Indication-wide drug pricing: Insights from the pharma market

Background

Pharmaceutical spending has been increasing rapidly for years and is higher than ever before. To control the rising costs, countries are implementing regulatory frameworks such as (internal) reference pricing, price cuts or generics substitution. Internal reference pricing establishes a reference price within a country which serves as the maximum level of reimbursement for a group of pharmaceuticals. Price setting in the German market is especially relevant for many European countries, which use Germany as a reference country for their own price setting.

Methods

We evaluate pharmaceutical price dynamics for not reference priced pharmaceuticals (NRPs) as well as for reference priced pharmaceuticals (RPs) in Germany—referring to the internal reference price system. 64,862 medication packs have been extracted from the German pharmaceutical pricing register Lauer-Taxe. For each pack, we extracted detailed data on the company, manufacturer rebates, pharmacy retail prices, reference prices, co-payments, import quotas, and discount agreements. We then investigated price setting and dynamics of NRPs vs. RPs for all 14 indication areas by ATC code level 1.

Results

The average manufacturer price per pack was 604.84€ for NRPs and 112.11€ for RPs. Similar differences were found for the wholesale price and the pharmacy retail price. The reference price was—as expected—0.00€ for NRPs, and 154.40€ for RPs. NRP packs were imported in 42.38%, while RP packs were imported only in 24.62%. Highest average pharmacy retail prices could be found in the therapeutic areas ‘antineoplastic and immunomodulating agents’ (1711.47€), ‘systemic hormonal preparations’ (1331.95€), and ‘blood and blood forming organs’ (1260.58€). We detected high fluctuations in pharmacy retail prices per indication, as well as for reference prices per indication. The indications with the highest number of reference price regulated medical packs are ‘cardiovascular system’, ‘musculo-skeletal system’, and ‘nervous system’. Highest co-payments were found in the indications ‘antineoplastic and immunomodulating agents’, ‘blood and blood forming organs’, and ‘antiinfectives for systemic use’.

Conclusion

Price setting and price dynamics vary substantially between NRP and RP medication packs. Further, we saw major differences across all indication areas as well as when comparing medication packs launched by top 20 pharma companies vs. the rest.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00451-x.

Dynamic analysis of a dual-channel closed-loop supply chain with fairness concerns under carbon tax regulation

In this work, we study a dual-channel closed-loop supply chain (CLSC) where the manufacturer sells the new products via one fair caring retailer in the traditional channel and distributes the remanufactured products through her own direct channel in the presence of the carbon tax regulation. After solving the single-period Stackelberg game model by backward induction and analyzing the impacts of key parameters on the optimal pricing strategies and the performance of channel members, a multi-period dynamic Stackelberg game model with heterogeneous players is further established. The local stability of the Nash equilibrium point and complexity properties of the model are investigated by numerical simulation. The results reveal that (1) the retailer's fairness concern degree is negatively related to the optimal wholesale price as well as positively related to the optimal retail price of the new product. A high level of consumer discount perception for the remanufactured product is conducive to the manufacturer obtaining more profits while it is detrimental to the retailer. (2) The excessive value of the price adjustment speed, carbon tax rate or retailer's fairness concern degree has a strong destabilization effect on the system's stability. (3) The manufacturer suffers profit loss while the retailer's utility levels are elevated when the system falls into periodic cycles and chaotic motions. (4) The delay feedback control method can eliminate the chaos effectively in the dual-channel CLSC system.

Designing an optimization model for green closed-loop supply chain network of heavy tire by considering economic pricing under uncertainty

The conditions of global competition and environmental sensitivities have made organizations and factories to collect returned products, in such a way that these organizations have tried to rehabilitate, recycle, or destroy these products in order to protect the environment. This paper propose a mathematical model for the green closed-loop supply chain network of heavy tire by considering the economic pricing of its products under conditions of uncertainty, which economically determines the price and leads to more profitability. In addition, the relevant model is a two-objective fuzzy model, the first objective of which is to minimize costs and maximize profits, and the second objective is to minimize environmental issues. The proposed model can also determine the optimal location of each center based on potential locations, the optimal amount of production, distribution, collection, recycling, as well as the reproduction of products. The ε-constraint method is used to solve the model with two objective functions; this method ensures strong Pareto optimal answers and prevents weak Pareto answers. Independent two-sample t-test is used to verify the results of certain and uncertain models in the studied model. In order to evaluate the effectiveness and profitability of the proposed method, a case study in the field of heavy tires is finally used, through which very useful results are obtained.

