Time to Prioritize Pharmacoequity over Profits

By Marion Laurençon

This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.

Merck & Co.

Board of Directors

126 East Lincoln Avenue

P.O. Box 2000

Rahway, NJ 07065 USA



Dear Merck & Co.,

I am writing as a deeply concerned advocate for global health equity, accessible pharmaceutical pricing, and Universal Health Coverage. The Inflation Reduction Act has raised attention to the issue of medicine prices in the United States, and I would like to touch upon a matter of profound importance, insulin pricing.

The new legislation aims to reduce patient costs through Medicare's negotiation authority with drug companies (1). Regrettably, this effort was called a “sham” and a form of “extortion” by your company, raising questions regarding Merck & Co’s commitment to pharmacoequity (1). Merck & Co’s focus on profitability rather than global health equity is deeply disappointing for a pharmaceutical leader.

The company must do better, address its unethical behavior, and recognize the far-reaching consequences of high insulin prices on individuals and society.

Consider the story of Cassie, a 19-year-old Mexican woman forced to work multiple jobs due to the exorbitant cost of insulin. Cassie faces life-threatening situations because she has to ration her insulin due to its high cost.

Her story, narrated in the film "Purple Hearts," underscores the severe consequences of insulin affordability issues (2). Individuals living with diabetes should never face the awful choice of rationing or forgoing insulin due to the added burden imposed by the cost of the medication. Selling life-saving medicines at exorbitant prices contradicts the principle that all individuals, regardless of socioeconomic status, should have the right to access essential medications.

Furthermore, it is essential to acknowledge the rising prevalence of diabetes in the United States. The Centers for Disease Control and Prevention (CDC) report that over 38 million Americans have diabetes, with another 110 million adults having prediabetes (3). The burden of diabetes is not limited to individual patients but extends to the healthcare system, the economy, and society at large. The sale of diabetes medication at prices accessible only to the wealthiest individuals perpetuates a system of oppression and white supremacy that creates barriers to proper diabetes treatment, leading to worsening health outcomes and increased healthcare costs with a disproportionate impact on marginalized communities.

Merck & Co.’s leading diabetes medications, Januvia and Janumet, cost nearly $9,000 per year for people without health insurance coverage (4,5). In a world where everyone should have the right to access life-saving medications, such exorbitant costs are indefensible. Moreover, in the context of insulin pricing, the disparities between the U.S. and international pricing are striking. Insulin, a life-saving medication, is 247% more expensive in the US than in other countries (6). In the context of Merck & Co, Januvia and Janumet, are respectively priced in the U.S. at 1,120% and 790% of the average international price6. These disparities are impossible to justify and demand urgent attention and rectification from Merck & Co.

Merck & Co.’s responsibility extends beyond the United States, with the urgent need to distribute more diabetes medication to LMICs. Christine Ngaruiya, a Professor at Yale University, witnessed a member of her family dying from Diabetic ketoacidosis due to a lack of access to insulin. It is a shame to see that big pharmaceutical companies like Merck & Co. are failing to provide access to essential medicine on not one, but several continents.

Another point I want to address is Merck & Co.’s patents on its Januvia and Janumet diabetes medication (7). The patent regime represents a vast and monstrous economic injustice that prevents countries in need of diabetes medication from saving their populations. A “patent cliff” is coming for big pharma companies in the following years, and if Merck & Co wants to survive in the pharmaceutical industry, it needs to play a key role in facilitating medication access to low-income regions where population survival depends on essential medicine like insulin, antiretroviral drugs, vaccines, and diagnostic testing (8).

Eli Lilly, a well-known pharmaceutical company, sets an admirable ethical example for Merck & Co., emphasizing the fact that pharmaceutical companies can prioritize both patient well-being and profitability. Indeed, Eli Lilly has taken a step in the right direction by cutting insulin prices by 70% (9). This move demonstrates a step back from the profit-centric approach that has been a concern in the pharmaceutical industry. This ethical decision showcases a recognition of the impact of medication affordability on society and the importance of ensuring that life-saving treatments are accessible to all of those who need them, wealthy or not.

