in the long term.

Insurance companies can mainly save on costs by investing in prevention and patient support. That would prevent illness and increase medication compliance. Prevention costs money, but it can also save a lot of money.’

Els Maeckelberghe

Associate professor of ethics

‘There are two very important principles in the Dutch healthcare system: everyone has a right to access to care and everyone has the right to be treated equally, no matter their affliction. So whether you’ve got a rare condition that requires expensive medication or a common illness that can be treated with cheap medication, you have a right to proper care. That’s the solidarity principle. We pay the costs together, provided the medication is effective and efficient.

What might be missing in this discussion is courage, one of the moral virtues. Everyone is passing the buck to other parties. Someone should take the lead so we can put our heads together and start working on a solution instead of always blaming each other. In the end, it’s about solidarity: are we all willing to pay the increased cost of expensive medication?

People are working on a solution, trying to curb the costs of developing medication. But once self-interest is involved, like in pharmaceutical companies, it becomes much more difficult to find a solution. That’s when we see pharmacists making their own medication in an effort to counter the injustice of unequal care. They put themselves at risk by breaking the rules. That’s courageous.’


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