In his management classic named, ‘The Practice of management’, published in 1954, the universal management guru Peter Drucker postulated that any successful business is driven by only the following two fundamental functions:

• Marketing
• Innovation

…and all the rests are costs. Drucker’s above postulation is as valid today as it has been in the past for so many decades. Cutting edge expertise in managing innovation, which may not necessarily mean the Intellectual Property Rights (IPR), and marketing the same better than competition will continue to remain the name of the game for business excellence, perhaps in all time to come, across the world and India is no exception. No doubt, for the same reason the current decade has been termed as ‘the decade of innovation’ by none other than the Prime Minister of India.

The innovators’ financial and non-financial claims on the fruits of value-adding creations following the prescribed inventive steps is epitomized in the IPR, which confers a legal protection to the innovator based on the relevant national IP Act of individual countries. Any successful innovation will give rise to meeting an unmet need with innovative products or services for doing things more efficiently and effectively than ever before.

Excellence in the financial performance of business organizations driven by innovation is expected to keep this wheel of progress moving with optimal speed in perpetuity. Thus, innovation must be encouraged through appropriate legal protection of IP, creating a win-win socioeconomic environment for a country.

Why protect patent? 

The pharmaceutical major Eli Lilly had very aptly summarized the reason for patent protection in their website called ‘LillyPad’, as follows:

“Pharmaceutical companies continue to invest in innovation not only because it is good for business, but it is what patients expect. If we want to continue to have breakthrough products, we need patent protection and incentives to invest in intellectual property.  The equation is simple, patents lead to innovation – which help lead to treatments and cures”.

Positive impact of an IPR regime:

In a paper  titled “Strengthening the Patent Regime: Benefits for Developing countries – A Survey”, published in the Journal of Intellectual Property Rights, the authors concluded that innovativeness of developing countries has now reached a stage where it is positively impacted by a robust Intellectual Property regime. The authors further stated that a robust patent ecosystem is among other important policy variables, which affect inflow of Foreign Direct Investments (FDI) in the developing nations.

Another paper titled, “The Impact of the International Patent system in the Developing Countries”, published by the ‘World Intellectual Property Organization (WIPO)’, though a bit dated of October 2003, states that a robust national patent system in developing countries contributes to their national socioeconomic development.  The paper also highlights the experience of some developing nations, which found usefulness of a strong patent system in creation of wealth for the nation.

IPR debate is not non product exclusivity: 

It is important to understand, though a raging debate is now all pervasive related to the level of IPR protection for drugs, across the world, there has not been many questions raised by most stakeholders on the exclusive rights on patents by the innovators. The center piece of the arguments and counter-arguments revolves predominantly around responsible pricing of such IPR protected medicines affecting patients’ access.

Need to go beyond IPR: 

Echoing similar sentiments in the Indian context the Global CEO of GSK commented in October 18, 2012 that while intellectual property protection is an important aspect of ensuring that innovation is rewarded, the period of exclusivity in a country should not determine the price of the product. Witty said, ‘At GSK we will continuously strive to defend intellectual property, but more importantly, defend tier pricing to make sure that we have appropriate pricing for the affordability of the country and that’s why, in my personal view, our business in India has been so successful for so long.’

Is this view shared by all in the global pharma industry? 

Not really. All in the global pharmaceutical industry does not necessarily seem to share the above views of Andrew Witty and believe that to meet the unmet needs of patients, the Intellectual Property Rights (IPR) of innovative products must be strongly protected by the governments of all countries putting in place a robust product patent regime and the pricing of such products should not come in the way at all.

The industry also argues that to recover high costs of R&D and manufacturing of such products together with making a modest profit, the innovator companies set a product price, which at times may be perceived as too high for the marginalized section of the society, where government intervention is required more than the innovator companies. Aggressive marketing activities, the industry considers, during the patent life of a product, are essential to gain market access for such drugs to the patients.

In support of the pharmaceutical industry the following argument was put forth in a recent article:

“The underlying goal of every single business is to make money. People single out pharmaceutical companies for making profits, but it’s important to remember that they also create products that save millions of lives.”

