<轉載自2018年7月19日 明報 社評>
內地真人真事改編電影《我不是藥神》，揭露癌症病人「看不起病」、「買不起藥」的殘酷現實，在內地引起極大迴響，總理李克強也表示關注，要求相關部門「急群眾所急」，降低抗癌藥物價格。本港與內地醫療制度迥異，然而癌症病人面對天價藥費苦况則一，一人得病舉家受苦，為了治癌傾家蕩產時有所聞。特區政府應調撥更多資源，協助癌症病人應付高昂藥費。當局應加快治癌新藥審批程序，同時降低申請藥費資助的門檻，讓更多癌症病人和家庭受惠。
天價藥物難以負擔 患癌苦况不分地域
《我不是藥神》製作費不高，「卡士」亦不算強勁，票房卻賣個滿堂紅，內地上映14日已大收超過26億元人民幣，引起輿論廣泛關注，皆因劇情笑中有淚，痛陳內地醫療體制弊端，道出老百姓「不敢病、病不起」的辛酸，引起公眾共鳴。電影描述內地慢性白血病人面對每月4萬元人民幣的天價藥費，很多人「因病致貧」，大多數人只能看着貧窮吞噬自己的生命。《我不是藥神》叫好叫座，連李克強也作出批示，強調抗癌藥是救命藥，對癌症病人來說，進口救命藥「買不起、拖不起、買不到」，反映解決抗癌藥「降價保供應」問題迫切，政府必須加快落實措施，協助病人。
癌症是香港和內地頭號疾病殺手。本港癌症人口比例不斷上升，新症年均增長2.8%，每年死於癌症的港人，佔全港總死亡人數三成，至於內地情况就更嚴重。世衛報告顯示，內地癌症發病率位居全球首位，平均每天有1.2萬人確診患癌，7500人死於癌症。由於進口專利抗癌藥價格高昂，無論在內地還是本港，很多病人都因為未能負擔昂貴藥費，無法得到最有效治療。
以本港為例，倘若治癌藥物不在政府資助之列，病人隨時要每月自費逾萬元買藥對抗癌魔，莫說低下階層負擔不來，連中產家庭也要傾家蕩產，若患癌者是家庭唯一經濟支柱，無法繼續工作，舉家生活更將陷入困境。調查顯示，多達三成癌症病人要賣樓買藥救命，境况堪憐。
有論者認為，專利治癌藥物售價高昂，只是反映研發成本巨大，不能歸罪於跨國藥廠貪婪。誠然，藥廠有利可圖，才會積極投入新藥研發，可是部分藥廠抬價牟取暴利，也是現實。在美國，有治療腦腫瘤的抗癌藥物上市40載，專利保護已到期，然而由於缺乏廉價仿製藥競爭，竟然可以在2013至2017年間漲價14倍。自由市場機制並非萬能，治癌藥物關乎人命，並非一般商品，政府必須積極介入，協助病人以較易負擔的價錢，取得急切需要的藥物。
過去半年，內地為了設法降低抗癌藥價格，推出多項措施，包括進口抗癌藥物零關稅、鼓勵創新治癌藥進口、加快審批已在境外上市的新藥等，然而很多治癌藥物仍是供不應求，出現「稅降了價不降」情况。李克強最新批示強調，必須多管齊下，消除藥物流通環節各種不合理加價，務求盡快落實降價，原因亦在於此。雖然有人主張仿效印度大力發展仿製藥，國務院亦推出改革措施鼓勵仿製藥生產，可是發展尖端生物醫藥產業，亦是「中國製造2025」目標之一，當局必須在發展仿製藥和保障專利鼓勵創新之間，求取平衡。
花錢搞不切實際工程 不如資助更多患癌者
香港方面，近年特區政府亦有加大投入，協助癌症病人應付高昂藥費，可是無論是資助金額、藥物涵蓋範圍，乃至審批治癌新藥，都遠遠未如理想。目前當局透過撒瑪利亞基金和關愛基金醫療援助項目，資助經濟有困難的病人購買昂貴藥物，然而涵蓋的抗癌藥物種類有限﹕兩個基金分別只涵蓋10多種治癌藥和標靶藥物。
近年有不少治癌標靶藥物面世，初步效果甚佳，然而大都未納入政府資助藥物名冊，若要納入資助範圍，隨時要等上多年。兩個援助基金申請資格太嚴，也令很多癌症病人望門興嘆。當局必須加快新藥審批程序，擴大治癌藥物資助範圍，同時應放寬資產審查，降低申請資助門檻，令更多病人受惠。醫管局委託顧問，檢討病人藥費資助和分擔機制，報告今年稍後出爐，財政預算案僅僅預留5億元配合，金額未免太小。特區政府坐擁萬億儲備，與其將公帑用在不切實際的地區工程，又或為基建項目巨額超支埋單，不如投入更多資源協助癌症病人。
跨國藥廠財雄勢大，香港市場規模太小，特區政府議價能力不足，難獲甜頭。相比之下，內地對跨國藥廠來說卻是極大市場，近年內地藥品價格談判，都是由政府出面，跟跨國藥廠周旋，隨着內地生物製藥企業崛起，政府議價本錢也顯著增加，幾年間當局成功爭取數十種藥物大幅降價四至七成。特區政府應探討跟內地部門合作是否可行，以抗衡跨國藥廠在藥物定價方面的優勢。
The government should increase subsidies for cancer drugs
DYING TO SURVIVE, a mainland film based on real-life stories about the
cruel reality faced by cancer patients who cannot afford to see doctors or buy
medicine, has drawn a lot of attention on the mainland. The healthcare system
of Hong Kong and that of the mainland are very different, but the plight of
cancer patients in the face of exorbitant drug prices is similar. The SAR
government should allocate more resources to help cancer patients to pay for
costly drugs. It should also streamline the approval procedures for new drugs
and lower the threshold for subsidy eligibility to benefit more cancer patients
and families.
