FORT
LAUDERDALE,
Fla.
—
After
taking
HIV
drugs
for
years,
John
was
showing
the
classic
signs
of
AIDS
atrophy
—
sunken
cheeks
caused
by
loss
of
fatty
tissues
in
the
face.
“It
made
me
look
older,
and
it
was
making
me
depressed,”
said
“John,”
a
patient
of
Apex
South
Beach
clinic
in
Miami
Beach,
who
did
not
want
his
real
name
disclosed
because
of
concerns
about
job
security.
In
March,
John
decided
to
participate
in
a
clinical
trial
of
Sculptra,
a
new
treatment
for
HIV
atrophy.
After
three
treatments,
John
was
looking
and
feeling
more
like
his
old
self
again.
“People
started
complimenting
me
and
telling
me
how
good
I
looked,”
John
said.
“It
made
me
feel
better
about
myself.”
His
reconstructed
cheeks
“look
very
natural,”
he
said.
But
John,
who
relies
on
Social
Security
and
help
from
his
family
to
pay
his
medical
bills,
will
not
be
able
to
afford
the
follow-up
Sculptra
maintenance
treatments,
which
are
required
every
one
to
two
years
depending
on
the
patient.
After
the
Food
&
Drug
Administration
approved
Sculptra
in
August,
the
manufacturer,
Dermik
Laboratories,
in
Berwyn,
Pa.,
priced
the
treatment
nearly
four
times
higher
than
the
price
in
Europe,
where
the
treatment
has
been
used
since
1999.
Sculptra
sells
for
$125
per
bottle
in
Europe
and
South
America,
according
to
Dr.
Peter
Engelhard,
director
of
Apex
South
Beach
clinic,
which
specializes
in
the
treatment
of
HIV
atrophy.
Engelhard,
who
previously
purchased
the
treatment
from
the
French
company
that
originally
created
it,
now
must
pay
$480
per
bottle,
the
price
the
manufacturer
has
set
for
the
U.S.
Each
treatment
requires
two
to
three
bottles
of
Sculptra,
and
each
patient
needs
three
to
six
treatments,
depending
on
the
severity
of
their
condition,
Engelhard
said.
After
the
initial
treatment
phase,
a
maintenance
treatment
that
requires
one
to
two
bottles
is
needed
every
one
or
two
years.
Karen
Boyce,
manager
of
communications
for
Dermik
Laboratories,
said
the
company
had
received
“several
inquiries
about
the
cost
of
the
drug
and
access
to
the
drug.”
Boyce
said
the
company
is
developing
a
“patient
access”
program
for
Sculptra,
to
help
make
it
available
to
people
who
cannot
afford
the
drug.
But
she
declined
to
discuss
details
of
the
program
because
it
has
not
been
finalized.
She
said
details
about
the
access
program
would
be
available
in
late
October.
Boyce
pointed
out
that
Sculptra
is
sold
to
doctors,
not
patients,
and
suggested
doctors
could
set
lower
prices
for
patients
with
hardships.
But
Engelhard,
who
was
planning
to
meet
with
Dermik
officials
this
week,
doesn’t
think
the
access
program
will
be
sufficient
to
meet
patient
needs.
“I
don’t
think
it
will
offer
enough
of
a
discount,”
he
said.
Engelhard
said
he
had
170
patients
on
a
waiting
list
before
the
FDA
approved
the
drug.
But
after
the
drug
was
approved
and
the
price
was
hiked,
all
but
about
30
percent
of
the
patients
on
the
list
told
him
they
couldn’t
afford
it.
“They’re
either
getting
a
different
product
or
none
at
all,”
Engelhard
said.
“It’s
too
bad
because
this
is
the
best
one.”
Engelhard
thinks
the
treatment’s
U.S.
price
will
severely
limit
its
use
in
the
people
who
need
it.
Engelhard
said
insurance
companies
are
not
likely
to
cover
Sculptra
because
they
consider
it
a
cosmetic
treatment
in
the
same
class
as
Botox
treatment
for
wrinkles.
But
he
thinks
treating
atrophy
is
much
more
vital
to
the
quality
of
life
for
HIV
patients.
“Our
argument
is
that
this
is
reconstruction,”
said
Engelhard,
likening
the
procedure
to
reconstructive
surgery
following
breast
cancer.
“People
do
things
like
stop
taking
their
medications
because
of
atrophy,
and
that
does
change
their
longevity.”
But
the
treatment
is
not
likely
to
be
included
in
state
drug
assistance
programs
because
it
is
not
actually
a
drug,
according
to
Jonathan
Appelbaum,
of
Fenway
Community
Health,
a
Boston
center
that
specializes
in
gay
health.
Sculptra
is
considered
a
treatment,
or
device,
not
a
drug,
Appelbaum
said.