IPR, product price and patients’ access: 

In the paper titled ‘TRIPS, Pharmaceutical Patents and Access to Essential Medicines: Seattle, Doha and Beyond’, published in ‘Chicago Journal for International Law, Vol. 3(1), Spring 2002’, the author argues, though the reasons for the lack of access to essential medicines are manifold, there are many instances where high prices of drugs deny access to needed treatments for many patients. Prohibitive drug prices, in those cases, were the outcome of monopoly due to strong intellectual property protection.

The author adds, “The attempts of Governments in developing countries to bring down the prices of patented medicines have come under heavy pressure from industrialized countries and the multinational pharmaceutical industry”.

While the ‘Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS)’ of the World Trade Organization (WTO) sets out minimum standards for the patent protection for pharmaceuticals, it also offers adequate safeguards against negative impact of patent protection or its abuse in terms of extraordinary and unjustifiable drug pricing. The levels of these safeguards vary from country to country based on the socioeconomic and political requirements of a nation. 

The Doha Declaration:

Many independent experts in this field consider the Doha Declaration as an important landmark for recognizing the primacy to public health interest over private intellectual property and the rights of the members of WTO to use safeguards as enumerated in TRIPS, effectively. To protect public health interest and extend access to innovative medicines to majority of their population whenever required, even many developed/OECD countries do not allow a total freehand for the patented products pricing in their respective countries. 

How much then to charge for an IPR protected drug? 

While there is no single or only right way to arrive at the price of an IPR protected medicine, how much the pharmaceutical manufacturers will charge for such drugs still remains an important, yet complex and difficult issue to resolve, both locally and globally.

A paper titled, “Pharmaceutical Price Controls in OECD Countries”, published by the US Department of Commerce, after examining the drug price regulatory systems of 11 OECD countries concluded that all of them enforce some form of price controls to limit spending on pharmaceuticals. The report also indicated that the reimbursement prices in these countries are often treated as de facto market price. Moreover, some OECD governments regularly cut prices of even those drugs, which are already in the market. 

An evolving rational system for responsible pricing of IPR protected drugs:

The values of health outcomes and pharmacoeconomics analysis are gaining increasing importance for drug price negotiations/control by the healthcare regulators even in various developed markets of the world to ensure responsible pricing of IPR protected medicines.

In countries like, Australia and within Europe in general, health outcomes data analysis is almost mandatory to establish effectiveness of a new drug over the existing ones.

Even in the US, where the reimbursement price is usually negotiated with non-government payors, many health insurers have now started recognizing the relevance of these data.

Such price negotiations at times take a long while and may also require other concessions by manufacturers, just for example:

• In the UK, a specified level of profitability may constrain the manufacturers.
• Spain would require a commitment of a sales target from the manufacturers, who are made responsible to compensate for any excess sales by paying directly to the government either the incremental profit or by reducing the product price proportionately. 

Metamorphosis in Pharmaceutical pricing models:
Pharmaceutical pricing mechanism is undergoing significant metamorphosis across the world. The old concept of pharmaceutical price being treated as almost given and usually determined only by the market forces with very less regulatory scrutiny is gradually but surely giving away to a new regime. Currently in many cases, the prices of patented medicines differ significantly from country to country across the globe, reflecting mainly the differences in their healthcare systems and delivery, along with income status and economic conditions.

Global pharmaceutical majors, like GSK and Merck (MSD) have already started following the differential pricing model, based primarily on the size of GDP and income status of the people of the respective countries. This strategy includes India, as well.

Reference pricing model is yet another such example, where the pricing framework of a pharmaceutical product will be established against the price of a reference drug in reference countries.

The reference drug may be of different types, for example:

1. Another drug in the same therapeutic category
2. A drug having the same clinical indications available in the country of interest e.g. Canada fixes the drug prices with reference to prices charged for the same drug in the US and some European Union countries. 

Responsible pricing in the changing paradigm:

Taking note of the above scenario, while looking at the big picture, the global pharmaceutical players, experts believe, should take note of the following factors while formulating their India-specific game plan to be successful in the country without worrying much about invocation of Compulsory License (CL) for not meeting ‘Reasonably Affordable Price’ criterion, as provided in the Patents Act of the country:

• While respecting IPR and following Doha declaration, the government focus on ‘reasonably affordable drug prices’ will be even sharper due to increasing pressure from the Civil Society, Indian Parliament and also from the Courts of the country triggered by ‘Public Interest Litigations (PIL)’
• India will continue to remain within the ‘modest-margin’ range for the pharmaceutical business with marketing excellence driven volume turnover.
• Although innovation will continue to be encouraged with IPR protection, the amended Patents Act of India is ‘Public Health Interest’ oriented, including restrictions on patentability, which, based on early signals, many other countries are expected to follow as we move on.
• This situation though very challenging for many innovator companies, is unlikely to change in the foreseeable future, even under pressure of various “Free Trade Agreements (FTA)”.  

