Raphael Vassallo On average, Maltese consumers pay around 40% more for imported medicinal products than anywhere else in Europe: a fact which has prompted health officials to question the ‘unhealthy’ relation between government and the pharmaceutical industry.
Statistics tabled in parliament earlier this year by Finance Minister Tonio Fenech revealed that Maltese consumers pay considerably more for their pharmaceutical products than their counterparts in the rest of Europe.
The list, tabled in answer to a PQ by Nationalist MP Dr Jean-Pierre Farrugia, features no fewer than 119 pharmaceutical products – anything from eye-drops to potentially life-saving medicines – all of which are noticeably more expensive in Malta than elsewhere.
Price differences range from the minimal to the downright astronomical. For instance: Canestan cream, a very commonly used antifungal treatment, sells at €4.96 per 20g tube... when the average price in European markets is €3.07. Similarly, well-known cough syrup Actifed DM Linctus, on sale at €5.43, is only €1.13 more expensive than other European countries.
At the opposite end of the scale are exorbitant products such as Zovirax: an antiviral developed by GlaxoSmithKline for the treatment of shingles, genital herpes and chickenpox, and which sells in Malta for a scarcely credible €225.13 – in other words, 70% more than the European average of €138.71.
As a whole, the average price difference between the 119 products works out at roughly 40%.
Is this a cartel? In an interview with MaltaToday last week, Farrugia openly questioned whether the government of Malta was turning a blind eye to medicines importers because it owes them money.
“Drug importers are owed lots of money by the state. So there is also a great laissez-faire attitude by the state towards these importers. How is it possible that Malta is one of the few countries where a highly effective drug against Ischaemic heart disease is no longer found on the market? Is this because this drug is very cheap?”
Contacted later this week, Jean Pierre Farrugia acknowledged that in some cases, the price difference between individual products in Malta and Europe may be accounted for by economies of scale. But the MP reasons that this factor alone cannot account for the often unreasonable price differences revealed in parliament earlier this year.
One example of a heart disease drug whose local price can be described as “inflated” is Imdur – a nitrate commonly prescribed for dangerous heart conditions such as angina pectoris.
At Maltese pharmacies, a packet of 28 60mg tablets sells for €17.28 – significantly dearer than the average of €14.65 paid in Europe. What this statistic does not reveal, however, is the availability of much cheaper equivalent drugs in other EU states.
Before the development of Imdur by AstraZeneca International, the prescription drug of choice for angina was a product known as Isordil. Pharmacologically speaking, these products are almost identical. But there are two significant non-medical differences.
The first is the price, which is an estimated seven times cheaper for Isordil than for Imdur. The second is the fact that ever since the introduction of the more expensive drug, Isordil is no longer imported to Malta at all – leaving Maltese heart patients with no option but to pay through the nose, when much cheaper equivalents could easily be available.
In these and other cases, medical practitioners question the motives behind the switch from one drug to another.
As Farrugia put it last Sunday – though not necessarily referring to the same product – “Is this a cartel? Have the importers of the more expensive drugs bought out the importer of the much cheaper drug?”
Another issue involves very expensive drugs which are not available on the NHS, such as medicines for the treatment of osteoperosis: a serious, debilitating condition that causes bones to weaken over time.
Osteroperosis is a particularly common ailment among the elderly (persons aged 70 upwards), and above all, post-menopausal women. It is estimated that 60% of Maltese women over 50 will sooner or later seek treatment for this condition – a fact which might explain why the government has to date resisted pressure to provide any osteoperosis drugs for free.
Sufferers are therefore compelled to buy their drugs privately, and so far the only locally available product is Alendronate: patented by Merck, and sold under the brand name Fosamax.
But it isn’t cheap: at €47.08 for four 70mg tablets (taken once weekly), Maltese consumers pay easily the highest price in Europe, where it sells on average at €32.60.
Some doctors however argue that we may be paying more than necessary. Merck’s patent on Alendronate expired in 2008, and since then, the USA’s Food and Drug Administration has approved a number of generic versions, produced among others by American drugs companies Barr and Teva.
Since the release of these new products, the price of Alendronate has fallen sharply in US and European markets, as the original product has had to compete with other similar products.
But to date, none of the available generic variations have been imported to Malta, where Fosamax remains prohibitively expensive.
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