Why China’s premier used hit movie ‘Dying to Survive’ to push for cheaper cancer drugs

Li Keqiang has been trying to speed up price cuts for life-saving medication for months, and it’s a boon that the box-office hit has generated widespread awareness

PUBLISHED : Thursday, 26 July, 2018, 6:42pm
UPDATED : Thursday, 26 July, 2018, 9:58pm

When China’s premier has to turn to a box-office hit to gather new steam for a government campaign to tame cancer drug prices, it’s clear he is facing an uphill battle.

Billed as the Chinese answer to Dallas Buyers Club, the tear-jerking film Dying to Survive last week became Premier Li Keqiang’s new rallying cry for speeding up price cuts for cancer medications. It is an issue of such complexity that he has held two cabinet meetings about it in the past three months.

Based on the real-life exploits of a leukaemia patient who smuggled cheaper generic drugs from India to save himself and others, the dark comedy has struck a chord with viewers in China, where many life-saving cancer medications are too expensive for ordinary families to afford.

The country sees 4.29 million new cancer cases each year and sees 2.81 million deaths. The five-year cancer survival rate in China is just over 30 per cent – less than half that of the United States, according to a 2014 study published in the International Journal of Cancer.

Although 95 per cent of the population are covered by some form of public medical insurance, the coverage focuses mainly on basic medical care and excludes many life-saving cancer drugs or treatments.

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This has resulted in heavy financial burdens being placed on the families of many people who contract cancer, sometimes even dragging them into poverty.

Last July, 15 cancer drugs were included in public health insurance schemes.

The Chinese government has been negotiating with foreign pharmaceutical companies and campaigning to reduce drug prices for years, with limited success.

Part of the problem is the hospitals rely on the income they make from prescribing more expensive drugs, analysts said.

Li had previously tried to take the initiative to lower the cost of imported drugs, holding a State Council meeting in April to discuss the issue.

The following month it was announced that tariffs on imported cancer medications would be lifted and value-added tax would be cut from 17 per cent to 3 per cent.

A second meeting in June prompted the announcement that the market entry approval process for drugs already available overseas would be sped up.

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Days before the film’s release, US pharmaceutical giant Pfizer decided to cut prices on more than a dozen drugs in China, including those for kidney cancer and lung cancer, by up to 10.2 per cent. Xian-Janssen Pharmaceutical, a Chinese joint venture with Johnson & Johnson, cut the price of a blood cancer medication by 51.6 per cent.

But it was not until Dying to Survive stormed the box office and became the talk of the country that the issue again generated widespread public awareness, prompting many to call for government action.

Two weeks after the movie’s release, Li weighed in, urging regulators to “speed up price cuts for cancer drugs” and “reduce the burden on families”.

A Guangzhou-based man in his thirties who identified himself as Lin said that he has been taking anti-viral drugs for hepatitis for years.

“Just like many cancer patients who are receiving targeted treatment, I used to pay a lot for the imported drugs which have been proven to be effective for me,” said Lin, adding:

“Thanks to the reduction of tariffs and the inclusion of many of the drugs into the shortlist covered by medical insurance over the past few months, I only have to pay a little more than 100 yuan (US$14) a month rather than up to 800 yuan in the past.”

Lin underlined that he thought the government was forced to do something to address the issue, as a result of widespread discontent among tens of thousands of patients across the country.

But experts warned that for many patients the efforts were unlikely to yield substantial, immediate results.

“Don’t expect that cancer drug prices will drop in the short term,” Zhang Lufa, vice-dean of Shanghai Jiao Tong University’s school of international and public affairs, said.

“Solving this problem is a systematic project and involves interests from various parties.”

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A problem inherent in China’s health care system – and not unique to cancer drugs – is that doctors tend to prescribe expensive medicine, he said.

“Under the current system, hospitals in China rely on drug sales to keep themselves running,” said Hu Xingdou, an independent economist in Beijing. “Although most are public hospitals, they only receive [on average] about 10 per cent funding from the government.”

After a pilot programme, China’s public hospitals were ordered last year to scrap a controversial 15 per cent mark-up on drug sales — an practice that provided them with more than a third of their income.

But that has not changed the hospitals’ preference for expensive drugs, Professor Zhu Hengpeng, director of the public policies centre at the Chinese Academy of Social Sciences, told online news outlet Jiemian.com.

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Some would even avoid buying drugs when their prices are reduced, Zhu said.

“Although hospitals cannot charge mark-up for drugs, they still can make profits by selling drugs – by postponing the transfer of the income of drug sales for months or even years,” Zhu was quoted as saying.

Even after prices are reduced and included for reimbursement, patients in different provinces have to pay varying amount of money out of their own pocket, depending on how wealthy their regions are and thus what percentage of drug expenses can be reimbursed.

“After more cancer drugs are included in the medical insurance scheme, this public fund will have higher pressure in paying these expenses,” Zhang said. “As I know, some cities’ medical insurance funds already have deficits.”

Additional reporting by Choi Chi-yuk