THE PROBLEM

When we started our research to find the best drug combinations for the 4 most common cancers in 2011, we were staggered by the prices charged. Contacting wholesalers around the UK and the wider EU [UK was then still part of the EU], we come across pharmaceutical companies who manufacturing cancer drugs and charging more than a £1000 for a single infusion.

For over 11 years, as part of the research, we have been provided with the wholesaler’s internal lists, which are on average twenty to twenty five pages long. These price lists detail, in very meticulous small letters and codes, the price to be charged to the health insurer and the government; plus the real, usually considerably lower price, charged to the wholesaler.

The additional income that hospital/pharmacists can make at the expense of the purchasers is staggering.

All the prices were blatantly published in black & white.

We couldn’t believe what we were seeing! Rough estimates on several medications only suggest this could cost health insurance companies [eg. NHS] up to £½ bn per a year.

This deceitful profiteering applies to chemotherapies as well as other infusions against cancers.

For example, the monoclonal antibody bevacizumab, one of the currently most commonly used active ingredients for people suffering from cancer: Last year, the health insurance companies paid £1288 to the pharmacist per pack, who had bought the pack for £246 from the wholesalers.

In my case, my bespoke cancer drug cocktail was made by 3 different pharmaceutical manufacturers plus 14 individual pharmacies, and came with 17 different price points. All 17 variations used the same components; but with some adding an extra £1,000 on top - the deception by the pharmaceutical  companies and individual pharmacies is enormous. 

And this is not an isolated case!

Further examples: Pharmacists regularly earn an extra £694 - £811 on each pack of monoclonal antibody bevacizumab; Trastuzumab deruxtecan is a frequently prescribed drug - the health insurance companies paid £1392 per pack, while the wholesaler cost is just £316. Again more than £1000 of additional income for the pharmacist - with a single dose.

There are over 4200 pharmacies in Europe and the UK who have their own “clean room” and mix these cancer cocktails together. Each infusion bag is prepared individually because the dose is calculated according to the weight and height of the patient. The mixing itself takes only a few minutes, and the pharmacists receive a flat rate of £100 per bag from the health insurance companies for the production.

To be fair, reimbursement prices have fallen slightly. In September last year, health insurance companies lowered reimbursement prices for some cancer drugs. But the cancer pharmacists can still generate astonishing profits: They can buy a pack of Pemetrexed, a remedy for lung cancer, for less than £128 and settle it with the health insurance companies for £1290.

CONSPIRACY THEORY?

I have written year after year to the Department of Health - which has been in the hands of the conservative party for the past 13 years; to The Secretary of State’s for Health (2012-2018) Jeremy Hunt present Chancellor of Exchequer 11 letters, and to his successor Matt Hancock (2018-2021) 7 letters [all 18 letters posted by Special Delivery] I have not received a single answer about where these enormous profits for cancer therapies end up. Similar non-responses were received from the contacted health insurance companies, who suggested the query was a waste of time  and money.

Make no mistake - prices are freely negotiable! Pharmacists make greats profits in a variety of ways. But - in contrast to almost all other drugs - cancer pharmaceutical companies are allowed to freely negotiate the price of these drugs with manufacturers and distributors. Consequently, the health insurance companies often do not know the real purchase prices and pay a predetermined price. The profits are sometimes gigantic! As printed in the “internal price lists” .. . .

We compared the price paid by the health insurance companies with the listed purchase price of the Wholesalers. In the case of the five top-selling active ingredients alone, whose patent protection has expired, the health insurance companies could have saved up to £½bn per year just on few cancer medication. What would be the figure if we would check all over 20,000 prescription drugs which are approved for marketing? Year after year, this “ additional expenditure” [obscene profits] ends up with the approximately 4200 cancer pharmacists or is there something more sinister?

The high profit margins are not consistent for all the drugs on the list. Why is that? Because cancer is the biggest/largest illness in majority of countries. And all this is happening "Like in a bazaar".

We also performed/commissioned some quality checks on the same medications supplied from different manufacturers. Not only are the prices wildly different, but also the generics of each component varies enormously; some were out of date and some were not the listed ingredient at all - were they counterfeited product(s), we had to ask ourselves: More significantly, how could such an untested drug/cocktail work on cancer at all? Is this the reason that cancers recur?

In the UK , the prices which pharmacists receive for their medicines are set by one of the government umbrella associations, usually the ABPI (Association of British Pharmaceutical Industry).

They are so concerned about this industry's profiteering that they are revamping the voluntary branded medicines scheme as te current one "has lead [to] escalating, unsustainable payment rates which have jeopardised the UK's position as a life sciences superpower". If these are the concerns they have about the price of all the known products, one can  only imagine their deep disquiet about the cost of personalised cancer therapies.

The health insurance companies only ask the manufacturers for the prices - but the prices communicated by the pharmaceutical companies are apparently significantly higher than the actual purchasing possibilities of the pharmacists. If pharmacists and health insurance companies do not agree in their negotiations, an arbitration board must decide. According to the research, this arbitration board does not have any price lists either.

Why do the health insurance companies not determine the real prices - especially since I have been reporting my concerns since 2016 about these far too high profit margins for cancer drugs. Apparently, the health insurance companies rarely ask the pharmaceutical companies about the actual price of these important cancer drugs. Perhaps because they are not following what is coming out. For example, bevacizumab or rituximab prices were only queried in 2017 and 2021.

One of the major players with this deception is the German/ UK company ZytoService. The German’s acknowledged that there was something wrong, after hearing all the protests from different channels and levels, and the Hamburg public prosecutor's office acted instantly. What has happen in the United Kingdom? Nothing, brushed under the carpet! Who was PM? Boris Johnson (Conservative Party).

These high profits are "not a sustainable state of affairs". The chairman of the Drug Commission in one EU country finally considered the enormous earning potential of cytostatic pharmacists to be "absolutely unjustified". No action is being taken in the United Kingdom.

From my point of view as the NHS is already on its knees, this money could be invested in better palliative care for cancer patients, which we all know is often "not sufficiently available". Various corruption scandals in the cytostatic industry have come to light. This is one of the reasons why we have to stop these "omissions” to continue to enable these enormous profits in this area; we need crack down sharply on the offenders and prosecute all who profiteering from all this “bazaar business”.

My suggestion was and still is for the sale of the preparations to be put out to tender where the low-cost suppliers would be awarded the contract, which has long been the case with some other drugs without patent protection. From the figures available to me, I have readily identified a savings of £4.2bn per year inside the EU and United Kingdom. And all this saving just from several cancer medications and components for cancer drugs.

All this is going on and on and nobody in the United Kingdom blinks an eye. It doesn’t matter how many millions are being wasted on x-ray contracts; or what we revealed on a quick survey of 24 laboratories in one area only who were able to buy their Corona PCR tests at a fraction of the cost reimbursed by the health insurance companies.

Should there be a line between making a profit and profiteering?

Where all do all these billions of pounds end up? In whose pockets? Pockets of politicians and their families, relatives, families friends, ... who are in government? How much went into the pockets of all the shareholders of all this these companies, and who are the shareholders? How much went into the pockets of the pharmacies?

You want to know?

If you are struggling to know who or what to trust, it’s little wonder.

The consequences are real: Democracy is threatened, and in some cases, civil unrest erupt what we are seeing now with all kind of strikes while in some extreme cases even armed conflict might erupt.

To be continued …