Generic drugs don't always push prices down
I am hoping that as more TKIs go off patent the prices in the US will enter the realm of sanity. Unfortunately that appears to be unlikely to happen. It is probably far cheaper to fly to India and buy generic Gleevec made from the same manufacturers than it is to buy it in the US.
NICE in the UK indicates £1,946.67 for Novatis imatinib 400 mg, 30 tablets. Could be £23,684 a year without pharmacy cut.
The cheapest generics on the list are priced at £199.98 for the same. Could be £2,433 a year without pharmacy cut.
So it would appear that generics are pushing down the price in the UK.
Presumably, buying a drug in an area where patent protection does not apply and shipping it to an area where patent protection does apply would infringe the area patent. Clearly, in any territory, there will also be the requirement for the local licensing of any generic medicine.
I won't give the exact figure, but as I understand it the NHS has negotiated a supply of generic imatinib from a supplier that is at a very significant discount to the price quoted there. It's of course no surprise that pharma companies push 2G TKIs hard - and while for some people (such as me) that is the answer, but for others inexpensive generic imatinib is on the whole the best thing.
If it's private non commercial use, then in most countries importation into a patent protected area is not infringement. Regulatory issues may make personal importation more difficult, however...
Commercial sales (or sales promotion - ie offers for sale) from a non-patent area into a patented area would be infringement, hence generic imatinib is only recently commercially available in the US (or at least, relatively recently). In the US such infringing imports can be stopped relatively easily.
The price impact really depends on prescribing and/or prescription fulfilment practice in a given country. In countries where prescribing is generic (as opposed to by brand name) and/or there is mandatory substitution to a generic alternative to the branded drug, the cost comes down because it's the cheaper generic which gets used to fulfil the prescription. This can influence the originator price too.
In the US, you see lots of prescription drug advertising (illegal in the UK) which is aimed (so I understand) at patients "persuading" their doctors to prescribe branded pharmaceuticals. Or at least to discuss it with their doctor... I don't think this happens with TKIs though, I hasten to add - maybe one of our US friends can comment. In any case, if the originator can hang on to a large chunk of its market via consumer (ie patient) demand and/or prescribing habits (ie branded prescribing and no mandatory substitution), then prices won't reduce so quickly. It may be this is part of the dynamic in the US - in the UK, the cost to the NHS of imatinib is certainly coming down.