Enhancing access to innovative cancer drugs: Cross-sector consensus on a way forward to benefit patients

New discoveries and technologies are driving major advances in our understanding of cancer and underpinning a new era of precision medicine and immunotherapy. However, advances in treatment have been uneven: whereas survival rates for some common cancers are improving rapidly, for others there has been much less progress. In addition, healthcare systems are finding it difficult to provide access to expensive new treatments. There is an urgent need for imaginative policy solutions to incentivise the creation of novel therapies that address the full range of cancer-causing mechanisms. We have worked with organisations across the medical research community to develop consensus statements on how to enhance access to innovative cancer drugs. Here, we present our reflections on these statements.

Value-based pricing for advanced therapy medicinal products: emerging affordability solutions

The emergence of advanced therapy medicinal products (ATMPs), a disruptive class of health technologies, is generating important challenges in terms of value assessment and their high prices introduce critical access and affordability concerns. The aim of this article is to analyze the challenges of traditional value assessment and price and reimbursement methods in the evaluation of ATMPs and to characterize the current and prospective financing solutions that may ensure patient access and affordability for these health technologies. Standard Health Technology Assessment (HTA) is not designed for ATMPs, and may delay access to these health technologies, thus a broader concept of value is required. As a consequence, value-based pricing methodologies have been gaining terrain to cope with the specific challenges of ATMPs. The pricing and reimbursement framework should ensure the balance between encouragements to innovation and maximization of value for money for payers, through the attribution of a fair price to new health technologies. Early scientific advice by regulatory and HTA bodies to developers is key, as it will contribute to diminish the perspective gap between developers, regulators and payers. The high efficacy/high price dynamic of many advanced therapies will demand novel financing models, both in the EU and US. Managed entry agreements (MEA), with financing being conditional to the submission of additional evidence, associated with methods of leased payments, may offer effective strategies to address the uncertainties caused by the evidence gap associated with ATMPs, ensuring affordable and sustained access.

Virtual currencies: different schemes and research opportunities

The digitization of money has led to the emergence of numerous virtual currencies. Despite their great financial relevance, virtual currencies have not received much attention in marketing research. We classify virtual currencies into three different schemes and highlight potential factors that influence consumer behavior related to these new payment methods. This article provides marketing researchers with a research framework as well as specific research questions to initiate discussions and future research on this novel topic.

Online revenue maximization for server pricing

Efficient and truthful mechanisms to price resources on servers/machines have been the subject of much work in recent years due to the importance of the cloud market. This paper considers revenue maximization in the online stochastic setting with non-preemptive jobs and a unit capacity server. One agent/job arrives at every time step, with parameters drawn from the underlying distribution. We design a posted-price mechanism which can be efficiently computed and is revenue-optimal in expectation and in retrospect, up to additive error. The prices are posted prior to learning the agent's type, and the computed pricing scheme is deterministic, depending only on the length of the allotted time interval and on the earliest time the server is available. We also prove that the proposed pricing strategy is robust to imprecise knowledge of the job distribution and that a distribution learned from polynomially many samples is sufficient to obtain a near-optimal truthful pricing strategy.

Social distancing in public transport: mobilising new technologies for demand management under the Covid-19 crisis

Dense urban areas are especially hardly hit by the Covid-19 crisis due to the limited availability of public transport, one of the most efficient means of mass mobility. In light of the Covid-19 pandemic, public transport operators are experiencing steep declines in demand and fare revenues due to the perceived risk of infection within vehicles and other facilities. The purpose of this paper is to explore the possibilities of implementing social distancing in public transport in line with epidemiological advice. Social distancing requires effective demand management to keep vehicle occupancy rates under a predefined threshold, both spatially and temporally. We review the literature of five demand management methods enabled by new information and ticketing technologies: (i) inflow control with queueing, (ii) time and space dependent pricing, (iii) capacity reservation with advance booking, (iv) slot auctioning, and (v) tradeable travel permit schemes. Thus the paper collects the relevant literature into a single point of reference, and provides interpretation from the viewpoint of practical applicability during and after the pandemic.

