The spiralling price of new drug therapies is placing health systems under severe pressure. While advanced new drugs undoubtedly have positive consequences for patients, there is a risk that their benefits will be confined to the fortunate well off few if the current pharmaceutical innovation and patent system is not rethought. This is the core theme of the UCD Michael Smurfit Graduate Business School Laurence Crowley Lecture 2026 to be delivered by Prof Susi Geiger next Monday, January 19th.
A full professor of markets, organisations and society at UCD, Prof Geiger is a leading international expert on pharmaceutical and digital markets, a member of the World Health Organisation technical advisory group on pharmaceutical pricing policies and an access to medicines activist.
In her lecture, Prof Geiger will present key insights from her just-published book Peak Pharma: Toward a New Political Economy of Health (Oxford University Press).
“In 2014 Sofosbuvir, a drug for hepatitis C was launched at a price of $84,000 per patient per treatment,” she notes. “It was a $1,000-a-day treatment. At the time, it was the most expensive drug launch in history. Last year, the Irish Government approved for reimbursement the gene therapy Libmeldy at €3 million per treatment. It’s not the only drug priced in millions. We see more and more of these drugs coming on the market at a price point of above €1 million. I have to acknowledge that a lot of these drugs are revolutionary, but, having said that, no health system in the world can afford hundreds of these €1 million-plus priced drugs, so we have to rethink how we do things.”
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Of course, the pharma companies make the case that these drugs cost vast sums to develop and many of them are single-dose therapies, and they need to be compensated.
But a lot of these drugs are not actually developed by the pharma companies, Geiger points out. “They are developed either in the academic context or by small biotechs and are then bought up by pharma companies. A lot of the time, large public investment in terms of huge subsidies, tax breaks, extension of patent protection periods, and all sorts of other incentives have gone into them. Some would argue that taxpayers are paying twice for the drugs. First for the innovation and second for the product.”
If public money is going in at the beginning and at the end, why are we privatising the middle as well? she asks. “Collectively, we need to rethink the role of pharma industry in the entire value chain. How do we keep some of the value in public hands so pharma products are a common good or public good rather than something that can be financialised and profited from by shareholders.”
There is, of course, a place for profitable pharma companies in the system. “What pharma does really well is production at scale and distribution,” she says. “We need that.”
In rethinking the system, she looks at three tiers with generics at the bottom. “We need to ensure fair margins for generics to ensure they are viable. Society needs to have a supply of generic medicines such as antibiotics, HRT, and other really basic stuff.”
The middle tier is the pharma blockbusters. “Typically, these are products destined for mass markets. That’s the tier where pharma plays very well. We want them to be profitable, but with certain terms and conditions. When they launch a new product, we want it to be genuinely innovative, not just a ‘me too’ of an earlier product.”
The top tier comprises advanced therapies and gene therapies. “Pharma doesn’t play well in that space,” she contends. “Cell and gene therapies are moving closer to the patient and the healthcare providers. It’s a personalised medicine model, so they may have to be made in an almost artisanal fashion. So why not think about the hospital as the space where these are produced and innovated?”
Indeed, she points to an example of a hospital in Barcelona where gene therapies are being produced under what’s known as a hospital exemption at a third of the price that the pharma company might charge saving around €500,000 per patient.
Geiger calls for a move away from the belief that the pharma industry is the answer to everything. “To be clear, I don’t want to get rid of the pharmaceutical industry altogether. I just want to put it in places where it serves a real purpose and creates real value for society.”
The last two chapters in her book look at a pharma dystopia and a pharma utopia. “The dystopia is a highly privatised system where these very advanced drugs are only available for the select few, which we don’t want,” she says. “We want a pharma utopia which provides equitable access to medicines for everybody. Let’s work collectively to direct the system towards a utopia.”
The 2026 UCD Smurfit School Laurence Crowley Lecture Series will take place at 6:30pm on Monday, January 19th. This event is free and open to the public. Click here to register.
