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Replying to:
PLEASE CIRCULATE TO HCV AND HIV GROUPS AND LISTS
SIGN-ON LETTER IS COPIED BELOW AS WELL AS IN ATTACHMENT
INTRODUCTION
Please note the attached community letter that will be sent to
Hoffman-La
Roche regarding the excessive price they had set for their new and
improved
version of interferon called Pegasys. Pegasys alone will cost nearly
$14,000
for a year's treatment. In addition, it must be used in combination
with an
antiviral drug, ribavirin. Currently, ribavirin must be purchased
separately
from Schering Plough at a cost of an additional $14,000 to $21,000
(depending on dosage). Thus, the total cost of 1 year's treatment for
HCV,
using Pegasys plus ribavirin, would range from $28,000 to $35,000
wholesale
(figures are approximate). Hoffman-La Roche is offering the first 12
weeks
of Pegasys free,
but this offer extends only until the end of the 2002 calendar year.
At these prices, the great majority of people in need of treatment
for HCV
will be unable to access it. For those who have only HCV without HIV,
there
are no such things as ADAP and Ryan White funding, and it is unclear
whether
Medicaid will be able to put the drug on the formulary for
reimbursement.
For those with both HCV and HIV, the price all but makes it
impossible to
cover the drug under the ADAP program or Ryan White funded programs.
In
short, only those with high quality private insurance have much
chance of
getting access to treatment.
We feel it is critical that community groups express their strongest
possible concern about these prices. One good way to do this will be
by
signing on this letter, which already has the endorsement of many
prominent
HCV and HIV activist groups. Please read the letter and, as quickly as
possible, send confirmation and how you or your organization wishes
to be
listed. Sign-on confirmations should be sent to Ryan Clary at Project
Inform, using this address: tan@projectinform.org. Ryan has graciously
agreed to manage the sign-on process. Sign-on confirmation should be
sent by
5 PM, Pacific Time, Friday November 1.
Thank you for your prompt attention to this critical matter, and
thanks to
all who helped in getting this letter out.
Martin Delaney, Project Inform and the Fair Pricing Coalition
Brian Klein, Hepatitis C Action and Advocacy Coalition
PS. Apologies in advance to anyone who had already agreed to sign-on
but
whose name or organization is not currently listed on the letter. We
may
have lost track of an email or two along the way.
--------------------------------------------------------
Mr. George Abercrombie
Chief Executive Officer
Hoffmann-La Roche
(cc to Franz Humer, Basel Switzerland)
Dear Mr. Abercrombie,
We are writing on behalf of the undersigned groups, organizations and
individuals. We are writing to express our extreme dismay at the
pricing
actions taken by Hoffmann- La Roche in the launch of its new product,
Pegasys, for treatment of HCV infection.
Several of our members spent a great deal of time and effort
attempting to
convince your firm that it had an important opportunity in the launch
of
Pegasys to undercut the outrageous pricing set by Schering for its
version
of pegylated interferon. We talked about how much easier it would be
to
establish reimbursement for Pegasys if the price were substantially
lower.
We hoped to see a price that would make it possible to put the drug on
formularies for Medicaid, MediCal and perhaps even the AIDS Drug
Assistance
Programs (ADAPs), as well as to secure similar forms of reimbursement
for
HCV patients who are not co-infected with HIV. We stressed how the
bulk of
the target markets for HCV treatment are not covered by private
insurance.
We pointed out how high drug prices are forcing people out of the
market for
private insurance and causing dramatic increases in the "co-pays" for
prescription drugs. Earlier on, many advisory board members,
activists and
HCV coalition members worked with the FDA to clear the path for
regulatory
approval of Pegasys, stressing the need for competition because of the
incredible price charged by Schering. Most of all, we warned Hoffmann-
La
Roche not to use the Schering price as a standard of reference, but
rather
make its pricing decision on a higher moral and ethical plane..
To our dismay, it appears that Hoffman-La Roche wasn't listening. Your
company chose a price that, unbelievably, is in fact higher on an
annual
basis than Schering's: $13,963 for a year's treatment with Pegasys,
versus
$13,116 for Peg Intron. We have all experienced this as betrayal.
