Who can pay for innovative medicines?

Innovative medicines are of vital importance to the patients affected with one of the many acute or chronic illnesses, for which current treatments are often suboptimal. In particular chronic non-communicable diseases are becoming more prevalent, and this is even seen as a real crisis requiring United Nations action [1, 2]. It is widely known that, although the investments of the pharmaceutical industry in research and development (R&D) have increased substantially in the past decade, the number of innovative medicines that were registered with the US Food and Drug Administration and the European Medicines Agency has decreased over the same time period [3, 4]. A prime example is the respiratory field in which only nine new drugs have been developed over the past 40 years, four of which were for one particular disease, i.e. primary pulmonary hypertension [5]. Despite R&D spending at a high of 18% of revenues, the R&D productivity of the big pharmaceutical companies declined by 20% between 2001 and 2007 [6]. The innovation pipeline remains anaemic. A further thread is that shareholders are not willing …