Tuesday, 25 September 2012

Is teriflunomide overpriced?

I was at a meeting yesterday with some American colleagues and nearly fell off my chair when I heard  that teriflunomide has been priced at $45,000 per year for American MSers. Even more astounding was the news that glatiramer acetate and fingolimod have increased their prices to over $50,000 per year. Common wisdom would tell you that competition and the market would bring down the price of DMTs. This cycle of price rises is clearly madness and unsustainable. I predict a black swan is winging its way into the MS market and we will all suffer; in particular MSers. 



You may want to read the following editorial that gets to the heart of the issue:

Hauser SL, Johnston SC. Multiple sclerosis drugs: sticker shock. Ann Neurol. 2012 May;71(5):A5-6.


Two excerpts:

"Fewer than 0.1% of prescriptions written in the US are drugs for multiple sclerosis (MS), but these represent 3.1% of total drug costs. The global MS drug market is now estimated at $10 billion, and is predicted to experience double digit increases on an annual basis.1,3 Two MS drugs are now in the top 20 in terms of global sales: glatiramer acetate (Copaxone, produced by Teva) was #12 in 2011, with sales of $3.3 billion, followed by interferon beta 1a (Avonex, Biogen Idec) at #20 with $2.5 billion. Currently, drug costs account for more than half of the total cost of care for MS."

 "Not everyone pays the same price for drugs, of course, and rules that underlie various pricing levels in the US (Medicare, commercial, individual), added to negotiated rebates, patient assistance programs, and different rules for international buyers provide enough complexity to make the most seasoned economist’s head spin. However, it is clear that prices in the US are higher than almost anywhere else, and because of these prices the value of any drug will be lower. For example, the cost to provide one quality of life year (QALY) from an MS drug may be unacceptably high in the US – over $800,000 in one recent study.6 In the UK, by contrast, interferon treatment costs approximately $12,000 USD annually, and because of this lower cost, the value of MS drugs dramatically improves. One could reasonably argue that it is patently unfair for the American health care system to pay such a premium for these needed therapies. If overall pricing is justified, is the disproportionate US burden our gift to Europe and the rest of the world?"


"This issue needs serious discussion and debate!



21 comments:

  1. Thanks for your honest point of view, Prof. G. In my opinion (and I'm not a conspiracy-theory or black hand fan), there is clearly a price negotiation within big-Pharma sector. Hopefully new therapies (like vit. D or over the counter nutriceuticals Nrf-2 mediators alternative to BG-12 which will be as expensive for sure) will prove as useful as the low-effect Teriflunomide, and people will make their choice against such short-sighted price policies from our greedy friends.

    ReplyDelete
  2. Is this further evidence that it is not really competition but Cartels?

    The Organisation for Health Exporting Companies....OH-EC

    Heck = a way of refering to Hell :-)

    ReplyDelete
  3. "Common wisdom would tell you that competition and the market would bring down the price of DMTs."

    This would be correct if we had a free market.
    But we have a found which has a lot of money. So everybody is trying to get the biggest share.

    Interferons have set a minimum price and the next big thing will cost more and everybody is willing to pay that price for the "greater good".

    That's what happens in a socialised market.

    ReplyDelete
  4. It appears in the world of big pharma, the tenets of Adam Smith certainly do not apply. It surely must fall to governments to show them the error of their ways in what is in my mind sheer profiteering off the backs of the vulnerable who are desperate for new drugs.
    Let us not forget that pharma marketing budgets are usually at least twice their research spend.
    Of course this wouldn't be so bad if the business was ethical but as Ben Goldacre points out this frequently isn't the case.
    http://www.guardian.co.uk/business/2012/sep/21/drugs-industry-scandal-ben-goldacre
    I'm sure people from pharma visit these pages from time to time and perhaps some might like to educate us in their thinking on decisions such as above.

    ReplyDelete
  5. I thought the US in particular took a dim view of companies operating as cartels, which certainly seems to be what is operating here. perhaps the US will act as they have on previous big pharma malpractice, where the fines have run into billions of dollars.

    ReplyDelete
  6. If GA and teriflunomide, which are only moderately effective cost that much, it's scarey to think what they will charge for BG12 and alemtuzumab? Also GA and the interferons could price themselves out of the market if health providers decided to purchase teriflunomide instead (about as effective and no problems with storage, delivery or injection reactions)- and it would serve them right

    ReplyDelete
  7. I think the strategy is that the price of GA and beta interferon are hiked to squeeze as much profit out of their remaining patent life as more effective DMTs claim more of the market share.
    The thinking behind the outrageous price quoted for teriflunomide leaves me baffled.

