We agree with the statement (in response to our original publication) that the development of an improved framework for drug pricing requires streamlining of the process to ensure equal access of patients with new drugs (Response to proposal for a novel cancer drug pricing model. Nat. Rev. Clin. Oncol. https://doi.org/10.1038/s41571-018-0062-7). This requirement has been precisely the motivation for our entirely different approach in proposing a novel pricing system. Some potential practical impediments are also highlighted. Excuses to avoid implementing changes to the current practice of drug pricing will always exist. These excuses have helped to maintain the current impasse of unsustainable and insufficiently accessible cancer drug delivery to patients in need of treatment. There is no such thing as a perfect model for drug pricing and any system that is adopted can be further improved based on accumulating experiences. The emphasis of our proposal is to identify the key variables in the decision process and to move and take action, we hope with the full support of all stakeholders, actively supporting the necessity of change.
While we agree that aligning the interests of stakeholders, including the industry, with those of society is of the utmost importance, we emphasize that the current balance is unreasonable: exceptional profits have resulted in insufficient access to essential drugs and pose a threat to the sustainability of national health- care systems. On many occasions these issues have been raised by various stakeholders, including patient groups, policy makers, professional, scientific, and medical societies.
As a very recent example, the European Parliament has adopted a resolution on options for improving access to medicines in the European Union (EU). The text of this resolution states that more transparency is urgently required in determining the costs of research and development, including the proportion of publicly funded trials and the costs of marketing. The language of the resolution is unambiguous regarding the equal rights of citizens of the EU, and the resolution stipulates that access to essential medicines should be improved substantially. Our model is in line with this resolution. Patients have a fundamental right to health and to receive the best available medical treatment, therefore we have to address this challenging issue together. We hope that our model will be instrumental in creating an acceptable balance between social and economic entrepreneurship.