The pharmaceutical industry, including Merck, needs to contribute to creating a more equitable healthcare landscape, aligning its influence and resources with the principles of Universal Health Coverage so that all people have access to the quality health services they need, when and where they need them, without financial hardship (10). Addressing insulin pricing disparities is imperative, and I believe Merck has the capacity and responsibility to make progress similar to Eli Lilly.

As an advocate for global health equity, I urge Merck to follow the lead in addressing insulin pricing disparities and advancing ethical pharmaceutical practices. Here are some recommendations for Merck & Co.

  • Follow Eli Lilly's lead and reduce insulin prices by 70%. Merck & Co.'s high annual sales revenues of $5,288 million on Januvia & Janumet highlight the potential for affordability without compromising profitability (11).

  • Commit to transparency in pricing, production costs, and distribution to build trust with patients, healthcare providers, and the public.

  • Collaborate with international organizations, non-profits, and governments to improve insulin access. Such partnerships can help in distributing insulin to underserved regions and populations, aligning with the goal of universal health coverage.

  • Enter agreements with generic drug manufacturers to enable the production of more affordable generic versions of Janumet and Januvia.

I am open to discussing with you how Merck can address these concerns and work toward building equity in global health. I look forward to your response.


Sincerely,


Marion Laurençon

McGill University, PPHS 511 Student

This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.

References

1. Rowland C, Romm T. Merck sues over Medicare price negotiations. Washington Post [Internet]. 2023 Jun 6; Available from: https://www.washingtonpost.com/business/2023/06/06/merck-medicare-price-controls/

2. Flaherty J. ‘Purple Hearts’ Delivers a Realistic, Unforgettable Main Character with Type 1 Diabetes [Internet]. Beyond Type 1. 2022. Available from: https://beyondtype1.org/diabetes-purple-hearts- review/#:~:text=Unable%20to%20pay%2C%20Cassie%20has,burdens%20of%20type%201% 20diabetes.

3. National Diabetes Statistics Report | Diabetes | CDC [Internet]. Available from: https://www.cdc.gov/diabetes/data/statistics-report/index.html

4. Admin, Admin. The world’s top selling diabetes drugs. Pharmaceutical Technology [Internet]. 2016 Mar 29; Available from: https://www.pharmaceutical- technology.com/features/featurethe-worlds-top-selling-diabetes-drugs-4852441/

5. Team S, Team S, SingleCare. How much is Janumet without insurance? [Internet]. The Checkup. 2023. Available from: https://www.singlecare.com/blog/janumet-without- insurance/#:~:text=As%20a%20brand%2Dname%20drug,people%20without%20health%20i nsurance%20coverage.

6. A Painful Pill to Swallow: U.S. vs. International Prescription Drug Prices. Prepared by Ways and Means Committee Staff. 2019 Sep; https://www.cusd.com/Downloads/EBC_013020_US_v_Int_RX_Drug_Prices.pdf

7. Product patents - Merck.com [Internet]. Merck.com. 2022. Available from: https://www.merck.com/products/patent/

8. Gardner J. Big pharma’s looming threat: a patent cliff of ‘tectonic magnitude.’ BioPharma Dive [Internet]. 2023 Feb 21; Available from: https://www.biopharmadive.com/news/pharma-patent-cliff-biologic-drugs-humira- keytruda/642660/

9. Blank C. Sanofi cuts insulin prices, joining Eli Lilly and Novo Nordisk. Drug Topics [Internet]. 2023 Apr 11; Available from: https://www.drugtopics.com/view/sanofi-cuts-insulin-prices- joining-eli-lilly-and-novo-nordisk

10. World Health Organization: WHO. Universal health coverage [Internet]. 2019. Available from: https://www.who.int/health-topics/universal-health- coverage#:~:text=Universal%20health%20coverage%20(UHC)%20means,need%20them%2C

%20without%20financial%20hardship.

11. Merck announces Fourth-Quarter and Full-Year 2022 financial results - Merck.com [Internet]. Merck.com. 2023. Available from: https://www.merck.com/news/merck- announces-fourth-quarter-and-full-year-2022-financial-results/



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