By Bob Roehr
SAN FRANCISCO – AIDS physicians and activists officially launched a boycott of Abbott Laboratories at a news conference on February 10 in San Francisco, during the retroviral conference.
They are protesting Abbott s 400% increase in the price of the Norvir that was announced in December, and want it rolled back. It is another in a series of steps the AIDS community has taken against the company.
This is an unprecedented, unethical increase, said Benjamin Young, a Denver physician. He is one of the leaders of the ad hoc group the Organization of HIV Healthcare Providers that is organizing the boycott.
They are asking physicians to sever all ties with Abbott, including withholding service from company advisory boards and education programs, bar Abbott s representatives from their offices, and where there alternatives, to use drugs made by other companies in preference to Abbott s.
Young called the huge price jump an issue of freedom of choice for physicians and patients in selecting the most appropriate treatment regimen. More than 200 physicians have already joined the boycott and the buzz at the retroviral conference is that there is near unanimous support for the action.
Edwin DeJesus, an Orlando physician, said, Of the top twenty docs in Florida, as measured by the number of HIV prescriptions they write, more than a dozen have already signed on to the boycott.
Norvir, also known by the generic name ritonavir, is used almost exclusively in small doses with other protease inhibitors (PIs) to keep high levels of those drugs in the bloodstream for longer periods of time, explained William Powderly. He is a leading researcher and professor of medicine at Washington University in St. Louis.
A rise in the price of Norvir has consequences not only for those who use the drug on its own but more importantly for the use of all other protease inhibitors, he said. It also may have considerable effect on the development of new drugs that use a ritonavir boost. Other companies may come to believe that they cannot successfully market a drug that depends upon a ritonavir boost.
Curiously, the price of ritonavir has increased for every PI but Kaletra another drug made by Abbott. It has caused many cynics to speculate that the increase was made to put Kaletra at a price advantage compared to other options
New York physician Howard Grossman said they have heard of at least one hospital that has already revised its formulary the list of preferred drugs that physicians may use because of cost, to give preference to Kaletra and restrict physicians options to use other drugs.
He was particularly galled by the increase because it is almost a cost-free drug for Abbott, it requires zero marketing dollars, everyone else is selling Norvir for them. It s pure profit. Grossman fears that they will price any improved, more tolerable version of ritonavir at an even higher level.
Abbott has claimed that it needed to raise the price to fund additional research, but most are skeptical. I know that the virologists that have been working on HIV at Abbott are no longer working on HIV, they are working on hepatitis, said Powderly. Which raises the question of what new HIV drug development is being done at Abbott.
The company has circulated a chart to physicians and patients showing the new price of Norvir as significantly lower than all of the other protease inhibitors, at $8.57 a day. But that is for the small, sub-therapeutic dose that is used to boost other PIs. A full dose of Norvir as a stand along PI would be $102.84 a day.
The message communicated by the chart: 100 mg Norvir is cheaper but equivalent to these other drugs, said Bob Huff, a member of the AIDS Treatment Activists Coalition (ATAC). In a letter to the FDA asking it to investigate, Huff said the marketing letter was inaccurate, misleading and could cause confusion and potential harm. He and ATAC have asked for an investigation.
Abbott has acknowledged that it is cooperating with an investigation by New York Attorney General Eliot Spitzer. And in the state where it is headquartered, Illinois Attorney General Lisa Madigan has launched an inquiry into the price increase. In a February 6 statement she said, it stands out as an example of unfair pricing that may violate the Illinois Consumer Fraud and Deceptive Business Practices Act.
Activist Mark Harrington, with the Treatment Action Group, reminded the audience that AZT was initially priced at $10,000 a year when it was introduced in 1987. Continual pressure, from protests to congressional hearings, finally rolled back the price to half of that, even while science found that a smaller dose worked better, so that the annual cost was $2,500. But that all took three years.