The price of prevention
Copaxone is a disease-modifying therapy, but it doesn't stop the progression of MS. Patients and physicians, as evidenced
by the level of utilization, are confident the drug does slow exacerbations of the disease, despite a Cochrane review that
found "no beneficial effects on disease progression," and only a "slight beneficial effect in the reduction of risk of relapses
in relapse-remitting MS patients." Slight is better than nothing, and patients wouldn't keep injecting themselves everyday
if they believed otherwise.
A neurologist and professor at one of America's top academic medical institutions—who asked to remain nameless for this article—said
Copaxone's "importance lay in showing that an approach of this type can work, albeit modestly...that said, we have no definite
idea of its mechanism of action."
To date, there haven't been any generic versions of disease-modifying MS drugs, which means that when a new product is approved,
and priced, all the other products increase up to the new price level. "Pricing of MS drugs is a national scandal," said the
professor, responding to a question about potential generic versions of Copaxone. "Anything that makes them more affordable
Derkacz says Copaxone "has never been a price leader...and its pricing is largely reflective of investments made to research
as the market-leading MS therapy." Derkacz also emphasizes the value and services built in to the cost; those nurses working
for Shared Solutions might be free for patients to call, but they don't work for free. If a generic version does launch, how
do payers put a value on injection frequency, particularly for patients who've developed injection site reactions?
It's not just MS, of course. Even products that are effectively curative, like Gilead's Sovaldi, for hepatitis C virus, are
being challenged on price. For drugs targeting chronic conditions, where patients must take them indefinitely, often for the
rest of their lives, pricing pressures will continue and are likely to intensify. Within the current system, the best cost
solution is both the simplest and the most difficult: discover a cure, pay a premium, then develop a generic version. MS patients,
their families, payers and even some taxpayers are willing to pay a little more in the short term for an assurance that the
disease never comes back in the long run.
Ben Comer is Pharm Exec's Senior Editor. He can be reached at firstname.lastname@example.org