Since the
price is so close to that set by Schering, it is obvious that your
company
simply decided that all it had to do was come near their price.
It's also striking that the Pegasys price is higher, by a large
amount, than
that any of the antiviral drugs developed for treatment of HIV, which
may be
the most reasonable point of reference. By comparison, Pegasys isn't
even a
new drug, but rather the application of a well-known modification to
an
existing drug. It is hard for us understand how such excess can be
ethically
justified. We recognize that Pegasys requires a greater quantity of
base
interferon as a raw material, but certainly not so much that it
justifies
the incredible annual price.
We recognize and appreciate that Hoffman-La Roche is providing free
drug for
the first twelve weeks, but that program will be forgotten after
January of
2003, just a few weeks from now. Its effect on overall pricing is
minimal.
We hear that the "real difference" might come when Roche's version of
ribavirin is added to the mix, that the price for this very old, very
cheap
and easy-to-make, off-patent drug will be substantially lower than
that
charged by Schering. We should certainly hope so, since Schering'
ribavirin
price borders on the criminal. Yet we have no reason at present to
believe
that Hoffmann-La Roche will suddenly change its spots and sell
ribavirin at
an appropriately low price. We expected a lower price for Pegasys
and got
one even higher than anyone imagined. Given the history, age, and
manufacturing simplicity of ribavirin, it would be impossible to
justify a
price even as high as the lowest priced nucleoside analogue used in
HIV
disease, which is under $3000 per year. Will your company listen to
us this
time?
We also made a major point that your pricing for Pegasys would be
closely
watched as an indicator of your intentions with regard to the pricing
of the
upcoming HIV entry inhibitor Fuzeon. Based on the Pegasys pricing, we
are
now gravely concerned about your plans for Fuzeon. An excessive price
will
surely lead some state ADAPs into virtual bankruptcy while further
reducing
the number of indigent HIV-infected Americans who can access this
program.
ADAP programs are already struggling underneath an anticipated
deficit of at
least $162 million in FY 2003. Many of us have worked for the last
few years
helping Roche and Trimeris ensure that the development of Fuzeon was
responsive to community concerns and the needs of people with HIV. In
light
of the Pegasys pricing, the company's protestations about the extreme
costs
of manufacturing Fuzeon will now fall on deaf ears. In it's pricing of
Pegasys, Hoffmann- La Roche has demonstrated that its pricing
policies are
based on greed and opportunism rather than legitimate need.
We await now with a sense of grave foreboding the pricing of both
ribavirin
and Fuzeon. The bonds of trust we had striven so hard to build with
Hoffmann-La Roche have suffered a severe setback. Hoffmann-La Roche
is
unlikely to enjoy the level of open communications and trust it had
recently
achieved with the hepatitis and HIV communities. Hoffmann-La Roche has
demonstrated the limits of that trust and communication by its
indefensible
price for Pegasys.
This letter is not the end of the matter from our point of view. We
will
continue to explore ways of lowering these prices. We believe your
company
has made a profound mistake, the result of which will be a much
smaller
market for Pegasys than might otherwise have been the case. We will
explore
all possible methods of telling this story in the media and the US
Congress,
both of which are currently very interested in the subject of drug
pricing.
We remain willing to meet with you or your designees to discuss this
matter
further. But as of now, we can only express our complete and utter
discontent, dismay and disappointment with your actions.
Sincerely, (in no implied order)
D.O.C. Religious Advisory Committee, Frontline Hepatitis Awareness
Fair Pricing Coalition
Hepatitis C Action & Advocacy Coalition (HAAC)
Hoffman-La Roche HCV Community Advisory Board
HIV and Hepatitis.com
AIDS Action Baltimore
AIDS Community Research Initiative of America
AIDS Treatment Data Network
Project Inform
Treatment Action Group
David Gilden, New York, NY
Michael Marco, Washington, DC
Tracy Swan, Co-Infection Project Director, TAG
Lynda Dee
Martin Delaney
James Learned
Allan Clear, Executive Director, Harm Reduction Coalition
