A cross-border investigation, by Cristian Niculescu, Eric Breitinger, Aleksandra Jolkina, Harry Karanikas, David Leloup, Dimitra Triantafillou and Stanimir Vaglenov, focusing on six European countries: Romania, Belgium, Bulgaria, Greece, Latvia and Switzerland.
Cancer patients in east Europe cannot afford newer drugs, because they are too expensive or unavailable in their own countries.
Meanwhile pharma distributors in the eastern EU cash in on a controversial system of re-exporting drugs destined for their domestic markets.
Multinational manufacturers of cancer drugs such as Roche and Novartis charge often equal or even higher prices for innovative drugs in poorer east European countries than in affluent western states, according to a report on the Linx/RCIJ website.
The European Commission has launched a study into this phenomenon, but has not yet intervened in the pricing and reimbursing of life-saving drugs in the Union until now.
This report finds that in Romania, despite having a National Health service that provides affordable medical care for all registered citizens, the Government is not paying for all necessary cancer drugs.
Many patients must borrow money or sell their properties to pay for their own treatment, even if they have contributed to the public system all their lives through a national insurance scheme.
But while the state lacks funds, corruption and controversial practices that manipulate free trade rules are rife across the pharma sector.
The small prices on some medicines in Romania set by the state means pharma products destined for the Romanian market end up in retailers in Germany, Denmark, Poland or any other EU country where they can sell for higher prices.
For example, Mabthera is an injectable onocology drug that treats lymphatic cancer, manufactured by Swiss pharma giant Roche. One ampoule in Romania costs around 1,330 Euro (6,000 RON).
Roche sells 500 of these to the leading Romanian pharma distributors - Mediplus, AD Pharma, Polisano, Farmexim and Farmexpert, according to industry sources. From this figure, 495 boxes go immediately to Germany - securing a minimum of a 15 per cent profit on the input price. A small fraction of this number remain in Romania for patients.
The big pharma players re-export a great number of the commodities received from the producers, by ignoring national regulations.
No one can prove this intra-community trade is taking place because the distributors “forget” to report the movements of products to the Romanian authorities, as required by law since 2013.
The lack of reporting opens the door to medication fraud, such as the secondary sale of products across borders. The huge profits to be made from pharma allow big distribution companies to corrupt doctors and eliminate independent competition.
The scheme works like this:
A pharma distributor offers cash to an oncologist. The oncologist writes out prescriptions for a patient to be bought from a branch of a pharmacy that belongs to the same distributor.
There is no patient present as the pharmacist enters the details of the prescriptions into the computer system.
Then the pharmacy invoices the state health insurance authority CNAS to reimburse them for the cost.
Meanwhile the drug itself stays on the shelf.
This means the distributor can export the product to another company or associate in its group.
Therefore the distributor can double its money - once in the reimbursement from the Romanian state - and again on the sale of the product for export.
The visible and dramatic effect is that the vital medicines become unavailable to patients, so many die.
The investigation details a 67 year-old woman from Romania who saves her husband from prostate cancer. Cristina Achimoiu regularly travels 200 km by train to Bucharest to sell her handmade wool garments, and uses the money for her husband's treatment.
Cristina has a pension of 400 lei (around 85 Euro) per month, ten times less than the amount of medicines needed by the patient. A journalist posted on Facebook the story of Cristina that later received helped from a lot of Romanians, impressed by her sacrifice. But this is the exception.
Mioara Dumitrescu was 47 years old when she was diagnosed with brain cancer, in 2011. She published a letter attacking the health authorities who refused her Avastin treatment and she asked for the state to consider her a candidate for euthanasia.
The drug is not included on the list of free medicines the state can provide in Romania. Drugs like Avastin, Herceptin, Interferon, Zoladex or Tarceva are issued only after special or complicated approval protocols.
In 2012 Mioara Dumitrescu sued the state and won the trial with the state health insurance authority CNAS. After lengthy procedures, CNAS finally approved the 4,000 Euro per month needed for her treatment. This was too late, as Mioara died in 2013.
This is a cross-border investigation developed with support from JournalismFund.eu