Tuesday, February 10, 2004

More On Ritonavir

A while back I wrote about Abbott Pharmaceuticals' decision to raise the price of their drug Ritonavir.

Since then, doctors have decided to fight back:
About 200 physicians have agreed to boycott Abbott drugs in favor of alternatives whenever medically appropriate, Young said. Norvir has no equivalent, but physicians can find substitutes for other Abbott products [...] The doctors also have agreed to ban Abbott sales representatives from their offices and to refuse to participate in any new Abbott-sponsored clinical trials, until the company rescinds the price hike.
It's a particularly smooth move to boycott Abbott products in general, given that HIV management is tricky enough that no one's going to change their patients' regimens for the sake of a boycott.

In return, Abbott's offering some concessions that look good on the surface but don't seem to get to the heart of the problem. They'd already promised not to raise the price of ritonavir purchased by state AIDS Drug Assistance Programs until 2005 - now they're making that "permanent." And they're promising to make ritonavir available free of charge to anyone who doesn't have insurance. But, as I said in my earlier post, not many people take straight-up ritonavir. The real issue is the role of ritonavir in combination with other protease inhibitors (it intensifies and extends their effects). Several new drugs depend on the inclusion of ritonavir to be practical and cost-effective - only now that the price has risen 400%, the "cost-effective" part no longer applies.

Abbott's promising to make ritonavir available at the former price for research studies of new drugs. That doesn't apply to the drugs that have just hit the market now, and which depend on a ritonavir boost. And of course, it will only benefit Abbott to encourage further research into ritonavir-dependent drugs, given that once those new drugs are FDA-approved the price of their ritonavir component will bounce back up with the 400% increase, payable to Abbott.

The Attorneys General of New York (yay, Elliot Spitzer!) and Illinois are investigating Abbott for possible antitrust violations, based on the argument that the ritonavir price increase was designed to shift prescriptions to Abbott's in-house ritonavir-plus-protease-inhibitor combo, Kaletra, and away from combinations of other companies' drugs with ritonavir.

Frankly, all of the things Abbott is doing to mitigate the price increase for people who use ritonavir as an independent drug, such as freezing the price for state buying programs, just further underline the argument behind the antitrust suit. They never meant the price increase to affect anyone but people who take ritonavir in combination with another company's protease inhibitor.