Living
with
HIV
since
1985,
Atlanta
resident
Hugh
Joiner
developed
a
hazardous
pattern
with
the
drugs
he
took
to
fight
the
disease.
Joiner
would
start
a
drug
regimen
and
experience
temporary
improvement,
but
within
12
to
18
months
he
developed
a
resistance
to
the
drug
combination,
rendering
the
medications
useless.
He
would
start
a
new
regimen,
and
within
12
to
18
months,
a
new
resistance
would
form.
But
at
the
end
of
the
long
line
of
drugs
that
no
longer
worked
for
him,
Joiner
found
hope.
In
2003,
Joiner’s
doctor
encouraged
him
to
join
a
trial
for
a
new
drug
called
Fuzeon
—
a
first-of-its-kind
drug
designed
for
people
who
found
no
relief
in
other
anti-HIV
drugs.
“The
drug,
for
me,
has
made
all
the
difference
in
the
world,”
Joiner
said.
“It’s
just
been
a
godsend.”
Fuzeon,
which
requires
an
injection
two
times
per
day,
even
helped
Joiner
get
over
his
fear
of
needles,
though
he
was
disappointed
to
learn
that
F.
Hoffmann-La
Roche
and
Trimeris
Inc.
—
Fuzeon’s
manufacturer
—
recently
postponed
trials
that
would
have
produced
a
similar
drug
that
required
as
little
as
one
shot
per
week.
Since
he
began
taking
Fuzeon,
which
stops
HIV
from
entering
healthy
cells,
Joiner
said
he
has
more
energy,
his
T-cells
have
increased
from
two
to
59
and
his
viral
load
has
dropped
considerably.
But
with
the
end
of
his
trial
approaching,
Joiner
said
he
is
uncertain
how
he
will
be
able
to
afford
Fuzeon,
priced
at
nearly
$20,000
for
an
annual
supply.
“The
cost
is
what’s
the
problem,”
Joiner
said.
“I
would
try
to
stay
on
it,
but
I
just
don’t
know
if
I
could
afford
it.
“Those
who
can
afford
it
will
get
it,
those
who
cannot
will
do
without,”
he
said.
“I
know
that’s
a
cruel
thing
to
say,
but
so
goes
life.”
When
asked
why
he
thinks
Fuzeon
costs
so
much,
Joiner
gives
a
popular
answer.
“They
say
because
it’s
so
hard
to
make,”
Joiner
said
of
Roche’s
justification.
“From
my
understanding
it’s
just
because
of
the
technology
and
the
difficulty
in
producing
the
drug.”
Pharmaceutical
companies
have
repeatedly
argued
that
the
amount
of
research
and
development
invested
in
anti-HIV
drugs
requires
high
prices.
“It’s
allowing
us
to
make
investments
in
future
innovations
—
novel
therapies,
drugs
with
less
side
effects
—
and
to
bring
those
to
market
so
patients
have
access
to
more
and
better
medicine,”
said
Heather
Mason,
vice
president,
specialty
operations
pharmaceutical
products
for
Abbott
Laboratories.
But
critics
say
the
R&D
argument
is
bogus.
“The
companies
for
years
have
done
some
real
smoke
and
mirrors,
as
if
there
is
some
kind
of
secret
formula
for
setting
prices,”
said
Dr.
Howard
Grossman,
a
longtime
AIDS
activist
with
a
private
practice
in
New
York
City.
“They’ve
never
really
proven
exactly
how
they
set
the
price
of
drugs,
and
given
they’ve
bought
most
of
Congress,
they’ve
never
been
forced
to.”
Clint
Trout,
associate
director
of
federal
and
international
policy
at
the
AIDS
Healthcare
Foundation,
said
market
forces
—
including
competitor
pricing
and
government
regulation
—
influence
how
companies
price
drugs
“100
percent
of
the
time.”
“R&D
really
doesn’t
have
that
much
influence
on
the
price,”
Trout
said.
“But
high
prices
are
necessary
for
all
the
consumer
marketing
the
drug
companies
do
—
they
send
a
drug
rep
to
our
clinics
every
five
minutes
trying
to
get
them
to
prescribe
their
drugs
to
patients.”
As
an
example
of
how
drug
companies
have
been
exaggerating
the
role
R&D
costs
play
in
drug
prices,
critics
point
to
a
recent
announcement
by
Abbott
that
it
was
raising
the
price
of
Norvir
—
a
protease
inhibitor
that
has
been
available
since
1996
—
by
more
than
400
percent.
“There
is
absolutely
no
reason
but
corporate
greed
for
the
Norvir
price
increase,”
Trout
said.
“It’s
really
inexcusable
what
Abbott
has
done.”
Because
Norvir
plays
a
booster
role
in
drug
cocktails
containing
drugs
manufactured
by
Abbott’s
competitors,
there
has
been
widespread
belief
that
the
company
raised
Norvir’s
price
to
steer
patients
to
its
more
expensive
drug,
Kaletra.
Norvir
used
to
cost
$54.25
for
a
month’s
supply,
but
now
costs
$265.67
for
the
same
amount.
Norvir
is
often
used
with
GlaxoSmithKline’s
Lexiva
—
which
costs
$480
per
month’s
supply
—
meaning
the
cost
of
that
combination
increased
from
$534
per
month,
to
$745.
The
old
price
of
a
combination
containing
Norvir
and
Bristol-Myers
Squibb’s
Reyataz
was
$738,
but
with
Norvir’s
price
increase
now
costs
$949.
Abbott’s
Kaletra
—
which
competes
with
Lexiva
and
Reyataz
—
has
Norvir
built
into
it,
and
is
unaffected
by
the
price
increase.
It
is
sold
at
$580
per
month’s
supply.
Still,
Mason
contends
Norvir’s
price
hike
was
triggered
by
R&D
costs.
“We
did
not
make
this
pricing
decision
lightly,”
Mason
said.
“We
carefully
considered
many
things,
and
ultimately
our
very
complex
decision
process
allowed
us
to
reach
this
difficult
conclusion
that
this
new
price
is
necessary
to
be
able
to
support
our
ability
to
continue
research
to
bring
the
next
generation
of
HIV
medications
to
market.”
In
their
complex
decision
process,
Abbott
officials
never
considered
that
Kaletra
would
benefit
from
Norvir’s
price
increase,
Mason
said.
Grossman
scoffed
at
such
explanations.
“It’s
all
about
their
market
position,”
he
charged.
“This
is
as
anti-patient
a
move
as
I
have
ever
seen.
“Their
feeling
is
Kaletra
is
the
best,
strongest
drug,
and
it
should
be
the
first,
last
and
only
drug
used
by
HIV
patients,”
he
said.
“They
don’t
understand
why
that
hasn’t
happened,
and
instead
of
lowering
Kaletra’s
price,
they’ve
raised
everybody
else’s.”
As
for
Fuzeon’s
$20,000
price
tag,
Trout
said
he
believes
it
is
a
test
case
for
pharmaceutical
companies
to
see
how
much
they
can
charge.
What
is
most
troubling
to
some
activists
is
that
in
addition
to
inflating
drug
prices,
the
pharmaceutical
companies
relentlessly
fight
any
efforts
to
cut
into
their
large
profit
margins
—
even
...