Social distancing in public transport: mobilising new technologies for demand management under the Covid-19 crisis

Dense urban areas are especially hardly hit by the Covid-19 crisis due to the limited availability of public transport, one of the most efficient means of mass mobility. In light of the Covid-19 pandemic, public transport operators are experiencing steep declines in demand and fare revenues due to the perceived risk of infection within vehicles and other facilities. The purpose of this paper is to explore the possibilities of implementing social distancing in public transport in line with epidemiological advice. Social distancing requires effective demand management to keep vehicle occupancy rates under a predefined threshold, both spatially and temporally. We review the literature of five demand management methods enabled by new information and ticketing technologies: (i) inflow control with queueing, (ii) time and space dependent pricing, (iii) capacity reservation with advance booking, (iv) slot auctioning, and (v) tradeable travel permit schemes. Thus the paper collects the relevant literature into a single point of reference, and provides interpretation from the viewpoint of practical applicability during and after the pandemic.

Comparing Costs and Outcomes of Treatments for Irritable Bowel Syndrome With Diarrhea: Cost-Benefit Analysis

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most expensive gastroenterological conditions and is an ideal target for developing a value-based care model. We assessed the comparative cost-benefit of treatments for IBS with diarrhea (IBS-D), the most common IBS subtype from insurer and patient perspectives.

METHODS

We constructed a decision analytic model assessing trade-offs among guideline-recommended and recently FDA-approved drugs, supplements, low FODMAP diet, cognitive behavioral therapy (CBT). Outcomes and costs were derived from systematic reviews of clinical trials and national databases. Health-gains were represented using quality-adjusted life years (QALY).

RESULTS

From an insurer perspective, on-label prescription drugs (rifaximin, eluxadoline, alosetron) were significantly more expensive than off-label treatments, low FODMAP, or CBT. Insurer treatment preferences were driven by average wholesale prescription drug prices and were not affected by health gains in sensitivity analysis within standard willingness-to-pay ranges up to $150,000/QALY-gained. From a patient perspective, prescription drug therapies and neuromodulators appeared preferable due to a reduction in lost wages due to IBS with effective therapy, and also considering out-of-pocket costs of low FODMAP food and out-of-pocket costs to attend CBT appointments. Comparative health outcomes exerted influence on treatment preferences from a patient perspective in cost-benefit analysis depending on a patients' willingness-to-pay threshold for additional health-gains, but health outcomes were less important than out-of-pocket costs at lower willingness-to-pay thresholds.

CONCLUSIONS

Costs are critical determinants of IBS treatment value to patients and insurers, but different costs drive patient and insurer treatment preferences. Divergent cost drivers appear to explain misalignment between patient and insurer IBS treatment preferences in practice.

Advantages of 3PLs as healthcare supply chain orchestrators

Given the expansion of the COVID-19 cases and the average infection rate globally, constructing a robust healthcare supply chain system for the crisis is highly crucial. The third-party logistics providers (3PLs), who can match the market demand with reliable manufacturers worldwide, have emerged as orchestrators. In addition to the basic transportation and storage services, some 3PLs can also provide procurement assistance to relatively small retailers. To illustrate the value of the above-mentioned business model, we build a game-theoretic model to capture participants' optimal strategy in a healthcare supply chain consisting of a manufacturer, a 3PL provider, and a retailer. We also investigate the conditions where the performance in this business model outperforms the traditional model. It is concluded that the 3PL's positive effect appears when the decentralized supply chain is characterized by high logistics outsourcing costs and high-level price sensitivity. We further design an incentive mechanism that can coordinate the supply chain. Finally, a series of numerical experiments are carried out to demonstrate the effectiveness of our model.

Variables affecting pricing of orphan drugs: the Italian case

Background and aim

Evidence on determinants of prices for orphan medicines is scarce and not available for Italy. The aim of this paper is to provide an evidence on variables affecting the annual treatment cost of orphan drugs in Italy, testing the hypothesis of a negative correlation with the dimension of the target population and a positive correlation with the added therapeutic value of the drug and the quality of the evidence of pivotal studies.

