english.prescrire.org > Topics > Advancing healthcare policy > Advancing healthcare policy in Europe: a chronological recap of actions > 2014 Recap > Providing "scientific advice" to pharma industry undermines the independence of regulatory authorities (7/2014)

Advancing healthcare policy

Advancing healthcare policy in Europe: a chronological recap of actions

A recap of actions in 2014
Providing "scientific advice" to pharma industry undermines the independence of regulatory authorities (July 2014)

Brussels, 15 July 2014

Joint consultation response by AIM, HAI Europe, ISDB and MiEF. Confidential discussions between pharma, EMA and health technology assessment (HTA) bodies threaten independence of pricing and reimbursement decisions.

> Click here to download the joint response (pdf, 612 Ko)


Health Action International Europe, the International Society of Drug Bulletins, the Medicines in Europe Forum and the Association Internationale de la Mutualité have criticised the European Medicines Agency (EMA) for providing confidential "advice" to pharmaceutical companies on their development plans for new medicines in exchange for fees – a potentially harmful practice that the EMA is now trying to extend to national health technology assessment (HTA) bodies in the European Union (EU).

The coalition of medicines advocates made the criticism in a joint response to the EMA’s public consultation on its ‘Best practice guidance for pilot EMA HTA parallel scientific advice procedures’.

"There is immense potential for conflicts of interest to arise when the EMA, through its Committee for Medicinal Products for Human Use, provides advice about specific pharmaceutical products in exchange for fees, then later decides the marketing authorisation for these products," said Ancel.la Santos Quintano, policy advisor with Health Action International. "This dubious practice should be ended; not refined and broadened to HTA bodies."

HTA bodies are widely consulted throughout the EU. They determine the ‘therapeutic added value’ and appropriate level of financial reimbursement for new medicines. If a new medicine provides no additional therapeutic value in comparison with safer and cheaper well-established treatments, yet receives authorisation from drug regulatory agencies, HTA bodies can recommend that it does not receive reimbursement. This limits European patients’ exposure to potential avoidable adverse drug reactions and helps minimise Member States’ healthcare expenditures.

"When the EMA and national HTA bodies sell scientific advice to pharmaceutical companies to aid in drug development, they essentially become co-developers of medicines and financially dependent on the pharmaceutical industry," said Joerg Schaaber, president of the International Society of Drug Bulletins. "Establishing financial and business ties with the pharmaceutical industry undermines the independence of HTA bodies, as well as the critical roles that both the EMA and HTA bodies have in protecting public health."

HAI Europe, ISDB, MiEF and AIM are also concerned that the EMA describes the scientific advisory process between it, HTA bodies and the pharmaceutical industry as "confidential" in its draft guidance document.

"Public institutions, such as the EMA, must at all times be transparent and accountable," said Pierre Chirac, coordinator with the Medicines in Europe Forum. "Advice to pharmaceutical companies by drug regulatory authorities and HTA bodies is not only unnecessary if scientific data is robust and clinical trials are designed to address legitimate public health needs, but dangerous because of its potential to result in regulatory capture, particularly when the process is conducted in secrecy."

Instead of providing customised advice to pharmaceutical companies, the coalition of medicines advocates recommend that the EMA continues developing guidelines that help drug manufacturers make development decisions that address genuine public health needs. It also urges HTA bodies, in their development of in-depth reviews, to refuse early discussions about drug development with the EMA and pharmaceutical companies and instead require full access to clinical trial data and complete assessment reports for medicines.

The EMA has provided scientific advice for a fee to the pharmaceutical industry since 2005. The same practice was applied to HTA bodies in 2010 under a pilot project. In March, 2014, the EMA also launched an ‘adaptive licensing’ project, which "builds on existing regulatory processes and intends to extend the use of elements that are already in place, including scientific advice."

The EMA’s public consultation on ‘Best practice guidance for pilot EMA HTA parallel scientific advice procedures’ closed on 14 July.

Contents of the complete joint response (6 pages):

  • EMA's consultation on parallel scientific advice: a part of a broader picture
    • HTA bodies are a priority target for pharmaceutical companies
    • EMA's increased control over HTA bodies is part of its “adaptive licensing” project
    • Towards greater intervention by companies in pricing and reimbursement decisions
  • Scientific advice procedures enable institutional capture by pharmaceutical companies
    • Early opaque interactions with pharmaceutical companies implies regulatory authorities are becoming co-developers of medicines
    • Cost-effectiveness assessments must remain independent from Drug Regulatory Agencies
  • Conclusion: Engaging in early opaque exchanges with pharmaceutical companies is a slippery slope
  • Annex 1:   Health technology assessment (HTA): a strategic target to be influenced by the industry
  • Annex 2:   Summary of the proposed process for EMA-HTA parallel scientific advice: the applicant in the driving seat


©AIM, HAI Europe, ISDB, MiEF July 2014