Last year, a group of doctors at New York’s Memorial Sloan-Kettering Cancer Center refused to prescribe Zaltrap, a new colon cancer drug, because it was twice as expensive as another drug and was not demonstrably more effective. The drug’s manufacturer cut the price in half.
A second drug protest last month, according to the New York Times, involved scores of cancer specialists from around the world in a united effort to persuade pharmaceutical companies to reduce prices on cancer drugs whose annual cost can be horrific.
Writing as a group in Blood, the journal of the American Society of Hematology, the doctors and researchers claimed that the prices of drugs used to treat myeloid leukemia, a cancer of the blood, are astronomical and unsustainable.
And immoral? How else would you describe a drug whose cost can exceed $100,000 … for a year?
The writers, said The Times, suggest that charging such exorbitant prices for a medicine necessary to save lives amounts to profiteering; that it’s gouging people who have no alternative.
So many medical professionals from so many countries (15) signifies that doctors, who can be remarkably ignorant of the cost to patients and insurers of some of their treatment, are starting to get it. As The Times reported, “[S]ome of the specialists even include researchers with close ties to the pharmaceutical industry.”
Many cancer drugs are expensive, but as chronic myeloid leukemia specialists, the journal writers were able to speak only to the medicines used in their field. One, called Gleevec, is a big moneymaker for its manufacturer, Novartis-sales in 2012 were $4.7 billion, making it the company’s best-selling drug. According to The Times, a newer Novartis leukemia drug, Tasigna, generated $1 billion.
The company, according to The Times, says few patients pay the full cost of Gleevec and that it’s priced so high because of the considerable expense in developing it, and because price reflects its value to patients.
So, if we’re interpreting the last point properly, the sicker you are, the more desperate you are, the more you should pay to get better?
When it came onto the U.S. market in 2001, Gleevec cost about $30,000 a year, the writers said. Since then, the price has tripled while newer, even more expensive drugs have also entered the market. As The Times noted, Gleevec’s cost recently came under the scrutiny of the Supreme Court in India, which ruled that it could not be patented. That was good news for manufacturers of generic versions, and patients who need them.
The intent of the Blood writers was to raise cost consciousness and initiate a dialog among manufacturers and members of the medical/insurance communities about controlling drug costs. Many of the 120-some writers work with pharmaceutical companies to develop and test new drugs. As we’ve noted many times, these financial relationships often are fraught with conflicts of interest. So it’s refreshing that this group, which supports a successful pharmaceutical industry, also believes that its prices are much higher than they need to be.
“If you are making $3 billion a year on Gleevec, could you get by with $2 billion?” Dr. Brian Druker, who was the primary academic involved in developing the drug, told The Times. “When do you cross the line from essential profits to profiteering?”
One co-author of the Blood article told The Times he knew several researchers who declined to become authors for fear of losing research money from the industry. The lead author agreed that was a risk. “I am sure I am going to be blackballed,” he said. “My research career will be hurt.”
But, he told The Times, it was time to speak out. “Pharmaceutical companies have lost their moral sense. [Prices] are getting to the point where it is becoming unsustainable.”
Representatives of Novartis said that the company provided Gleevec or Tasigna free to 5,000 uninsured or underinsured Americans each year, and that it has provided free drugs to more than 50,000 people in low-income countries.
But the writers said that despite these programs, most of the estimated 1.2 million to 1.5 million people in the world with chronic myeloid leukemia weren’t receiving the drugs. In some developing nations, cancer experts advocate risky bone marrow transplants because that one-time procedure is less expensive than continuing drug therapy.
The article also said the survival rate for U.S. patients appeared to be less than it should be, maybe because patients can’t afford the medicine. The drugs cost twice as much in the U.S. as in many other countries. And even if some patients have low out-of-pocket drug expenses, somebody in the health system has to pay, so the cost is just shifted, not necessarily reduced. And the writers say that some patient subsidy programs are difficult to use.
Raven Riedesel told The Times that she had been denied by various charities because her husband, a pipe fitter, makes too much money. But their insurance would require a $1,200 to $1,600 a month co-payment for Tasigna. She hadn’t yet approached Novartis itself.
“It would take everything that we had left over after buying necessities and paying our bills,” she told The Times. Now she’s in a clinical trial where she gets Tasigna free. It ends in November.