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Pharmaceutrical Company Rip-Off

Pharmaceutical Company Overcharging $1500 a Dose


     Health care costs keep on increasing and the province of Ontario wants to institute ways to reduce those costs. Maybe if they did not let pharmaceutical companies always have their way, we could drastically reduce the cost of prescription drugs in this province.

The latest scam involves injections to treat patients with the wet form of age-related macular degeneration known as AMD. It is the leading cause of vision loss in people over the age of 65. This also happens to be when the Ontario Drug Benefit plan kicks in to pay for most of your prescription drugs.

There are two injections available for the wet form of AMD: ranibizumab (Lucentis) and brevacizumab (Avastin). Both are biologics that inhibit blood-vessel growth and leakage into the eyes that causes vision loss. They were both developed by Genetech, which is now a subsidiary of the pharmaceutical giant Hoffman La Roche in Switzerland. If you are being treated with Lucentis, the cost is $1575 a month and the recommended dose schedule is two years. If you are treated with Avastin the cost is only $7 a month.

Both drugs are almost identical and both are manufactured by the same company but only Lucentis has been approved officially as a treatment for wet AMD. The use of Avastin is called “off label use”. However Avastin has been used to treat a variety of cancers such as colorectal cancer, selected lung, kidney, and brain cancers, and breast cancer for years but suddenly the Food and Drug of the United States, followed shortly by Health Canada, stopped the sale and use of this drug for cancers because it was not very effective and caused many side-effects. On the other hand it was very effective for wet AMD but Genetech did not want it approved for that purpose because it was too cheap compared to their approved more expensive brand, Lucentis.

In a recent study sponsored by the U.S. National Eye Institute, 1200 patients were involved in a head to head comparison of these two drugs. The results were published in the New England Journal of Medicine. Patients taking either one of these drugs had similarly low rates of death, heart attack and stroke but patients taking Avastin were slightly more likely to be admitted into the hospital than those treated with Lucentis – 24 per cent versus 19 per cent. There was no clear connection between this event and the treatment.

In Canada, the Common Drug Review is the agency that determines if drugs are cost effective and if they warrant being included in provincial drug formularies. They have approved Lucentis for wet AMD simply because it is the only drug in its class that is approved for this condition. All publicly funded health plans have followed that recommendation but British Columbia and Nova Scotia also allow for Avastin to be reimbursed.

It is very hypocritical when you consider all the drugs that are paid for by publicly funded health plans but are used in “off label” prescribing. The most common are the drugs that are approved only for epilepsy but are used as pain relievers and even for some mental disorders. A wide variety of antidepressants used for anxiety and antipsychotic drugs used for schizophrenia are used for many other unrelated mental disorders. These drugs are listed in the formularies and no one asks for what they were actually prescribed.

The Canadian Council for the Blind is lobbying vigorously for the continued and expanded funding of Lucentis. What they do not tell everyone is that the distributor of Lucentis in Canada, Novartis Pharmaceuticals, is one of their biggest donors. They actually want Avastin removed entirely from the picture. It is important to note that the CNIB, (The Canadian Institute for the Blind) which is much larger and more the official representative of the blind do not take a position on this matter and feels that these decisions are up to the government and not up to them.

Lucentis and Avastin is essentially the same drug since their have a near identical molecular make-up. The primary difference is that the molecules in Lucentis are slightly smaller. Both drugs are administered in the same way; an injection through the white of the eye into the central cavity.

In order to get physicians to use Lucentis over Avastin, the manufacturer, Hoffman La Roche packages Lucentis in a very easy-to use package. They are individual unit doses in a 1.25mg strength ready for injection. On the other hand Avastin is still packaged in its original form as a chemotherapeutic drug in vials of 100 to 400mg strength and must either be repackaged by the distributor or used as a multiple dose vial with the chance of contamination.

There have been hundreds of cases of eye infection, some of which lead to blindness, caused by Avastin but in every case it was caused by bacterial contamination caused by the repackaging of the Avastin. In other words, if it was manufactured and packaged the same way as Lucentis, these eye infections would not occur. Not only that the cost of these injections would be $7 and not $1575.  Legally Roche can get away with this because they own the drug and once again they do not want the less expensive Avastin to be approved for wet AMD.

There are no precise figures for Canada but based on the U.S. figures, the 25,000 people in Canada with wet AMD who receive about 70,000 treatments a year with Lucentis cost our drug plans over 100 million dollars. If they used Avastin, they could have almost 100,000 treatments at a cost of 40 million dollars. In other words if everyone had to use Avastin instead of Lucentis our health care system would save 100 million dollars annually.

The danger of the power of these pharmaceutical giants is that with all those extra millions in their pocket, they can lobby our politicians and make sure that they get their way and continue to rip off all the publicly funded health care plans in Canada.

Our forefathers founded this country on a democratic principle of one person, one vote. Today we live in a society of one dollar for each vote and those with the most dollars control our government.


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