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Never-ending Gleevec Drug Price Increases Are Prime Example of Market Failure and Greed

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Gleevec 400 mg tablets

Gleevec 400 mg tablets.  photo adapted from [CC BY-SA 3.0], Patrick Pelletier via Wikimedia Commons

An article in the Washington Post yesterday covered the steep rise in the cost of a cancer medication called Gleevec, drug company Novartis’ brand name for imatinib, which is incredibly successful in treating people with chronic myeloid leukemia (CML). Despite its concern with public perception over price at the time, Novartis charged $26,400/year when the drug hit the market in 2001. With today’s price for Gleevec now $126,000/year it seems any concerns by Novartis have gone by the wayside (or did they really exist at all?). One would think and hope that new, similar products would bring down – or at least slow increases of – the price of Gleevec. After all, competition is supposed to drive down prices.

Not in the pharmaceutical industry, at least not until a drug goes off patent. The launch of therapeutically equivalent brand medications to treat CML actually coincided with Gleevec’s steepest price increases. Bristol-Myers Squibb launched Sprycel (dasatinib) in 2006 and Novartis launched a second generation drug called Tasinga (nilotinib) in 2007, both at much higher prices than Gleevec. In 2007, the monthly prices for Gleevec, Sprycel and Tasinga were $3,757, $5,477 and $6,929, respectively. The details can be found in the Post’s article but essentially Gleevec started to play “catch up” to its competitors.

In 2007, the price of Gleevec was 46% less than Tasinga. By 2014, the discount had shrunk to 12% with Gleevec’s price at $8,156/month compared to Tasinga’s price of $9,300/month. Let’s keep in mind that the newer drugs were shown to treat people that Gleevec could not treat, which would soften the argument that these are truly competing products. But soon after their introduction, Sprycel and Tasinga were found to successfully treat people with newly diagnosed cases of CML, to more directly compete with Gleevec, yet the latter’s price soared!

Source: Graph below from the Washington Post.

Graph - increase in Gleevec Rising drug prices New drugs treating chronic myeloid leukemia were introduced at prices higher than Gleevec's. their prices have gradually risen since, and Gleevec's price has increased at a greater clip.

One source cited in the post’s article summed it up perfectly. A hematologist from the University of Chicago, Richard Larson, stated: “Ordinarily, you might think with three equally effective drugs on the market, the price should go down through competition, but it’s been a failure of the competitive pricing process.”

While the Washington Post’s article delved into the problem of out of pocket costs for Gleevec, it didn’t hammer home that the suffering in America is extreme when it comes to Gleevec’s drug price (and other medication prices as well). Gleevec is not a new topic on these blog pages, which has solicited comments from people and families crushed by drug costs. Yes, the irony is glaring: cancer medications that alleviate suffering also create suffering, too, in the form of cancer patients facing bankruptcy, feeling guilt, and causing anxiety.

It’s not just market failure – it is greed, too. I’ll let one American, Penny Kincaid, a commenter on this blog, bring it home:

“I guess I am luckier than many on Gleevec. I am paying 5% of the cost each month but the cost keeps going up. Our lives depend on this drug but still the cost is obscene. They praise themselves for creating [these] drugs for patients with [CML] but still we are forced to pay and many go broke. It is the cancer patient who has to pay up or die and they keep raising the cost. This is just wrong in so many ways and here we have the creators wanting to deny us the generic because they want that big money to keep rolling in. They should be ashamed of themselves.”

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Cancer drug costs and desperation: a reality for Americans

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This blog post concerns real people who are desperate, angry, and facing terminal illness because of the cost of a cancer medication. A woman named Lisa recently placed a comment on a blog post we wrote back in March 2013 called “The Price of Gleevec: A Tale of Two Supreme Courts.”  We noted at the time that the Indian Supreme Court told drug company Novartis to go fly a kite in its effort to stop lower cost generic versions of Gleevec, a cancer medication, from being sold in India, and that the U.S. Supreme Court was hearing arguments against a practice known as Pay-to-Delay involving a different medication.

But this post is not about policies and intellectual property or patent rights, the rightness or wrongness of India’s looser patent laws, pay-to-delay, personal drug importation or online pharmacies. It’s just about a woman’s husband and others who have cancer and can’t afford the medicine they need to get better or live.

Lisa gave me permission to re-publish her comment as a blog post here. I have made very, very slight edits, as you can see if you look at the original comment.

Lisa wrote:

This is very interesting news and gives us a little hope. My husband has Chronic Myeloid Leukemia (CML). He has been on Gleevec (here in So. California for the past 12 years. I thought I should mention Gleevec here in the U.S. is $10,600.00 a month for 400mg (30 pills). I thought should mention this because your prices listed here in the U.S. are inaccurate. That would bring the total cost to $126,000 a year.

We are going broke, will probably lose our home and my husband will probably never be able to retire (even though his body is breaking down from 40+ years of a very physical job as a pipe fitter. I (the wife), am permanently disabled. We will die homeless before this drug ever comes within an affordable price.

Many children and adults are cutting their pills in half, which defects the purpose. They too, will die before seeing Gleevec reach an affordable price here in the U.S.

All the countries you listed in the article, do NOT accept U.S. insurance companies and/or ObamaCare.

Why doesn’t anyone bring this to the press? Why does Congress and ObamaCare turn a blind eye? How many hundreds have to die before this drug and options are researched. I have written many letters to Norvartis, only to be ignored. I have written to Media Outlets only to be ignored. Now I am desperately asking for your help in bringing this to the media and anyone that will listen. We and many others are scared out of our minds. We are really loosing hope and it is tearing families apart. Some patients are becoming suicidal, because they don’t know how they are going to afford the next month supply of Gleevec. Novartis (GREEDARTIS) should be ashamed of themselves. You should research the substantial increases (quarterly), since the drug first went on the market. It will blow you mind! What if this was your child or loved one?

