May 13, 2013 | By Márcio Barra
A new sales strategy is making waves in Portugal lately. Some pharmaceutical companies, namely Astrazeneca and Sanofi Pasteur, are giving discount cards to physicians to be distributed to their patients, allowing patients to buy some medicines for cheaper.
One of the drugs abridged by this campaign is Sanofi Pasteur’s vaccine for human papillomavirus. Each dose (three are needed in total) costs 119 euros. If a patient presents the given discount card alongside the prescription, a 25 euro discount for each dosage is provided by the pharmacy. Astrazeneca is also providing similar cards to psychiatrists, so that chronic patients can buy the company’s anti depressive (the drug itself wasn’t identified, but I’m guessing Seroquel) for cheaper.
The Portuguese Newspaper Público asked Sanofi Pasteur for comments. A company representative explained that Sanofi has been giving these cards since the end of last year to physicians, so that patients can buy their prescription vaccine 25 euros cheaper. “By presenting the discount card, the discount that the pharmacy provides to the patient is later reimbursed”. The rep further stated that “there is no harm or loss to either the physician or the pharmacy, and only a benefit to the patient”.
Astrazeneca started giving similar cards around the same time as Sanofi. In a written statement, the company clarified that “since December 2012, the company has a special drug access program in place for patients with chronic illnesses, specifically schizophrenia, bipolar disorder and major depressive disorder, when prescribed by a psychiatrist”. This program is called Ser+, and the discount provided can go between 6,47€ in the standard reimbursement scheme, to € 3.46 in the special reimbursement scheme.
So why are companies giving out these cards, and why don’t they just outright lower the selling price of these drugs for everyone? The explanation provided was that the main objective of these cards is to make some prescription drugs more accessible to patients, without lowering their public sale price in Portugal, which would have repercussions in the international price and stimulate parallel exportation.
Paulo Macedo, the Portuguese minister of health, affirmed that this this was a practice “outside” of the Ministry of Health, and that Infarmed, the National Competent Authority, was already asked to investigate the situation, in declarations to Agência Lusa.
The president of the Order of Physicians José Manuel Silva thinks that this issue should be evaluated first by the Order Ethical Board. While he has some concerns on the fact that the physicians is acting as the main vehicle, since they are the ones who give the cards, he believes, however, that the situation shouldn’t “raise ethical issues”, since the one “who benefits is the patient, and not the physician.”
On the other hand, Miguel Oliveira e Silva, president of the National Council of Ethics for the Life Sciences (CEIC), thinks differently. “I do not know if this practice is legal or not, but I am sure it is unethical,” he stated. He further explained that “this practice is very non-transparent way of lowering the prices of these drugs, as only some patients who are provided a card benefit from the discount”. To conclude, he questioned: “why don’t the pharmaceutical companies just decrease the prices of these drugs for everybody?”.
Other potential ethical question, but one that isn’t mentioned anywhere, is that, by giving out these cards, companies may be “forcing” physicians to prescribe their drugs instead of ones from competitors, since physicians have the ethical obligation to take into account the cost factor when prescribing the drug. If a drug is cheaper than another via the discount card, a physician will surely prescribe the one with the discount.