AEGiS-GMHC: Getting Your Space on the Magic Crixi-van

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Getting Your Space on the Magic Crixi-van

GMHC Treatment Issues, Vol. 10, No. 3 - March 1996
Dave Gilden

As this month's Treatment Issues was preparing to go to press, the FDA announced that it had broadly approved Merck's protease inhibitor indinavir (brand name: Crixivan) "for the treatment of HIV infection in adults when antiretroviral therapy is warranted." Anticipating its product launch on March 25, Merck had established a number of procedures to assure a smooth transition when indinavir hits the market. The company's number one problem is that it planned to receive approval next fall, when its production facilities will be completely on line. Because the FDA encouraged Merck to hurry up, the supply of the drug will be somewhat limited until late this year. Just how limited, Merck will not say, terming this figure "proprietary information." (The unofficial word is that there is enough indinavir for 40,000 patients.)

To monitor the sales of indinavir and ensure that an individual will continue to get the drug once he or she starts taking it, the entire retail supply of indinavir will be placed in the hands of Stadtlander's Pharmacy, a mail- order concern. Doctors will have to send or fax a special prescription form to Stadtlander's to obtain indinavir for their patients. Stadtlander's will ship the indinavir after the patient's reimbursement coverage is verified, which should take no longer than 48 hours. (Stadtlander's will ship indinavir COD, too.)

In states where Stadtlander's does not operate or public reimbursement programs have no payment agreement with Stadtlander's, the firm will have to ship the indinavir to an intermediary drug supply company. Further, the Veterans Affairs medical system and perhaps large local hospitals will have their own direct connection to Merck.

To order Crixivan (doctors only) or for further information on the prescription procedure, call the Merck/Stadtlander Crixivan hotline at 800/927-8888. Some activists already are complaining that Merck's program will prove awkward and unworkable, especially for those under the care of public health clinics. Merck has promised to try to adjust the system if there are problems. (Treatment Issues would like to hear about people's experiences obtaining indinavir. Write to us at 129 W. 20th St. New York 10011, fax us at 212/337-3656 or e-mail DAVE_G@gmhc.org).

Before indinavir was approved, Merck would not comment on the price it planned to charge, again citing "proprietary information." There were considerable fears about how much Merck might ask, but the company has now announced that the factory wholesale price for indinavir will be equivalent to $4,380 for a year's supply, making indinavir the cheapest protease inhibitor available.

Merck is offering a financial assistance program for those who are having trouble raising that kind of money. Those eligible for the program must be uninsured and unable to qualify for any publicly financed program. Applicants will also have to pass a financial screening test given over the phone. Again, Merck will not reveal the formula it is using to determine financial need because this is "proprietary information." Alternative ways of qualifying for the program include reaching the annual drug expense cap in your insurance coverage or exhausting your available funds. Financial counselors who will help patients or their representatives obtain third-party payment or Merck's financial assistance also can be reached through the Crixivan hotline (800/927-8888).

The financial assistance program will also provide temporary aid to people whose reimburser is still considering whether or not to include indinavir in its formulary (list of covered drugs). If the third-party payer eventually decides to exclude indinavir, those of its members already benefiting from Merck's assistance will continue to receive free indinavir. But note: Patients whose reimbursers have formally refused to cover indinavir are ineligible for financial assistance (Merck fears if it offered such aid, then every program in the country would reject indinavir, passing the bill back to the company). This quirk is another incentive to start on indinavir as quickly as possible.

Indinavir has an attractive combination of relative potency and safety, and its price is relatively low. Demand is sure to be great. Treatment Issues advises its readers not to tarry if they want the drug any time soon.

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Copyright © 1996 - Treatment Issues. Reproduced with permission. Treatment Issues is published twelve times yearly by GMHC, Inc. All rights reserved. Noncommercial reproduction is encouraged. Subscription lists are kept confidential. GMHC Treatment Issues, The Tisch Building, 119 West 24th Street, New York, NY 10011 fredg@gmhc.org http://www.gmhc.org

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