    ReplyDelete
  8. I just met a group of Genzyme staff at the UK MS Society's awards who inform me that the price in the US is not $45,000. They promised to comeback to me ASAP with the correct price. Fingers crossed!

    ReplyDelete
  9. Prof. G you forgot Ampyra? It now costs $1200 per month! http://www.regencerx.com/docs/consumerRx/ampyra.pdf

    ReplyDelete
  10. I have made a comment on the post.

    If you look at the post the figures do not match!

    In the link although it states $45,000 but 28% lss than Gilenya ($48,000). It implies the cost will be below competitor drugs so doing the sums it would be
    below $40,000.

    Still extortionate for our MSer friends across the pond.

    ReplyDelete
  11. No $45,000 per year is correct: http://blog.pharmexec.com/2012/09/13/sanofis-aubagio-to-square-off-against-ms-injectables/

    ReplyDelete
  12. MouseDoc you have overlooked the fact that Novartis and Teva, have recently increased their prices for Gilenya and Copaxone! They are now selling way above $50,000 per year.

    ReplyDelete
  13. OK 8 % less than 50K is 45K

    Outrageous in my opinion the lot of them.

    ReplyDelete
  14. Another poster said 'If Pharma can't make a hefty profit on MS drugs then they will stop developing them', and that is right of course.

    Recently a doctor told me that where treatments are concerned, MSers are relatively better off than many others because MS is mainly a rich country disease. In contrast, very little research goes into diseases that are more prevalent here in India or elsewhere in Asia & Africa.

    The problem with this argument is that overpriced treatments don't help many people. Drugs are no use to patients who have no access to them.

    I got a phone call recently from somebody who asked if we would be willing to pay Rupees _____ per month for an oral treatment. My guess is this was in preparation for introducing teriflunomide in India

    The price she mentioned is much lower than the US price, lower than Rebif/Betaferon in India (unless they have become much cheaper recently), and much lower than Tysabri. So it seems they plan to price it low compared to other MS drugs. Even then, the annual cost at this price will be ALMOST DOUBLE what I pay for rituximab (which is also expensive)

    ReplyDelete
  15. I would have thought the logical thing to do would be undercut the competition and aim to get people changing from injections to a pill.

    Would the competition then drop their price to make it less attractive.

    Alternative the mantra is make em pay annd they will change because they want a pill not an injection.

    Pharma all need profits, but there are profits and there is profiteering.

    There are companies making drugs for other conditions where the cost of drug is not so high. We know it no longer has a bearing to cost of manufacture. What about cost of development.

    ReplyDelete
  16. For the pricing the companiens will have spent thousands doing market research..to get opinions from Neuros and doctors.

    ReplyDelete
  17. from Anon 6.52 again:
    This could also have been about fingolimod (not sold in India yet) or advance work for BG12. In either case it would be much better value for money

    ReplyDelete
  18. There's another side to this, which I'm sure the pharma companies don't care about, but still ...

    When many of us are diagnosed with MS, one of our regrets and fears is that we will become a burden. Of course, I worry about becoming a burden on my family. But the truth is I'm already a burden on my community.

    Despite the fact that I have virtually no disability and work all day every day, I'll now never contribute what I take from society just for the cost of my Copaxone. If my disease progresses, it just gets more expensive and I become a bigger burden to everyone.

    That's a a huge shift for me and one that changes my identity and sense of self almost entirely.

    ReplyDelete
  19. Teriflunomide is overpriced. With teriflunomide, the pharma did not invent anything. Teriflunomide is the active metabolite of leflunomide, a drug approved for rheumatoid arthritis in 1998. The industry choose teriflunomide instead of leflunomide to get a new patent. The academy keeps its mouth shut because they get incentives from the industry. Biologically, there is no difference between leflunomide and teriflunomide. Financially, leflunomide sells for 150 USD a month...

    ReplyDelete
    Replies
    1. Yes overpriced but what do you suggest academics do? What can they do?

      What is the solution?

      Say we wont prescribe them.....NICE does a pretty good job of taking that option away for the very expensive drugs

      Say you don't want them.....Not a good option

      As for tweaking something to get patents. Can you blame them if they are a money making machine?.

      They have done this with Fumaderm and BG-12 rituximab and ocreluzimab almost did it with cladribine and oral clabribine. They will do it again because it is de-risked.

      If you know the activity and the side effects of a class of drugs it is safer to develop than try develop a whole new class of agents.

      Delete
  20. There is an option: prescribe leflunomide instead. Logically, it's no different than using AZP for 6-mercaptopurine. At least offer the patient the possibility.

    ReplyDelete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.