Guerbet Korea has recently come under fire for threatening to stop the supply of its contrast medium Lipiodol unless the government raises the drug price by five folds.

Lipiodol is the only agent used in combination with anticancer drugs in transarterial chemoembolization (TACE) procedures for liver cancer patients.

Critics say the French pharmaceutical firm is abusing its monopolistic power.

However, the government should have taken a more flexible stance in price negotiations with Guerbet Korea, an expert told Korea Biomedical Review.

Kim Kang-mo, a professor at the gastroenterology department of Asan Medical Center, said civic groups and the media have been focusing only on the company’s “gapjil” when dealing with the issue. In Korean, gapjil refers to excessive abuse of power by those in advantageous positions.

He said that he wanted to raise his voice for patients and that the government did not deal with the drug pricing issue well.

Kim said the government should have accepted Guerbet Korea’s request considering the clinical necessity of Lipiodol, adding that Lipiodol does not cost millions of won a month like anticancer treatments.

Kim sees 20 patients with hepatic tumors a week, 80 a month, and over 900 a year. When he heard the hospital had Lipiodol stocks to last for fewer than two weeks, he felt hopeless, Kim said.

Besides Lipiodol-requiring TACE procedures, patients can choose radioembolization or drug-eluting beads. However, the other two options are more expensive than TACE. Physicians unfamiliar with the other two procedures might find it difficult to manage patients’ side effects.

“Patients whose cancer has spread to the entire liver cannot receive drug-eluting beads, and those with ‘shunt’ cannot receive radioembolization. Embolization is a difficult procedure. A side effect can be fatal,” Kim warned.

Due to such barriers, 90 percent of liver cancer patients receive TACE, rather than radioembolization or drug-eluting beads.

“As a physician, I am not in a position to express my view on drug pricing. However, I wanted to speak for patients,” said the Asan professor, who dared to say Guerbet Korea’s price hike request could be fair.

Guerbet Korea demands Lipiodol price be lifted to 262,800 won ($245.9) per 10 ml bottle, five times higher than 52,560 won in 2012.

Considering the needs of liver cancer patients, it was appropriate to raise the price whether its allegations are relevant or not, Kim said.

According to Kim, supposing that a hepatic tumor patient survives two and a half years, the patient receives typically four or five times of TACE. If Lipiodol costs 260,000 won per bottle, the total expense for Lipiodol will be slightly over 1 million won.

From the perspective of the government, which has to manage finance for health insurance, “only a meager 260,000 won” might sound uncomfortable but the government’s policy should be centered on patients, the professor said.

“Watching the news about this issue, I thought someone should say what I said. Lipiodol does not cost millions of won. If a multinational drugmaker wields unfair power, it should get punished. However, Lipiodol shouldn’t be the center of such talk. It’s the patients we should not forget,” Kim emphasized.

Lipiodol sold 610 million won last year, according to IQVIA data. Even if its price goes up five folds, selling 3 billion won a year would not make the drug a blockbuster.

However, healthcare civic groups lambasted Geurbet Korea’s demand for the five-fold price hike, saying five-fold is too much. The pharmaceutical firm’s using words such as “discontinuation of supply” or “supply shortage” was also intensely threatening to patients who have no other drug but Lipiodol to receive TACE procedures, they said.