Methods

Drugs with a European orphan designation reimbursed in Italy in the last 6 years (2014–2019) were considered. Univariate, cluster analysis and multiple regression models were used to investigate the correlation between the annual treatment cost and, as explanatory variables, the dimension of the target population, the existence of Randomized Clinical Trials as a proxy of the quality of the pivotal studies, the added therapeutic value.

Results

In the univariate analysis prevalence and added therapeutic value, as expected, have a negative and positive correlation with cost respectively. The correlation with RCT is not significant. In the multivariate model, coefficients for prevalence and added value are confirmed but for the latter are not significant anymore. We also found, through an interaction analysis, that the existence of an RCT has a positive impact on annual treatment cost when the target population is very small.

Conclusions

Our results suggest that value arguments and sustainability (dimension of the target population and its impact on budget impact) issues are considered for orphan drugs pricing: the role played by sustainability is systematically supported by our results. A more transparent and reproducible price negotiation process for orphan drugs is needed in Italy. This paper has contributed to highlight the implicit drivers of this process.

Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa

BACKGROUND

Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost needs to be assessed.

OBJECTIVES

To assess the prices of cancer medicines for the three most common cancers ((breast, prostate and colorectal) in the private healthcare sector of South Africa.

METHODS

The methodology was adapted from the World Health Organization (WHO)/ Health Action International (HAI) methodology for measuring medicine prices. The Single Exit Price (SEP) variations between product types of the same medicine between the highest- and lowest-priced product and between Originator Brand (OB) and its Lowest Priced Generic (LPG) of the same medicine brand was compared, as of March 2020. The affordability of those medicines for cancer usage based on treatment affordability in relation to the daily wage of the unskilled Lowest-Paid Government Worker (LPGW) was also determined. Also, a comparison of the proportion of the population below the poverty line (PL) before (I_pre) and after (I_post) procurement of the cancer medicines was determined.

RESULTS

SEP Price differences ranged from 25.46 to 97.33% between highest- and lowest-priced products and a price variation of 72.09% more for the OB than the LPG medicine, except for one LPG that was more expensive than the OB. Affordability calculations showed that All OB treatments for all three cancers (breast, prostate and colorectal), except for paclitaxel 300 mg (0.2 days wage) and Fluorouracil (Fluroblastin) 500 mg (0.3 days wage) costs respectively were more than 1 day's wage, with patients diagnosed with colorectal cancer needing 32.5 days wages in order to afford a standard course of treatment for a month.

CONCLUSION

There was a considerable variation in the price of different brands of cancer medicines available in the South African private sector.

Competitive pricing of substitute products under supply disruption

There has been an increased interest in optimizing pricing and sourcing decisions under supplier competition with supply disruptions. In this paper, we conduct an analytical game-theoretical study to examine the effects of supply capacity disruption timing on pricing decisions for substitute products in a two-supplier one-retailer supply chain setting. We investigate whether the timing of a disruption may significantly impact the optimal pricing strategy of the retailer. We derive the optimal pricing strategy and ordering levels with both disruption timing and product substitution. By exploring both the Nash and Stackelberg games, we find that the order quantity with the disrupted supplier depends on price leadership and it tends to increase when the non-disrupted supplier is the leader. Moreover, the equilibrium market retail prices are higher under higher levels of disruption for the Nash game, compared to the Stackelberg game. We also uncover that the non-disrupted supplier can always charge the highest wholesale price if a disruption occurs before orders are received. This highlights the critical role of order timing. The insights can help operations managers to proper design risk mitigation ordering strategies and re-design the supply contracts in the presence of product substitution under supply disruptions.

Implications of marijuana purchase task based demand functions for optimal legal pricing of cannabis

BACKGROUND

Legalization of recreational cannabis use in Canada has prompted a wide array of new policy decisions to be made at all levels of government. Policies had to be designed and implemented to cover everything from the structure of production, distribution, and retail markets to zoning requirements governing the location of storefronts. Policies concerning price have proven particularly challenging due to a lack of observation data on price sensitivity of cannabis demand and the degree to which users are willing to substitute legal cannabis for illicit cannabis and other drugs.

METHOD

The most rigorous estimates of demand elasticity to date are derived from a sample of 289 cannabis users in Ontario who completed a hypothetical marijuana purchase task (Amlung & MacKillop, 2019). We calculate the optimal price of legal cannabis given a fixed illicit price based on this demand system for a range of parameters around the point estimates provided.

