Mr. Labille, can you tell us about changes in the affordability of medicines in Belgium? Does this have an impact on patients’ access to medicines?
Jean-Pascal Labille, Secretary General, Solidaris, Belgium: In Belgium, since 2015, with the arrival of treatments for hepatitis C and then new treatments for cancer, spending on medicines has skyrocketed. For 2023 and 2024, we’re expecting growth of 7% a year, which is totally unsustainable. To contain this explosion, which is linked to increasingly excessive prices, patient access to new treatments is already being restricted. The rising prices demanded by the companies will unfortunately force us to limit access even further, and even refuse reimbursement for our patients, if we don’t find a solution soon.

What role does Solidaris play in access to medicines?
Jean-Pascal Labille: As Belgium’s 2nd largest health insurer, Solidaris plays an important role as co-manager of the Belgian universal health insurance system, as well as defending the interests of our members and all patients. Within this framework, we play a key role in allocating the budget between healthcare sectors, including drugs, and in controlling expenditure. We also play a decisive role in the “Commission de Remboursement des Médicaments”, which makes recommendations to the Minister on the reimbursement of new drugs, the patients for whom they should be intended, and their price.

Solidaris played a leading role in the development of the AIM fair price model and calculator. Mr. Labille, can you explain why your organization developed this project?
Jean-Pascal Labille: Our starting point was a simple observation: on the one hand, the current system does not defend the interests of patients, but rather those of the pharmaceutical industry, and on the other, current tools – such as the confidential contracts negotiated in each country – only serve to reinforce the power of this industry. Price negotiations have become so complex and opaque that no-one knows what they’re paying, or to what extent their price is right.
We therefore needed to make a radical change, and start again from an objective that was obvious to us, that of the general interest: health before profit. As a progressive mutual insurance company, we wanted to open up a fairer path that would ensure both the sustainability of our healthcare system and the well-being of the population, without holding back useful innovation. By proposing a model based on objective criteria that are in touch with reality, and transparent so that everyone can understand and join, we want to restore ethics and transparency to the way we spend the money of our solidarity-based social security systems.

In your opinion, can individual countries achieve fair drug prices on their own? How far can they go, and what role could the European Union play in this?
Jean-Pascal Labille: Achieving a fair price on our own is impossible in Belgium, or in any other country, as we clearly see in our negotiations with pharma. But together with other countries, we can get the industry to bend. This will necessarily require a price (possibly modulated by country) set at European level. But to get there, we need to convince each country of the value and possibility of obtaining a fair price. That’s why in Belgium we want to raise awareness among decision-makers by systematically informing them of the fair price they could pay for each new drug, by including in the law the obligation to calculate the price using the AIM model in reimbursement files.[1,2] We can see that the idea is slowly gaining ground among AIM members, and we are particularly pleased that our German colleagues are taking up the subject of fair pricing and companies’ profit-maximizing strategies. An example for all members to follow!

[1] https://lejusteprixdesmedicaments.be/

[1] What would be the impact of a fair price for drugs in Belgium? Analysis based on 7 drugs, Anne Hendrickx, Bénédicte Vos, Jérôme Vrancken, Alain Bourda and Bart Demyttenaere, 2022, available here : https://lejusteprixdesmedicaments.be/wp-content/uploads/etude-solidaris-fair-price-2022.pdf