Chicago Tribune - December 20, 2003
Bruce Japsen, Tribune staff reporter

Norvir, one of the earlier treatments for HIV, isn't the top-seller it once was, but it is commonly used to boost the effectiveness of other treatments used in so-called AIDS cocktails, which have been hailed in fighting the deadly disease.

Abbott has raised the wholesale price of Norvir to $8.57 a day, or $257.10 a month, from $1.75 a day, or $52.50 for a 30-day supply, company records show.

The spike has rekindled a heated debate over drug pricing policies and could jeopardize Abbott's otherwise good image in the AIDS community.

The North Chicago-based drug giant has long been among the leaders in providing low-cost AIDS medicines to African countries and a supporter of the HIV research and medical community.

"In the good, the bad and the ugly of the pharmaceutical industry when it comes to HIV treatment, I would say that, overall, according to many measures, Abbott is the good," said Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation. "They have been generous in supporting efforts in the developing world, and they have been cooperative in providing discounts. This is uncharacteristic."

With various combinations of treatments already costing up to $1,600 a month, AIDS activists believe Abbott could be encouraging cost-conscious health insurers to force patients to pick Kaletra, Abbott's next-generation AIDS drug.

Kaletra costs about $18.78 a day, or $563.40 a month, the company said. It doesn't need a boost from other drugs to be effective because it includes Norvir as an ingredient, but AIDS activists say Kaletra might not work for all patients.

"This is purely a marketing ploy to push for a larger market share for Kaletra by driving providers and patients to this cheaper Abbott combination therapy," Weinstein said. "The HIV community as a whole should unite and speak out against Abbott's baldfaced greed."

Abbott said its price increase for Norvir is long overdue after years of being priced well below rivals. Norvir, which came on the market in 1996, was one of the first protease inhibitors.

Market share for Norvir slides

Over time, though, Norvir lost market share, as did a lot of the other early AIDS treatments because some patients developed a resistance to them. Abbott scientists developed Kaletra as a replacement for Norvir, and the newer drug became the nation's top-selling protease inhibitor because of its effectiveness.

Since its launch in 2000, Kaletra has surpassed original projections and is expected to generate more than $700 million in worldwide sales this year.

At its peak, Norvir generated about $250 million in annual sales, but last year's revenues were about half that.

Price freeze in place for some

Abbott does not plan to revisit its decision. Furthermore, Abbott and even some AIDS activists admit most patients won't have to pay the huge increase because the company has frozen the price charged to community health centers and government insurers through 2005.

"We didn't take this decision lightly, which is why we froze the price of Norvir to AIDS drug assistance programs through March of 2005 and expanded our patient assistance program to ensure patients who can't afford it continue to have access," Abbott spokeswoman Melissa Brotz said.

"The value of Norvir in HIV treatment has increased dramatically over the last several years, and the new price of Norvir continues to represent a small fraction of the overall cost of an antiviral regimen," she said. "We continue to invest in HIV research both in Norvir and Kaletra and with a third-generation protease inhibitor currently in pre-clinical research."

Today, Norvir is largely prescribed by doctors as a boost to Kaletra rivals such as Bristol-Myers Squibb Co.'s Reyataz, a drug that came on the market this summer. Bristol would not comment about Abbott's move.

Cost might prompt switch

A higher cost for Norvir might force patients to switch to Kaletra, which may not work as well for them or could force them to lose access to medicines altogether, depending on what insurers do, doctors say.

The concern is real, analysts say, because Reyataz costs $22.08 a day, or $662.40 a month, and it was priced higher than Kaletra before Abbott raised the price of Norvir.

Abbott, however, thinks health plans have historically given doctors more latitude when it comes to prescribing HIV drugs that can mean life or death, rather than allergy or heartburn medications considered routine maintenance drugs with ample competition.

Still, health insurance companies increasingly look at ways to restrict access to more expensive treatment regimens, especially given that overall health-care premiums are rising rapidly.

"This much higher cost will likely raise insurance premium payments and increase the amount of individuals' co-payments for [Norvir]--co-payments that most people with HIV/AIDS can ill afford," Drs. Paul Volberding and Daniel Kuritzkes, members of the board of the HIV Medical Association, said in a letter to Abbott.

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