RESULTS

Our results clearly show a dichotomy between minimizing social harms and maximizing government revenue from legal cannabis net of production costs and social harm. In all cases the social harm minimizing legal price was below the illicit price while the net-revenue-maximizing price was above the illicit price.

CONCLUSIONS

The existence of the illicit market must be considered when designing legal cannabis pricing policies as it limits the effectiveness of price increases in controlling demand. Legal cannabis prices in Canada have so far been more consistent with revenue maximization than with minimizing social harms.

Assessing the pricing and benefits of oncology products: an update

Introduction: Oncology expenditure is outperforming all other health care sectors. In particular, the cost of oncology pharmaceuticals is soaring as it is fueled both by incremental costs and the introduction rate of new products. Due to the particularities of cancer as a disease, a significant multilayer of pressure is exerted toward the reimbursement of new treatments. Nevertheless, if the expenditure increase is left unattended, it may hamper the viability of any health care system worldwide.Areas covered: A literature review of the expenditure on oncology pharmaceuticals and the exploration of the root causes for the increase in expenditure was performed.Expert commentary: The surging oncology expenditure demonstrates a multi-layer causality that encompasses prices, the uncertainty of clinical trials, the specificities of cancer as a disease, and the artificial monopoly of oncology modalities. Moreover, laxity in the regulatory approval of new products was noted. In addition, the study design should be adequately justified. Finally, new reimbursement schemes, that explicitly reward and promote clinically meaningful and measurable outcomes, are also imperative.

Cooperation and decision making in a two-sided market motivated by the externality of a third-party social media platform

In recent years, with the rapid development of Internet technology, the integration of platform economy and e-commerce has become a popular business model. Two-sided platforms have a specific impact on sales, customer experience and transaction efficiency of both sides. In the current severe situation caused by the coronavirus pandemic, both the traditional unilateral market platform and the emerging two-sided market platform are in urgent need of a change in operation mode to reduce the marketing cost. Inspired by the cooperation between Meituan, a two-sided platform, and WeChat, a social media platform, this paper investigates the two-sided platform's scalable decisions on when to cooperate and how to optimize the pricing and investment decisions. We analyze how the two-sided platform makes decisions by considering the changes of network externalities from the cooperation with the social network platform. Compared with the scenario of non-cooperation, we derive the conditions under which platform cooperation can increase demands and increase platforms' profits, and analyze how cooperation affects the optimal pricing strategies. We find that the cooperation leads to a larger demand and a higher total profit, but might lead to higher registration prices for the platform users. Furthermore, we adopt the Nash bargaining framework and introduce platform bargaining power parameters to obtain the optimal cooperation and sharing strategy. Finally, we show how to adjust the investment strategy of the two-sided platform under platform cooperation.

Sales and pricing decisions for HIV self-test kits among local drug shops in Tanzania: a prospective cohort study

Background

Public health initiatives must look for ways to cost-effectively scale critical interventions to achieve high coverage. Private sector distribution channels, can potentially distribute preventive healthcare products to hard-to-reach populations, decongest public healthcare systems, and increase the sustainability of programs by getting customers to share costs. However, little is known about how sellers set prices for new products. By introducing a new product, HIV self-test kits, to local drug shops, we observed whether shops experimented with pricing, charged different buyers different prices, and whether prices converged within the local market over our study period.

Methods

From August to December 2019, we provided free HIV self-test kits, a new product, to 26 drug shops in Shinyanga, Tanzania to sell to the local community. We measured sales volume, price, customer age and sex using shop records. Using a multiple linear regression model, we conducted F-tests to determine whether shop, age, sex, and time (week) respectively were associated with price. We measured willingness-to-pay to restock test kits at the end of the study.

Results

514 test kits were sold over 18 weeks; 69% of buyers were male, 40% were aged 25–34 and 32% aged 35–44. Purchase prices ranged from 1000 to 6000 Tsh (median 3000 Tsh; ~$1.30 USD). Within shops, prices were 11.3% higher for 25–34 and 12.7% higher for 45+ year olds relative to 15–19-year olds (p = 0.029) and 13.5% lower for men (p = 0.023) on average. Although prices varied between shops, prices varied little within shops over time, and did not converge over the study period or cluster geospatially. Mean maximum willingness-to-pay to restock was 2000 Tsh per kit.