Many global companies are still gung-ho about India:

Despite above scenario, many global companies like GSK are reportedly still quite gung-ho about India as evident in the following recent statement of their Global CEO, Andrew Witty:

“I am a huge bull on India and I have a very strong sense of optimism about the future potential of this country. Of course, there continues to be policy uncertainties in certain areas of government decision-making, particularly in pharma. While there are the areas under question, but the overall picture makes you feel positive about India.”

Late 2011, echoing similar sentiment the Global CEO of Sanofi and now the ‘President Elect’ of the European Pharmaceutical Association EFPIA commented as follows:

“I do not want us to be a colonial company with a colonial approach where we say we decide on the strategy and pricing. If you have to compete locally then the pricing strategy cannot be decided in Paris but will have to be in the marketplace. People here will decide on the pricing strategy and we have to develop a range of products for it.”

Recognition of national healthcare priorities:

It may be prudent to recognize and accept that a paradigm change is taking place, slowly but surely, in the way pharmaceutical businesses are conducted in India, where replication of any western business model could be counterproductive. The strategy has to be India specific, accepting the priorities of the countries. 

Be a part of the solution process:

To achieve excellence in the pharmaceutical market of India, there is a dire need for all stakeholders to join hands with the Government, without further delay, to contribute with their global knowledge, experience and expertise to help resolving the critical issues of the healthcare sector of the nation. This will help demonstrating that the global pharmaceutical industry is extending its hands to be a part of the healthcare solution process of India, like:

• Creation and modernization of healthcare infrastructure leveraging IT
• In the implementation of ‘Universal Health Coverage’ project
• Reaching out to help formulate win-win regulatory policies
• Help Creating employable skilled manpower
• Ensure availability of reasonably affordable medicines for the common man through a robust government procurement and delivery system

Right attitude of all stakeholders to find a win-win solution for all such issues, instead of adhering to the age-old blame game in perpetuity, as it were, without conceding each others’ ground even by an inch, is of utmost importance at this hour.

In this rapidly changing scenario, the name of the game for all players of the industry, both global and local, I believe, is recognition of the changing socioeconomic environment and market dynamics of India, active engagement in its paradigm changing process and finally adaptation to the countries changing aspirations and priorities to create a win-win situation for all. 

Government should reach out:

It is high time for the Government of India, I reckon, to also reach out for reaping a rich harvest from the emerging lucrative opportunities, coming both from within and the outside world in the healthcare space of the country. Effective utilization of these opportunities, in turn, will help India to align itself with the key global healthcare need of providing reasonably affordable healthcare to all, despite a robust IPR protected regime across the world. 

Conclusion:

While encouraging innovation and protecting it with an effective IPR regime is very important for any country, no nation can afford to just wish away various socioeconomic expectations, demands and requirements not just of the poor, but also of the powerful growing middle class intelligentsia, as gradually getting unfolded in many parts of the globe.

At the same time, it should be recognized by all that there should be full respect, support and protection for innovation and the IPR system in the country. This is essential not only for the progress of the pharmaceutical industry, but also to alleviate sufferings of the ailing population of the country, effectively.

Having said that, available indicators do point out that the civil society would continue to expect in return just, fair, responsible and reasonably affordable prices for the innovative medicines, based on the overall socioeconomic status of the local population. It is, therefore, now widely believed that pharmaceutical products, which play a pivotal role in keeping the population of any nation healthy and disease free to the extent possible, should not be exploited by anyone.

Pharmaceutical companies are often criticized in this area by those stakeholders who claim to be genuinely concerned with the well-being of particularly the underprivileged population across the world.

Some experts have already opined that prices of IPR protected drugs will no longer remain ‘unquestionable’ in increasing number of countries. In that scenario, responsible pricing may, therefore, emerge as the ‘Final Frontier’ to address the conundrum of a robust IPR protected regime in India.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.