The Aspen Pharmacare laboratory has multiplied the income obtained by five drugs against cancer after removing them in 2014 from the Spanish market and obliging hospitals to acquire them in third countries where the company has managed to impose prices up to 30 times higher, according to documents that EL PAÍS has accessed.
These drugs have no other alternatives and Aspen has maintained for five years a pulse with the Ministry of Health to increase their prices by up to 4,000%. In its strategy, the company came to consider "destroying" whole lots of medicines after months of stock-outs, according to an investigation of the British newspaper. The Times. Health has so far refused to accede to these claims – last time last week – but the high international prices also benefit the pharmaceutical industry.
According to the data obtained by this newspaper, Spanish hospitals today pay 104 euros for each box of chlorambucil -For the treatment of chronic lymphatic leukemia-, 30 times more than the 3.37 euros that it cost in 2014. Busulfan -used for other types of leukemia- is paid today at 244.4 euros, 20 times more than then. Melphalan, useful against several tumors, has multiplied its price 19 times. Thioguanine and mercaptopurine, also indicated against leukemia, are now six and seven times more expensive, respectively. With the last molecule, however, the company came out in 2016 a competitor that sells something cheaper.
Aspen Pharmacare has not answered the information requests of this newspaper. Based in South Africa, the company acquired its batch of drugs in 2009 from GlaxoSmithkline. Soon after, he began to demand large increases in prices from several governments. In an interview made in 2015, the head of the company in Latin America, Carlos Abelleyra, summarized the company's philosophy: "Aspen does not investigate, what has made our growth so strong is that we determine very smartly the needs of certain markets. "
2009 Aspen Pharmacare buys GlaxoSmithKline five drugs against several types of blood cancer.
2012 Internal mail of the company reveal that it aims to increase the income obtained from European public health systems.
2013 Aspen asks the Italian government for an increase of 2,100% and for Spain, of 4,000%. Several countries suffer from stockouts.
April 2014. Aspen withdraws its products from Spain due to the refusal of the Ministry of Health to respond to their requests.
October 2016 Italy fines Aspen with 5 million euros.
February 2017 The Spanish National Commission of Markets and Competition (CNMC) opens an investigation into "abusive practices".
May 2017 The European Commission opens another investigation against Aspen for "unjustifiably raising" prices.
November 2018. The Interministerial Commission of Medicinal Prices of the Spanish Government rejects again Aspen's demands.
In 2013, Aspen had a first confrontation with the Italian government, which refused to multiply the price of the five drugs. During the conflict, the laboratory incurred irregular practices that caused a fine in 2016 with five million euros by the competition authorities of the country.
In Spain, the moments of greatest tension occurred at the end of 2013, when Aspen came to request increases that multiplied by 40 the initial prices, according to health sources. Given the refusal of the Spanish Agency for Medicines and Health Products (Aemps), the company stopped selling its products in the country at the end of April. From that moment, the drugs stopped being sold in the pharmacies and they began to be dispensed by the services of hematology of the hospitals.
In early 2017, the National Commission of Markets and Competition (CNMC) also put the focus on Aspen for "abusive practices". The process was put on hold four months later, when the European Commission announced its own investigation to detect irregular practices in several Member States. The Commission affirms that the process remains open and that it will not report on it until its conclusion.
The blocking situation between Aspen and the Spanish government was dealt with last Friday by the Interministerial Commission on Drug Prices, which studied the latest proposal from the pharmaceutical company. It continues to request an increase that goes from eight to 40 times more than the reference prices of 2014, something that the government once again rejected. The process, nevertheless, follows its course and a period of allegations is open in which the company could present lower prices. Health ensures that it is completing a file that will be sent to the European Commission to be included in its investigation.
All sources consulted admit that Aspen is "an extreme case" in the sector. "The first thing they do is keep the so-called orphan drugs. They are molecules without competition because they are cheap and they do not interest the big laboratories nor the generic manufacturers ", explains a manager of the sector. "Once the monopoly has been achieved de facto, they throw a pulse to the health authorities. They almost always win it because they manage to raise prices or withdraw from that market to divert purchases to others where they have gone up, "adds this source.
Francesc Bosch, chief of Hematology at the Vall d'Hebron Hospital in Barcelona, explains that "although there are now more modern, effective and expensive treatments, chlorambucil and other Aspen drugs are still essential." "They serve for those patients in whom it is more sought to slow down the progression of the disease than to cure it, since it is not indicated to subject them to the most aggressive treatments," he adds. Bosch is very critical of these practices: "We must dedicate the money to research and clinical practice. All this does nothing but create problems for doctors and patients. "
Ramón García Sanz, president-elect of the Spanish Society of Hematology and Hemotherapy, shares this vision, but also points to "the low reference prices in Spain." "Something we are doing wrong when nobody is interested in making a medicine that is still necessary. This creates the conditions for some companies to carry out this type of practice, "he concludes.
Since 2013, the pharmaceutical company Aspen Pharmacare has maintained an intense conflict with the Spanish Ministry of Health. The company started asking for an increase in prices close to 4,000% and ended up withdrawing them from the Spanish market, in April 2014, when their claims were not met. The reason alleged by Aspen was that he could not continue selling in Spain because the prices set by Health were unsustainable.
However, an investigation of the British newspaper The Times, who had access to internal emails of the company, unveiled its aggressive strategy a year ago. A message, dated October 2014, shows that, despite the company's assertion, Aspen Pharmacare still had significant stocks of drugs in Spain that it was not available for sale. An employee asked what to do with them and the response of a senior executive was that "the only alternative is to destroy them or donate them".
The messages reveal that, as of 2012, Aspen set itself the target of large price increases that governments paid for their drugs. In the following months, Germany, Spain, Italy, Belgium and Greece, among other countries, suffered supply problems.