Cancer is the number one killer disease both in Hong Kong and on the
mainland. Every year, people who die of cancer account for 30% of all deaths in
Hong Kong. The situation on the mainland is even worse. According to the World
Health Organisation, the incidence of cancer on the mainland ranks first in the
world. Since imported patented cancer drugs are very expensive, many patients
on the mainland and in Hong Kong do not have access to the most effective
treatment because they cannot afford the drugs.
In the last six months, the mainland has introduced a number of measures
to lower the prices of cancer drugs, including lifting all tariffs on imported
drugs, encouraging imports of innovative drugs, and speeding up the approval of
new drugs that have already been marketed overseas, etc. However, many cancer
drugs are still in short supply. This has resulted in a situation in which
"the tariff has gone down but not the price".
In Hong Kong, in recent years the SAR government has also allocated more
resources to help cancer patients to deal with the high prices of the drugs.
However, things are still far from satisfactory whether in terms of the level
of subsidy, the drugs covered or the approval of new cancer drugs. Currently
patients with financial difficulties get help from the government through the
Samaritan Fund and the Community Care Fund Medical Assistance Programmes in
buying expensive drugs.
In recent years there have been many new targeted therapy drugs for
cancer which prove to be effective at the initial stage. However, most of these
drugs are not included in the drug formulary subsidised by the government. The
criteria for applying for both funds are also too stringent and many cancer
patients are kept away. The authorities should speed up the approval procedures
for new drugs and expand the scope of subsidy to cover more cancer drugs. They
should also relax the criteria of the means test and lower the threshold for
subsidy eligibility. The Hospital Authority has commissioned a consultant to
review the mechanism for drug subsidy and patients' share of the cost. A report
will be published later this year. However, only $500 million has been
earmarked in the budget for drug subsidy even though the SAR government has
fiscal reserves of $1 trillion. Instead of spending public money on impractical
community projects or footing the bills for massive cost overruns of
infrastructure projects, the government might as well put more resources into
helping cancer patients.
Multinational pharmaceutical companies have enormous financial resources
and influence. The market of Hong Kong is too small. The SAR government does
not have enough bargaining power. In comparison, the mainland is an enormous
market for multinational pharmaceutical companies. In recent years on the
mainland, the government has stepped forth to negotiate with multinational
companies over drug prices. The authorities have succeeded in massively driving
down the prices of a few dozen drugs by 40% to 70% in just a few years. To
counter the advantage that multinational pharmaceutical companies enjoy in
price setting, the SAR government should explore the possibility of
collaboration with government departments on the mainland.
《藥神》道盡患癌者悲歌 政府應加碼資助藥費
內地真人真事改編電影《我不是藥神》，揭露癌症病人「看不起病」、「買不起藥」的殘酷現實，在內地引起極大迴響。本港與內地醫療制度迥異，然而癌症病人面對天價藥費苦况則一。特區政府應調撥更多資源，協助癌症病人應付高昂藥費。當局應加快治癌新藥審批程序，同時降低申請藥費資助的門檻，讓更多癌症病人和家庭受惠。
癌症是香港和內地頭號疾病殺手，每年死於癌症的港人，佔全港總死亡人數三成，至於內地情况就更嚴重。世衛報告顯示，內地癌症發病率位居全球首位。由於進口專利抗癌藥價格高昂，無論在內地還是本港，很多病人都因為未能負擔昂貴藥費，無法得到最有效治療。
過去半年，內地為了設法降低抗癌藥價格，推出多項措施，包括進口抗癌藥物零關稅、鼓勵創新治癌藥進口、加快審批已在境外上市的新藥等，然而很多治癌藥物仍是供不應求，出現「稅降了價不降」情况。
香港方面，近年特區政府亦有加大投入，協助癌症病人應付高昂藥費，可是無論是資助金額、藥物涵蓋範圍，乃至審批治癌新藥，都未如理想。目前當局透過撒瑪利亞基金和關愛基金醫療援助項目，資助經濟有困難的病人購買昂貴藥物。
近年有不少治癌標靶藥物面世，初步效果甚佳，然而大都未納入政府資助藥物名冊。兩個援助基金申請資格太嚴，也令很多癌症病人望門興嘆。當局必須加快新藥審批程序，擴大治癌藥物資助範圍，同時應放寬資產審查，降低申請資助門檻。醫管局委託顧問，檢討病人藥費資助和分擔機制，報告今年稍後出爐，財政預算案僅僅預留5億元配合。特區政府坐擁萬億儲備，與其將公帑用在不切實際的地區工程，又或為基建項目巨額超支埋單，不如投入更多資源協助癌症病人。
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