Conclusions

Shopkeepers charged buyers different prices depending on buyers’ age and sex. There was limited variation in prices within shops over time and low demand among shopkeepers to restock at the end of the study. Given the subsidized global wholesale price ($2 USD or ~ 4600 Tsh), further demand creation and/or cost-reduction is required before HIV self-test kits can become commercially viable in drug shops in this setting. Careful consideration is needed to align the motivations of retailers with public health priorities while meeting their private for-profit needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06432-1.

Challenges in valuing and paying for combination regimens in oncology: reporting the perspectives of a multi-stakeholder, international workshop

BACKGROUND

It is increasingly common for two or more treatments for cancer to be combined as a single regimen. Determining value and appropriate payment for such regimens can be challenging. This study discusses these challenges, and possible solutions.

METHODS

Stakeholders from around the world attended a 2-day workshop, supported by a background paper. This study captures key outcomes from the discussion, but is not a consensus statement.

RESULTS

Workshop attendees agreed that combining on-patent treatments can result in affordability and value for money challenges that delay or deny patient access to clinically effective treatments in many health systems. Options for addressing these challenges include: (i) Increasing the value of combination therapies through improved clinical development; (ii) Willingness to pay more for combinations than for single drugs offering similar benefit, or; (iii) Aligning the cost of constituent therapies with their value within a regimen. Workshop attendees felt that (i) and (iii) merited further discussion, whereas (ii) was unlikely to be justifiable. Views differed on the feasibility of (i). Key to (iii) would be systems allowing different prices to apply to different uses of a drug.

CONCLUSIONS

Common ground was identified on immediate actions to improve access to combination regimens. These include an exploration of the legal challenges associated with price negotiations, and ensuring that pricing systems can support implementation of negotiated prices for specific uses. Improvements to clinical development and trial design should be pursued in the medium and longer term.

Social distancing in public transport: mobilising new technologies for demand management under the Covid-19 crisis

Dense urban areas are especially hardly hit by the Covid-19 crisis due to the limited availability of public transport, one of the most efficient means of mass mobility. In light of the Covid-19 pandemic, public transport operators are experiencing steep declines in demand and fare revenues due to the perceived risk of infection within vehicles and other facilities. The purpose of this paper is to explore the possibilities of implementing social distancing in public transport in line with epidemiological advice. Social distancing requires effective demand management to keep vehicle occupancy rates under a predefined threshold, both spatially and temporally. We review the literature of five demand management methods enabled by new information and ticketing technologies: (i) inflow control with queueing, (ii) time and space dependent pricing, (iii) capacity reservation with advance booking, (iv) slot auctioning, and (v) tradeable travel permit schemes. Thus the paper collects the relevant literature into a single point of reference, and provides interpretation from the viewpoint of practical applicability during and after the pandemic.

A game-theoretic approach for decision analysis in end-of-life vehicle reverse supply chain regarding government subsidy

The presence of end-of-life vehicles (ELV) in the cities creates irreparable damage in environmental and economic terms. Thus, governments have been searching for ways to collect ELVs. An effective way to address ELVs is subsidies' policy. In this study, a supply chain including an ELV take-back center, an inspection center, and a repair center are considered. The decision variables are the purchase price of the ELVs, the sale price of the repaired vehicle, and the level of vehicle repair. In this supply chain, the government pays a subsidy to take-back centers that deliver their used vehicles. A Stackelberg game structure is considered with the government as the leader, the inspection center as the primary follower, and the collection and repair centers as the second followers. Using the game theory approach, the effects of government subsidies on equilibrium values of the decision-making variables of the centers in the ELV supply chain have been investigated in three scenarios. The scenarios comprise profit sharing, revenue sharing, and a centralized (cooperative) scenario. The results indicate that the centralized scenario has the most significant advantage compared to the two contracts of profit sharing and cost sharing. For example, the repair level of the ELVs, the amount of repaired vehicles demand, consumer surplus, and the whole supply chain's profit are at their maximum. The most significant impact of subsidy payment is related to the take-back center's profit and the ELV supply. On the other hand, the subsidy does not affect the profit of the repair center.

