Karl Schembri
Government’s recent decision to finally issue a call for tenders to provide Herceptin on the national health service has exposed the extent of the hardships and unfair prices that Maltese breast cancer patients were submitted to.
A call for quotations issued by the government’s health procurement services early last month for the supply of 150mg injections of trastuzumab – sold under the brand name Herceptin – has resulted in three shockingly different prices.
The lowest offer was made by UK-based pharmaceutical wholesaler, Miller & Miller, whose price for 10 vials of Herceptin was set at €5,756.81. In contrast, Cherubino – the Maltese wholesaler from whom breast cancer patients were buying their medicine – gave a price that was €1,779.61 more expensive, totalling €7,536.42 for 10 vials. Even more prohibitive was the price given by another UK-based company, P&D, which quoted the price of €9,341.79 for the same amount.
Attempts to get Cherubino’s explanations for the price difference were futile, as a spokesperson said the only person who could discuss Herceptin was abroad for two weeks.
But a representative of Miller & Miller said it was possible that the price discrepancies were mainly the result of different mark-ups set by the different suppliers.
“We are a large pharmaceutical wholesaler supplying our products to governments, hospitals, and other big clients, but irrespective of the amounts ordered our price structure is the same for everyone,” said John Miller. “I’m surprised there is such a big discrepancy in the prices you mention.”
From the prices submitted, it emerges that UK wholesaler Miller & Miller offers the drug for €177.96 cheaper per vial than the Maltese wholesaler. Considering that a patient normally needs around 55 vials, a Maltese would have paid €9,787.85 more for a full course.
Given that around 40 patients a year need Herceptin in Malta, this would have cost the government €538,331 more than if it had to buy it from the UK – that is a staggering 1% of the total amount government spends on medicines every year, at around €56 million.
However, sources who are familiar with the government tendering procedures said that companies are also known for submitting inflated prices in quotations, which would then be totally different when they bid for the actual tender.
Meanwhile the government call for tenders for the supply of trastuzumab is open until 16 December.
Produced by Roche, the prohibitive price of Herceptin has been the main reason why governments around the world have been dragging their feet before including the drug on their public health services.
According to the Medicines Authority, Cherubino Ltd is an authorised wholesale dealer and can thus distribute the product on the market in Malta within the regulatory framework.
However, a spokesman for the authority added that “medicines can only be dispensed to patients from pharmacies” – shedding light on a possibile irregularity given that breast cancer patients have been buying their drug directly from Cherubino.
Earlier this year, the Consumer and Competition Division was meant to investigate the price of Herceptin but nothing has been reported in public so far.
A finance ministry spokesman said prices of medicines sold in Malta are compared to a calculated average European price.
This is calculated by a specific mechanism agreed upon by the medicines committee set up by government in November 2006.
Meanwhile a spokesperson for the health ministry said government is also setting up a price regulation mechanism.

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