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No Prosecution for Prescription Access Hero Charged with Counterfeit Drug Sales in China

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At the beginning of this year, we brought you the story of Lu Yong, a Chinese citizen with Leukemia who was facing severe financial hardship due to the $3,783 monthly cost of his cancer medication, Gleevec. Mr. Lu found out he could order Veenat, a generic version of Gleevec, from India for a more affordable $640 a month. Soon thereafter he started helping fellow Leukemia sufferers – a thousand of them – access Veenat, in effect helping save their lives. Mr. Lu was rewarded by being charged with selling counterfeit drugs and credit card fraud!

The problem was that Veenat, an entirely genuine, legally manufactured and effective medication approved in India, is designated as “counterfeit” and unapproved in China. The credit card fraud charge was brought because Mr. Lu used other patients’ credit cards to order their medicine.

So, our earlier blog post on this story was called “Low Cost Counterfeit Drugs Save Lives in China…What?!” Seem like a stretch? Not really. Medication deemed “counterfeit” was in fact saving lives. A Chinese court seemed to agree, determining that Mr. Lu’s action should not be construed as “selling counterfeit drugs” since the medication was genuine. Additionally, because his use of other people’s credit cards was to help them, it was not “criminal behavior.” For more read about it in Chinese Radio International.

Lu Yong is a prescription access hero and we applaud him rancorously. Kudos to the Chinese legal system as well.

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Low Cost Counterfeit Drugs Save Lives in China…What?!

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I wish I was joking about the racy headline above. The United States is not the only great power in which citizens go without medication because of cost. The cancer drug Gleevec (imatinib), made by Novartis, costs 23,500 yuan, or about U.S. $3,783, per month, in China. Gleevec is not covered by health insurance in China so people there must pay for it out of pocket. Ten years ago, Lu Yong was diagnosed with chronic myelocytic leukemia and was prescribed Gleevec. After facing bankruptcy due to his drug costs, Lu discovered a generic version of Gleevec, called Veenat, and began purchasing it by mail-order from India where it is an approved drug, at a cost of only 3,000 yuan, or about $482, per month — 87% less than the brand name drug.

Lu’s condition improved quickly using  the generic version. He began to help people with leukemia who he met online obtain Veenat. Now, according to the English edition of Caixin, an independent Beijing-based media outlet, he is facing criminal charges for credit card fraud and selling counterfeit medication. The same story was covered by official Chinese media under the headline “Leukemia patient prosecuted for buying pills overseas.” Lu has helped 1,000 people with leukemia obtain treatment. Three hundred of them are petitioning the authorities to have his name cleared.

The medications involved are real and clearly life-saving! So why is Lu being prosecuted for counterfeit drugs? Under Chinese law, any drug not specifically licensed for sale in China, even a genuine medication lawfully manufactured by an authorized drug company, is considered counterfeit.

The charge of credit card fraud was based on Lu’s using a foreign credit card to make the purchases. Lu said he did so because using domestic Chinese bank-issued credit cards for international purchases is nearly impossible.

Lu was not charged for procuring his own cancer medication. The charges were for directly facilitating the purchase of the drug for 1000 people, who consequently regard Lu as a hero.

When people can’t afford to obtain life-saving medication locally, the U.S, and all countries, should consider themselves morally obligated to expressly permit their citizens to obtain it internationally.

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Specialty Medications Breaking the Bank; Online Options are Limited

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A few weeks back we wrote about drug affordability problems related to high deductible Obamacare silver plans. A new report finds problems across all four tiers for patients requiring expensive specialty drugs. Many plans have co-insurance rather than a fixed co-pay for these medications, which means patients pay a percentage of a drug’s price rather than a flat fee. In fact, over 50% of bronze, silver, and gold plans studied had co-insurance rather than fixed co-pays for specialty drugs. That compares to only 38% for platinum plans.

According to Wellmark, “Specialty drugs are prescription medications that require special handling, administration or monitoring. These drugs are used to treat complex, chronic and often costly conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.”

coinsurance_obamacare_tiers

Pamela Morris, of Zitter Health Insights, said “A lot of times, if someone has coinsurance their first exposure to OOP [out of pocket costs] is at the pharmacy, where they may be unsure if they’ve met their deductible or if the costs are purely coinsurance.”

So how big could this price shock be? Let’s look at Tecfidera, a sample oral Multiple Sclerosis drug. The cash price is around $6,000 for 60 capsules of the 120 mg dose. Even if your co-insurance is 25%, that’s $1,500. You can purchase the same amount for $1,200 from an international online pharmacy. Still expensive, but a $300 savings is nothing to scoff at. And it’s likely that the co-pay would be even more than 25% in which case the international savings could be much higher.

 

Gleevec, a medication used to treat certain types of leukemia, is around $29,000 for 90 pills. That will cost you $7,500 if your co-insurance is only 25%. Using an international online pharmacy, you can purchase 90 pills of generic Gleevec for $725 from a Canadian pharmacy. This may even be cheaper than using Novartis’s patient assistance program for brand name Gleevec. The program has strict eligibility requirements but is worth pursuing if you believe you’re eligible.

We’re sorry to report that many specialty meds may not be safe to order from an international online pharmacy. Some might be extremely temperature sensitive, others are administered in a clinical setting, only sold by specialty pharmacies, and some aren’t even approved for sale outside the U.S. For some specialty drugs, the savings might not even be that great, as prices are high globally!

We promise to research all avenues of savings for these medications and report back to you soon…

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