open access: Developing and paying for medicines for orphan indications in oncology: utilitarian regulation vs equitable care? (references EU/US)

Defining orphan indications

"The US Orphan Drug Act (ODA) applies to conditions affecting fewer than 200000 Americans. This currently translates to approximately 7 per 10000 individuals. It offers manufacturers 7 years of marketing exclusivity, exceptions from certain FDA fees and additional regulatory advice and tax benefits....."

"Despite ‘orphan drug' legislation, bringing new medicines for rare diseases to market and securing funding for their provision is sometimes both costly and problematic, even in the case of medicines for very rare ‘ultra orphan' oncological indications. In this paper difficulties surrounding the introduction of a new treatment for osteosarcoma exemplify the challenges that innovators can face. The implications of current policy debate on ‘value-based' medicines pricing in Europe, North America and elsewhere are also explored in the context of sustaining research into and facilitating cancer patient access to medicines for low-prevalence indications. Tensions exist between utilitarian strategies aimed at optimising the welfare of the majority in the society and minority-interest-focused approaches to equitable care provision. Current regulatory and pricing strategies should be revisited with the objective of facilitating fair and timely drug supply to patients without sacrificing safety or overall affordability. Failures effectively to tackle the problems considered here could undermine public interests in developing better therapies for cancer patients....."