The Pharma Industry: Hard to Swallow
制药业：难以下咽
Cancer drugs are getting better and dearer
抗癌药物变得更有效也更昂贵
The debate in rich countries about the high price of drugs is a furious and frustrating one. The controversy is already having an impact on spending on drugs, suggest new figures from the Quintiles IMS Institute, a research firm. The rate of growth in spending on prescription medicines in America fell to 4.8% in 2016, less than half the average rate of the previous two years (after adjusting for discounts and rebates). Michael Levesque of Moody’s, a rating agency, reckons that pressure over pricing is contributing to a deceleration in earnings growth at pharma firms. Public scrutiny constrains their flexibility over what they can charge and allows payers to get tougher.
富裕国家对高药价的争论趋于白热化且令人沮丧。研究公司昆泰医药信息研究所的新数据表明，这番争议已对药物开支造成影响。2016年，美国处方药开支的增长率下降至4.8%，不到前两年平均水平的一半（已计入折扣及返利）。评级机构穆迪的迈克尔·莱维斯克认为，定价压力导致制药公司盈利增长减速。公众监督限制了它们的定价空间，也使得支付方态度更为强硬。
In one area, however, earnings are expected to keep rising: cancer. Oncology is the industry’s bright spot, says Mr Levesque. The grim fact is that two-fifths of people can now expect to get cancer in their lifetime because of rising longevity. This is one of the reasons why the number of new cancer drugs has expanded by more than 60% over the past decade. The late-phase pipeline of new medicines contains more than 600 cancer treatments. New cancer drugs are being approved more quickly.
然而，有一个领域的收入仍有望继续上涨：抗癌。莱维斯克表示，肿瘤药物是医药行业的亮点。如今，由于寿命延长，一个严酷的现实便是五分之二的人会在生命某个阶段罹患癌症。这是过去十年抗癌新药数量增加超过60%的原因之一。在进入研发后期的新药中，有600多种是抗癌药物。抗癌新药的审批也在加快。
More are arriving all the time. On May 1st, America’s Food and Drug Administration approved durvalumab (trademarked Imfinzi), a drug from AstraZeneca, a British firm, which treats cancer of the bladder. Imfinzi, which has a wholesale price of $180,000 for treatment lasting a year, joins a growing crowd of medicines known as “checkpoint inhibitors”, designed to work on a key molecular target that helps the body’s own immune system to fight cancer. Merck of America has pembrolizumab (Keytruda); Bristol-Myers Squibb has nivolumab (Opdivo); and Switzerland’s Roche has atezolizumab (Tecentriq).
更多新药陆续上市。5月1日，美国食品和药物管理局批准了英国公司阿斯利康（AstraZeneca）研发的膀胱癌药物durvalumab（商品名为Imfinzi），一年期疗程的批发价为18万美元。它作用于关键分子标靶，激发人体自身免疫系统对抗癌症，是日益壮大的免疫检查点抑制剂（checkpoint inhibitors）大军中的一员。其他这类药物有美国默克公司（Merck）的pembrolizumab（商品名为Keytruda）、百时美施贵宝（Bristol-Myers Squibb）的nivolumab（商品名为Opdivo），以及瑞士罗氏（Roche）的atezolizumab（商品名为Tecentriq）等。
These checkpoint inhibitors are expected to account for much of the growth in spending on cancer medicines. Merck, in particular, has done well with Keytruda. A sense of the value of the new drugs came when Opdivo failed a key clinical trial in August last year. The market value of Bristol-Myers Squibb fell by 16%, and its shares have been in the doldrums since.
这些检查点抑制剂将成为抗癌药物支出增长的主力。默克公司的Keytruda表现尤其出色。去年8月，Opdivo的关键临床试验失败，百时美施贵宝的市值下降了16%，其股价自此一蹶不振。新药价值举足轻重，由此可见一斑。
Handsome prices for cancer drugs are far less pleasing for governments, insurers and patients. Even five years ago, most newly-approved treatments had gross annual prices of more than $100,000. But the pressure on budgets has worsened with the new generation of more expensive immuno-oncology drugs, and could become more severe still if they are found to work best in combination with each other.
但对政府、保险公司和病人而言，药价高可不是什么开心的事。即便在五年前，大部分新批准药物一年的药费也要超过十万美元。但随着新一代更昂贵的免疫肿瘤药物面世，预算压力进一步加剧。如果发现这些药品相互配合使用效果最佳，形势还可能更加严峻。
Making a mistake over which cancer drugs to use can be extremely costly for a payer, as illustrated by a disastrous recent attempt by Britain’s government to increase access to new cancer drugs by creating a special fund in 2010. By the time it closed in 2016, £1.27bn ($1.83bn) had been spent, mostly on drugs that were later shown to be ineffective for the conditions they were tried on.
选错抗癌药物可能让买单者付出极为高昂的代价。最近的例子是，英国政府在2010年创立了一个专项基金来增加抗癌新药的使用，结果惨淡收场。到2016年项目结束时，英国政府共花费了12.7亿英镑（18.3亿美元），但后来的情况表明，大部分钱都没有带来疗效。
Some think a better approach would be to try drugs out on patients and for payers to pay a price based on how well they work, an approach known as “value-based pricing”. That would mean collecting a great deal of data from patients, which would be far from straightforward.
有人认为，更好的做法是采用所谓的“价值定价”，即患者试用新药，然后由支付方根据疗效来支付费用。但这意味着要从患者那里收集大量数据，远非简单易行。
Some companies, such as Genentech, a biotech company owned by Roche, are trying to do just this, as are some payers including American health insurers. But however reassuring it is to know that money is going on drugs that are proven to work, it does not solve the broader problem of affordability.
罗氏旗下的生物技术公司基因泰克等企业就在做这方面的尝试，包括美国医疗保险公司在内的一些支付方也在做同样的努力。知道钱是花在有效的药物上，这一点着实令人宽慰，但在更大层面上，吃不起药的问题仍然没有解决。
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