title: Affordable orphan drugs: a role for not-for-profit organizations.
abstract: The success of the Regulation on Orphan Medicinal Products in the European Union is evidenced by the 127 orphan drugs that have had market authorization since 2000. However, the incentives aimed at stimulating research and development have had the unintended consequence of increasing drug cost, resulting in many orphan drugs not being cost-effective. Orphan drugs command an increasing share of the pharmaceutical market and account for a disproportionate amount of healthcare expenditure. Orphan drug ownership by socially motivated, not-for-profit organizations may facilitate access to more affordable orphan drugs, for the benefit of patients and healthcare systems alike. This study aims to describe opportunities for such organizations to become orphan drug Market Authorization Holders.
  
  
  
  We reviewed data on the ownership of EMA designated and approved orphan drugs, identified funding opportunities and business models for not-for-profit organizations, and summarised relevant legal and policy documents concerning intellectual property rights and drug regulation.
  
  
  
  Using repurposed drugs as a paradigm, this narrative review navigates the regulatory hurdles, describes the legal context and identifies funding opportunities, in a bid to facilitate and encourage not-for-profit organizations to lead on the development of affordable orphan drugs.
  
  
  
  Although the regulatory steps required to obtain an MA for an orphan drug are numerous and challenging, they are not insurmountable and can be achieved by not-for-profit organizations that are socially motivated to reduce the costs of orphan drugs to the payers of healthcare. Opportunities for orphan drug development resulting in affordable products lie mainly with repurposed drugs.
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, LL57 2PZ, UK.
authors.forename: Elin H
authors.initials: EH
authors.lastname: Davies
authors.affiliation: Hogan Lovells International LLP, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Fulton
authors.affiliation: Hogan Lovells International LLP, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brook
authors.affiliation: Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Holyhead Road, Bangor, LL57 2PZ, UK.
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
mesh_terms: D003362:Cost-Benefit Analysis; D017277:Drug Approval / Q000191:economics / Q000331:legislation & jurisprudence; D016527:Drug Costs; D058492:Drug Repositioning / Q000191:economics; D005062:European Union / Q000191:economics; D017408:Guidelines as Topic; D006801:Humans; D009939:Organizations, Nonprofit / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D009965:Orphan Drug Production / Q000191:economics* / Q000331:legislation & jurisprudence / Q000592:standards; D010067:Ownership / Q000191:economics* / Q000331:legislation & jurisprudence
keywords: drug development; drug regulation; drug repurposing; not-for-profit organization; orphan drugs; public sector