Abbott Laboratories quietly increased the price of ritonavir (Norvir) by 400% Dec. 4, from $1.71 to $8.57 per 100 mg pill. The protease inhibitor (PI) primarily is used in sub-therapeutic doses with other protease inhibitors to delay their clearance by the liver. That means the price increase will be felt widely.
The AIDS community has only slowly become aware of the increase and is reacting with outrage and threats of boycott.
The company has asserted that the increase is a long-overdue price adjustment and reflects the cost of past research when they had to reformulate the compound. It also is not increasing the price to state-run AIDS drug assistance programs (ADAPs).
But many observers are calling it a ploy by Abbott to increase the market share of Kaletra, its other protease inhibitor. Kaletra had been losing ground to other PIs that have recently been approved for sale. This would boost the total cost of other PIs that must use Norvir as booster.
Michael Weinstein, president of the AIDS Healthcare Foundation, noted that even while the price of Norvir was skyrocketing, the price of Kaletra, which uses Norvir to boost its potency, did not increase at all.
'This is purely a marketing ploy to push for a larger market share for Kaletra by driving providers and patients to this cheaper Abbot combination therapy,' Weinstein said. 'The HIV community as a whole should unite and speak out against Abbott's bald-faced greed.'
'Abbott is feeding like a vulture on the bones of our healthcare system,' the AIDS Treatment Activists Coalition (ATAC) said in a flyer they are distributing about the price increase (see Web site www.atac-usa.org/Abbott%20Vulture.pdf).
ATAC, in a letter to Abbott dated Dec. 22, noted that tipranavir, a promising PI under development by Boehringer Ingelheim, uses 400 mg of Norvir daily. If the price increase stands and if tipranavir is approved by the FDA, its price would be about $20,000 a year, several times that of other currently available PIs.
'Abbott has changed the landscape of HIV/AIDS for the worse—is this what it wants to be known for?' asked ATAC. 'We believe that it is in the overall interests of your company to reconsider this shameful and destructive path.'
The HIV Medicine Association called on Abbott to rescind the price increase. 'It is critical that the implications of your actions on access to the majority of treatment regimens available to persons living with HIV/AIDS in the U.S. be given paramount consideration,' it wrote in a Dec. 18 letter to Abbott.
'This increase comes at a time when public programs that provide access to HIV treatment are struggling to keep costs down, and numerous ADAPs have been forced to impose eligibility and formulary restrictions and/or waiting lists.'
Howard Grossman, a physician in New York City with a large HIV practice, said in an e-mail he is 'going to refuse to have Abbott reps in my office and will try to find alternatives to any of their drugs I can.' He is asking the American Academy of HIV Medicine, where he serves as chair of the policy committee, to return funding from Abbott.
'To receive academic or financial support from Abbot Laboratories would be an insult to the many patients who this decision so greatly impacts,' Benjamin Young wrote to the company. The HIV doc and clinical instructor of medicine at the University of Colorado has rescinded any offer to lecture on behalf of the company, attend its advisory committee meetings, or support its research projects.
The London-based AIDSmap quoted one pharmaceutical company research scientist as saying, 'This isn't just an attack on competitors' pricing, it's an attack on their research strategies. Why bother investing in these areas if Abbott has effectively priced you out of the market?'
There is an unconfirmed report that the crusading New York Attorney General, Elliot Spitzer, has initiated an investigation into the price increase.
Grapefruit juice and a number of other drugs have an effect similar to Norvir in terms of slowing the liver's clearance of drugs such a PIs. But none of the alternatives have been studied and so there is no data on whether or how they might be substituted. Given Abbott's price increase, that is an area that researchers are likely to give new attention.