Emma's palbociclib campaign - your questions answered!

What is Palbociclib (Ibrance)?
Palbociclib, also known by brand name Ibrance, is a treatment for patients with advanced breast cancer that is HR (hormone receptor) positive and HER2 (human epidermal growth factor) negative. This means that the cancer cells respond to the hormones oestrogen and progesterone, which help the tumour grow. 

Marketed by drug company Pfizer, palbociclib is given in combination with a hormone therapy treatment, such as letrozole (Femara), anastrozole (Arimidex) or fulvestrant (Faslodex), which blocks the effect of oestrogen and progesterone on the cancer cells or decreases their production. 

Palbociclib specifically targets cancer cell proteins CDK4 and CDK6, which are involved in uncontrolled growth of the tumour. This means that it stalls cancer progression but doesn’t actively kill the cells.

How effective is Palbociclib?
Palbociclib is a highly effective treatment, stopping cancer growth for an extra 10 months on average and potentially also increasing the overall likelihood of survival. Clinical trials were even stopped early because the benefit of the drug over other treatment options was so clear.
As with all cancer medications, there is a risk of side effects, which you can find out more about here. However, only a small proportion (4%) of patients needed to stop taking the drug because of these reactions. 

Patients being treated with palbociclib are living longer, with a better quality of life compared to patients on the current standard treatment of an aromatase inhibitor or chemotherapy. However, the drug, which could be benefitting up to 7,000 patients across the UK each year, is not currently available on the NHS.

Why is the drug not available on the NHS?
Palbociclib is not available on the NHS at the moment because of the high price Pfizer is charging for it. The drug failed the initial approval process because NICE, the government body that determines whether drugs should be available on the NHS, decided that the drug was too expensive for the benefit that it brings patients. 

NICE is currently reviewing its decision and negotiating a new price with Pfizer. The result is still pending but is expected to be announced in November 2017. If NICE decides to make the drug available on the NHS in England, it is likely to also become available for patients in Wales and Northern Ireland. Scotland’s drug decision body, the Scottish Medicines Consortium (SMC) is also reviewing the drug and we expect a decision from them in December.

“When a drug is refused by NICE there’s only one reason it’s refused - the company has knowingly overpriced the drug”
— Prof Richard Sullivan, Professor of cancer and global health at King’s College London.

How much does the drug really cost?
Pfizer is currently charging £140 per pill or £38,482 per patient per year, despite the fact the drug could be made and sold at a profit by the company for £1 a pill. Generic manufacturers currently supply the active pharmaceutical ingredient in small quantities for use in research for less than 60p per pill. Manufacturing a generic version for use on the NHS would result in some extra costs due to regulatory processes, but also significant economies of scale - so £1 a pill is a good estimate for a price that would cover the cost of production and allow a fair profit margin.

In 2015 and 2016, Pfizer made over £2 billion from the sale of just this one drug because of the extortionate price they are charging cancer patients and health services. Their justification for this is the pharmaceutical industry claim that it costs $2.87 billion to research and develop a new drug, a figure former drug company CEO Andrew Witty called “one of the greatest myths of the industry”. More recent estimates however suggest it costs less than $200 million to develop a new drug from scratch.

Why won’t the NHS pay what Pfizer is charging?
The reason the NHS won’t pay Pfizer’s price for the drug is because the high price tag would put the NHS under massive financial pressure. However, here at Just Treatment, we know that Pfizer is knowingly overcharging our health service. Pfizer knows that many patients are desperate for palbociclib because it could halt the progression of their cancer and so they charge as much as they think they are able to get away with.

NICE has a very difficult job in deciding what is a cost effective use of the finite NHS resources. Prices for cancer and other drugs are escalating, and over the past 5 years NHS spending on medicines has increased by 29% or £3.8bn. This rise is equal to twice the current NHS deficit and poses a real threat to the financial security of our health service. 

The price Pfizer want to charge for palbociclib would inevitably mean the NHS would have to cut back on other treatments and services available to patients so it is crucial we get a lower price for the drug.

How do we solve this problem? What can I do about this?

There are two main ways that we can solve this problem:

  1. Get Pfizer to drop the price of the drug. Emma is a Just Treatment leader and takes palbociclib to treat her secondary breast cancer. She is campaigning to get Pfizer to drop the price of palbociclib to £1 a pill so that every patient who needs the drug can access it. This week, she wrote to Pfizer’s UK boss, Erik Nordkamp, and asked him for a meeting so that she can present her petition to him. Over 18,000 people have signed it so far and you can join her and the rest of the Just Treatment team to hand it in within the next few weeks.
“It makes me really sad and incredibly angry actually that a private company can hold the NHS to ransom like that”
— Emma, Just Treatment

2. Push the government to issue a Crown Use License on the drug. A Crown Use License is a way that the government can overturn a company’s patent on a drug if there is dire need for it. It has been used a number of times in the past and would mean that palbociclib would be available to the NHS at a drastically lower price. This would save taxpayers money and mean that all 7,000 patients who need the drug every year would be able to access it.

We can no longer let Pfizer play with patients’ lives. They have already made huge amounts of money from sales of the drug and it is now time that it was fully available to all patients who need it on the NHS.

Elizabeth Baines