According to Kathy Presto of Roche (Fuzeon's mission control director), as of March 26, only two days after the drug's price had been published, 633 prescriptions had been received and demand was reflecting a diverse mix of payers, with roughly 30% private insurance and 70% public payers. Due to limited production capacity, Roche estimates that only 1,500 patients can be added during the first month after launch. Also, because of the high price of Fuzeon and the limited circumstances in which it is most likely to be useful, Roche has established a gatekeeping system to handle physician requests for the drug.
Each prescription that is received by Chronimed, Roche's exclusive pharmacy source for Fuzeon, is date- and time-stamped on a first-come, first-served basis and each patient is guaranteed that a supply of drug will be held for them while their reimbursement situation is worked out. Chronimed will perform a preliminary screening for ability to pay, then pass along the prescriptions to Roche's reimbursement specialist group for verification. Roche can then refer difficult cases that require advanced processing to another contract company that "really knows how to work the system." The goal is to see that everyone who submits a prescription is served, although it remains to be seen if that can be achieved and how long the wait will be for those unable to pay for the $20,000+ drug.
Patients with no ability to pay will be evaluated by several, somewhat flexible, criteria, says Roche, and those with no recourse to third party payers will ultimately be covered by the company's patient assistance program. Eligibility will hinge on a number of variables besides income and insurance coverage and could include the size of the patient's household and whether the applicant is a head of household, the state of residence and number of dependents. Non-U.S. citizens will not be eligible. For now, at least, no medical criteria will be used to allocate Fuzeon, although that could change if the demand puts a severe strain on the supply.
Volunteers in the U.S. clinical trials have been guaranteed uninterrupted access to Fuzeon. They will be transitioned from the study supply to the commercial supply and Roche will continue to pay until third-party payment can be secured. Presto said, "We will not interrupt Fuzeon for trial participants even if they never get any other reimbursement." By year end, the 1,500 U.S. trial participants could consume up to 17% of the commercially available drug supply.
One outstanding question is what will happen when a person earns too much for their state's ADAP, yet still can't afford T-20. Or if their private insurance won't deal with Chronimed. The answers will become clearer as Roche gets a month or two into the process.
Back to the GMHC Treatment Issues April 2003 contents page.
The content on this page is free of advertiser influence and was produced by our editorial team. See our content and advertising policies.