The Band Marches On
However, whether the pharma industry in Europe chooses to trumpet its views or not on the transparency directive, and whatever
its motivations, the consultation is going ahead, and a brief glance at the substance is not altogether out of place.
The primary formal rationale for the consultation is, as the EU itself spells out, that "pricing and reimbursement measures
can affect the capacity of pharmaceutical companies to sell their products in national markets and are, therefore, susceptible
to create barriers to trade within the EU."
Barriers to trade are anathema in the EU—in principle anyway (although pharma is not the only sector to still be hindered
by them, even decades after the so-called single market was so-called completed). So the official aim of the transparency
directive is, in the EU's own words, to "limit the potential impact of such national measures on the internal market."
And since, as the EU admits, "National policies to control pharmaceutical expenditure have considerably evolved," now it is
time, it goes on, to seek input into its reflections on "consistency between the directive and the current policy environment."
The consultation itself consists of a lengthy series of detailed questions on discrimination between domestic and imported
products, speed and transparency of pricing and reimbursement decisions, availability of legal remedies, effectiveness of
sanctions for non-compliance by national authorities, access to medicines for patients, and the competitiveness of the pharmaceutical
industry. This is not the place to rehearse them—the consultation is available here: http://bit.ly/PublicConsult.
But the impression given by the questionnaire is not entirely neutral. It makes a reference, for instance, to the pharmaceutical
sector inquiry of 2008, which the innovative industry still feels was an unwarranted intrusion into the world of patent licensing,
driven by an ideological determination to promote generic medicines.
Similarly, the questions relating to how the EU might have a greater role in assessing incentives to increase generic use
or to comply with global prescription budgets strikes an unwelcome chord with those suffering interventionist measures to
massage downward the value of the pharmaceutical market. And the anodyne reference to the "considerable evolution" of national
policies hardly does justice to the near-calamitous meltdown of economic conditions in many of Europe's major drug markets.
Tajani's own remarks, when he announced the consultation, did nothing to inspire confidence. When he spoke about "rejuvenating
the existing framework," he carefully made the point that "transparency in pricing and reimbursement procedures" can "help
diminish the strain on public health budgets."
Who Conducts the Power
But the clincher in industry distrust of, and distaste for, the entire exercise may well lie in the consultation's own circumscription
of its scope.
"It must be emphasized that any initiative of the Commission to update the existing regulatory framework shall respect the
responsibilities of the member states in the area of pricing and reimbursement," the consultation document says.
The document loudly and clearly confirms that, "Member states are competent for the definition of their health policies and
for the organization and delivery of health services and medical care. Their responsibilities include the allocation of resources
assigned to healthcare." Consequently, it goes on, "national or regional authorities have competence to determine the procedures
and conditions under which medicinal products are priced and financed by their health insurance system."
Expressed in simple terms, this is an unquestioning acceptance that the EU is largely powerless over the decisions that its
member states make in this area.
Respondents are invited by the consultation "to focus their comments on aspects related to the actual objectives of the directive."
But any issues falling within the scope of national competence—such as national policies and the capacity of member states
to make their own pricing and reimbursement decisions—"will not be addressed in the framework of the present initiative,"
So the bottom line of the Trappist-like hesitancy to discuss the consultation may not be a conspiracy of silence, but merely
a pragmatic response based on the melancholy reflection that this is no more than—to misquote a famous headline—a small earthquake
in Brussels, not many changes.
Reflector is Pharm Exec Europe's anonymous columnist, a commentator so close to the action in Europe that his identity must remain secret