Intended for healthcare professionals


Removing the blindfold on medicines pricing

BMJ 2018; 360 doi: (Published 26 February 2018) Cite this as: BMJ 2018;360:k840
  1. Suerie Moon, director of research
  1. Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
  1. suerie.moon{at}

Increased transparency would enable more evidence based policy making

Tisagenlecleucel (Kymriah), one of several promising chimeric antigen receptor T cell (CAR-T) therapies, is the first gene therapy to get US approval. Novartis announced in September 2017 that the leukaemia treatment would cost $475 000 (£340 000; €390 000)—double the median house price in the US, or 60 years of mortgage payments for the average family.

What we don’t know

Medicines pricing debates have run the same, stale course for decades: on one side is the need to ensure access to lifesaving medicines; on the other, the importance of rewarding risky, costly research and development. Unsurprisingly, industry’s estimates of the average cost of developing new medicines—albeit hotly contested—have ballooned every few years.12 More surprisingly, society has been participating blindfolded in this debate.

What don’t we know? The actual prices paid for medicines are increasingly hidden behind confidentiality agreements.3 In a “beggar thy neighbour” dynamic, every payer believes it is getting the best price but cannot verify this—and largely negotiates in the dark. Companies claim that …

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