HER2 Support Group Forums - Stealth 22% price rise on herceptin took place in July!

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FAKE NEWS: Genentech raises price of Herceptin by 22.7%
Published on June 7, 2017

Lawrence Riccio RPh. BCOP
Lawrence Riccio RPh. BCOP

Oncology Pharmacist at SUNY Downstate Medical Center
Mr. Lawrence Riccio, RPH BCOP

Chloe Haber, PharmD candidate

The image of the woman in the banner above is not new to any of us, though we all call her by a different name. Ancient Greeks called her “Artemis”, and Romans “Diana”, but the newest generation calls her “Wonder Woman”. Some of us know that female warrior fighting breast cancer as “Mom”, “sister”, “or “daughter”. Genentech created the Herceptin symbol of female empowerment using an image of a woman in battle stance, poised to target her disease and wipe it out. When I look at this image, I hear the battle cry ring clear, I hear the manufacturer’s shouts of support, I hear the Little Engine that could screaming “YOU CAN DO IT!” But Genentech’s latest business move tells a different story.

In April of 2017, Genentech announced that starting on July 7th, they will only ship the 150mg single-dose vial of Herceptin, which will replace the 440mg multi-dose vial that is being discontinued. Herceptin is dosed based on weight, with doses of 2mg/kg for weekly regimens and 6mg/kg for thrice weekly dosing. Multi-dose vials are ideal for this type of dosing because you can open a vial for one patient then use the remaining drug for the next patient within 28 days. The new 150mg single-dose vial will ensure drug wastage. How much drug wastage? The quantity will depend on obesity (which is a risk factor for breast cancer) and surprisingly, race.

According to the Center for Disease Control and Prevention (CDC), the average white female in the United States weighs 75.0kg. The average black female weighs 85.2kg. In a dosing regimen of 2mg/kg, that means that one 150mg vial will be sufficient to treat the average white female, but the average black female will need 170.4mg, or two vials. Single dose vials cannot be reused, so 129.6mg (43.2% of the dose) will go to waste. That means that the average black woman will be paying for twice as much medication as the average white woman (even though she only needs 13.6% more drug), and in an institution that serves a largely black population, this will result in thousands of dollars wasted. With this in mind, I conducted an analysis of all the patients who received Herceptin over the last year in my institution. I tracked a total of 23,694mg of Herceptin administered over a twelve-month period. Switching to the single-dose vial would result in 5,386mg being wasted. This number denotes 22.7% wastage (23,694/51,167), and at $9.50/mg, this amounts to total of $51,167 lost. This number is the result of a single analysis conducted in a single institution, so it might not represent the national total, but this data is supported by a recent study published in the British Medical Journal which found that the total US revenue from cancer drugs in 2016 was $18 billion, with 10% or $1.8 billion from discarded drugs. One thing is certain: this switch will not benefit anyone but the Genentech executives and shareholders.

Herceptin had $2.5 billion in US sales in 2016, and a 22.7% increase will result in a $570 million bonus in the upcoming year. Genentech tried to assuage any worries, reassuring its buyers that the price per milligram will remain stable at $9.50. The official net price will not be increasing, hence the title “FAKE NEWS”, but in actuality, we, the US health-care consumer, the taxpaying citizen, will be paying about 20% more for this drug. It is up to us to take a stand against big pharma, to stand up for your mother, your sister, and your daughter. We are fighting a powerful adversary and I think we’ll need the help of Wonder Woman in this most important battle for equity in our health-care system.

References:

Bach Peter B, Conti Rena M, Muller Raymond J, Schnorr Geoffrey C, Saltz Leonard B. Overspending driven by oversized single dose vials of cancer drugs. BMJ 2016; 352 :i788

Fryar CD, Gu Q, Ogden CL. Anthropometric reference data for children and adults: United States, 2007–2010. National Center for Health Statistics. Vital Health Stat 11(252). 2012.

Klasa M. Drill Down: Herceptin Multi-dose Vial Waste Targeted by OIG and WellPoint. RACmonitor. https://www.racmonitor.com/drill-dow...-and-wellpoint. Published December 17, 2013. Accessed June 6, 2017.

Roche Annual Report 2016. Roche; 2017. http://www.roche.com/investors/ar16e...al-report-2016. Accessed June 6, 2017.

FollowLawrence Riccio RPh. BCOP
Lawrence Riccio RPh. BCOP
Lawrence Riccio RPh. BCOP
Oncology Pharmacist at SUNY Downstate Medical Center
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Lawrence Riccio RPh. BCOP
Oncology Pharmacist at SUNY Downstate Medical Center
Where's #WonderWoman when you need her?