Value regimes and pricing in the pharmaceutical industry: financial capital inflation (hepatitis C) versus innovation and production capital savings for malaria medicines

The idea of this paper is to draw a parallel between two diametrically opposed political economies of medicine that coexist today. The first is embodied in the invention, appropriation, and distribution of antivirals for hepatitis C, particularly sofosbuvir, which was commercialized at an initial price of $85,000 in the United States, €56,000 in France, and $8000 in Brazil. These prices destabilized payers in both the North and the South. The second economy encompasses the invention, industrialization and distribution of new therapeutic combinations for malaria that were commercialized by Sanofi from 2007 onwards at a price of $1 per treatment for public markets. This price was set by a contract negotiated with Médecins sans Frontières. In this paper, I examine the pricing of these 2 classes of drugs, and I argue that the prices synthesize these political economies: they summarize the policy of appropriation of these molecules, aimed at their monopolization or a model of common good; they are referred to economic value regimes designed to optimize the profitability of advanced capital or to increase the accessibility of drugs for public payers and patients; and they are justified or contested by moral economies.

A Market Shaping Approach for the Biopharmaceutical Industry: Governing Innovation Towards the Public Interest

Enhancing research and development and ensuring equitable pricing and access to cutting-edge treatments are both vital to a biopharmaceutical innovation system that works in the public interest. However, despite delivering numerous therapeutic advances, the existing system suffers from major problems: a lack of directionality to meet key needs, inefficient collaboration, high prices that fail to reflect the public contribution, and an overly-financialized business model.

Legal cannabis market shares during Canada's first year of recreational legalisation

BACKGROUND

This study estimated legal products' share of Canada's total cannabis consumption during the first year of recreational legalisation, October 2018 to September 2019.

METHODS

Government data was used to estimate monthly recreational sales in dollars per capita, grams per user, and percentage share of kilograms or litres consumed. As explanatory factors, the analysis considered provincial differences in retail pricing (percentage mark-ups) and store density (stores per million users), as well as national monthly production of dry cannabis (kilograms) and cannabis oil (litres) finished products.

RESULTS

Legal recreational products' share of Canada's overall cannabis consumption began at 7.8% in October 2018 and grew to 23.7% by September 2019, with an average of 14.5% over the first 12 months. Sales growth was delayed by shortages of both dry cannabis products and licensed stores, but not cannabis oils. Across the 10 provinces, legal recreational shares in September 2019 varied from 13% to 70%; differences in store densities and retail prices partly explained the variation. Prince Edward Island's large 70% share seemed due to it having minimal product shortages, high store densities, and low prices.

CONCLUSIONS

Legal recreational products captured market share to the extent they were available, accessible, and low-priced. Problems with those factors slowed the initial expansion of legal product sales but also suggested ways to gradually increase their market share.

Islamic finance and food commodity trading: is there a chance to hedge against price volatility and enhance food security?

This paper evaluates current food commodity trading from the Shariah point of view, which is particularly relevant for the MENA region. It focuses on futures contracts as the main instrument for grain trading and analyzes the traders’ activities. Through a qualitative and multifaceted approach, the paper accumulates and evaluates the suggestions for 15 Shariah-based alternatives to futures by contemporary researchers. Sukuk, commodity funds and takaful programs are among potential structures that could be developed and broadly implemented. The research compares the current criticism of futures markets with the opinions of Islamic scholars and researchers, as well as Shariah standards. The paper also evaluates several recent suggestions by researchers to raise the efficiency of the international commodity trading market for the sake of food security. The results show that there is space for cooperation taking into account Islamic financial principles and conventional commodity exchange regulations, in combining existing best practices of the latter and the rulings of the former in engineering a sounder system of grain trading for the benefit of market players and the end consumers. This would require a joint effort and support from exchanges, standard-setting bodies, and regulators. Among the areas of cooperation are the approach towards corners (ihtikar), squeezes, speculation (gharar, maysir, and najash), and defining the border between reasonable and excess speculation; financial architecture using new technologies in developing a commodity trading contract conforming to the Shariah regulations and the exchange requirements. There is a need to develop the ideas for global food contracts and grain reserve systems, and to test the contracts based on existing exchanges.