Doctors protest 400% price hike in HIV medication

Physicians shocked and disgusted over a drug company's decision to raise an HIV medication's cost to $8.57 a day -- a 400% increase -- have joined together in protest.

These 200 doctors, many of whom are among the leaders in HIV treatment, say they don't have any choice but to continue to prescribe Abbott Laboratories' protease inhibitor Norvir to help their patients live quality lives. The drug is commonly used as a "booster" for other HIV-suppressing medications, and it has no competitor.

But to protest Norvir's December 2003 price increase, they will prescribe drugs by Abbott competitors when the choice exists and is medically appropriate, they said.

The grassroots physicians' group also will opt not to participate in Abbott postmarketing drug studies that seem to benefit the company more than patients.

The physicians say they understand that pharmaceutical companies need to make money for research and development, and they also understand that companies have to answer to shareholders. But, they say, an increase of this size is unprecedented and cannot become an acceptable practice in the drug industry.

"This sets a precarious precedent for the pricing of drugs if there is not a professional or legislative reply," said Benjamin Young, MD, PhD, an HIV specialist from Denver and one of the doctors to write Abbott about his concerns. "A 400% increase in the price of a life-saving drug is unethical."

The price jump is "outrageous," said Howard Grossman, MD, a New York City HIV specialist. "It's like talking about the price of gas going from $2 to $10. People would scream. It just isn't done."

Abbott spokeswoman Ann Fahey-Widman said company representatives met with doctors, including members of the HIV Medicine Assn. and the American Academy of HIV Medicine; patients; and patient advocates about the matter.

Afterward, the company decided to leave the drug pricing at the current level in most cases, but agreed to:

• Permanently freeze the charge for Norvir soft gelatin capsules for state-administered AIDS Drug Assistance Programs at the price in place before the December 2003 increase.
• Offer free Norvir to patients without private or government drug coverage who participate in the U.S. HIV Patients Assistance Program, which does not have an income requirement.
• Give free Norvir to patients who exceed their annual drug coverage maximum.

"We've actively listened to the concerns of doctors, and we've taken those concerns to heart," Fahey-Widman said.

States, courts get involved

Some physicians say those actions aren't enough to address the problem.

Their objections have raised the attention of several government officials. Washington Gov. Gary Locke sent a letter to Abbott in mid-January expressing "concern" about the cost increase and asking the company to reconsider its decision. Illinois Attorney General Lisa Madigan and New York Attorney General Eliot Spitzer launched investigations into the price hike.

"Increasing its price is like increasing prices for life-saving cancer drugs or heart drugs," Madigan said. "This investigation is aimed at determining the real reason for the price increase and assessing whether the increase violates Illinois law."

Also, the AIDS Healthcare Foundation in February sued Abbott, claiming that the company had violated antitrust and restraint-of-trade laws.

Fahey-Widman said the investigations and lawsuits are "without merit" and that Abbott complies with the laws.

In a letter to the American Academy of HIV Medicine, Abbott officials wrote that their pricing decision was not made "lightly." The company said Norvir's role had changed since it was introduced in 1996. Then it was a stand-alone protease inhibitor with a 1,200 mg daily dose. The cost was $20.52 a day, the company said. Today, it's used with other protease inhibitors at a 100 mg daily dose. Before the December 2003 price change, it cost $1.75 a day.

"At the new price of $8.57 per 100 mg ... Norvir continues to represent a fraction, typically one-fifth, of the daily cost of therapy," Abbott stated in the Jan. 20 letter.

But Dr. Grossman said he saw the cost change as monopoly pricing.

"What happens the next time someone tries to raise prices?" asked Dr. Grossman, who is encouraged that state attorneys general are investigating. "This kind of thing puts the entire health care system at risk."