AIDS Treatment News #165, December 18, 1992
John S. James
Unfortunately this program is only for patients who do not have third-party coverage for their acyclovir use.
The cost of acyclovir has become an issue, especially during the last year, because more people are using high doses continuously after a major study in Europe and Australia reported finding survival benefit in some patients. (Youle, M. Double blind, placebo controlled trial of high dose acyclovir for the prevention of cytomegalovirus (CMV) disease in late stage HIV disease. VIII International Conference on AIDS, Amsterdam July 19-24, presentation number MoB 0056.) Most patients use acyclovir occasionally or temporarily. But the new use can cost $5000 per year or more, creating severe financial hardship or making the drug unavailable to patients for whom it was prescribed. The U.S. patent on acyclovir does not expire until 1997.
AIDS treatment activists from several organizations had negotiated with Burroughs Wellcome for ten months seeking price relief; according to Andrew Zysman, M.D., of ACT UP/Golden Gate, the company rejected an overall price cut but agreed to a price cap. Activists were not told the amount of the cap, or that patients with third-party coverage for the drug were ineligible, until the day the program was announced to the press, so they were unable to advocate for important changes.
"There are two problems with the policy," said Dr. Zysman. "The cap, while a start, does not go far enough. A workable solution would be an annual cap of $2000 per patient, which would continue to generate great profits, while making acyclovir more accessible.
"Second and most disappointing, the cap only applies to people without insurance. Activists are concerned about the cost of AIDS care not only to uninsured individuals, but also to the bankrollers of health care in America, the government and private insurers. Many physicians, for example in public health settings, are unable to suggest the use of acyclovir because it would bankrupt their clinic's budget; hence patients will not be able to benefit.
"We believe Burroughs Wellcome has made a grave error, acting neither in its own interests nor in the interests of the HIV community. A lower price cap, applied to all patients irrespective of insurance coverage, would affect physicians' attitudes about the cost-benefit ratio of acyclovir, and would create more widespread usage, generating greater, not lesser profits for Burroughs Wellcome."
Dr. Zysman has heard that Burroughs Wellcome did plan for the cap to cover all U.S. patients, but that pharmacists' representatives argued that their prescription-monitoring software was not set up to track such use. He also heard that activists were kept out of these negotiations because the company feared running afoul of regulations on the disclosure of "inside information" which could affect stock prices.
Note: Burroughs Wellcome replied that it already provides a 26 percent rebate to Medicaid, and effective January 1 will provide comparable discounts to state AIDS programs, sexually transmitted disease clinics, community and migrant health centers, homeless programs, public housing clinics, and mental health, tuberculosis, and family planning clinics.
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