Acyclovir Annual Price Cap for Some Patients, $2500; Registration Required

On December 7, Burroughs Wellcome Co. announced that it will
cap the price of acyclovir (Zovirax) for patients who pay for the
drug themselves. Those who use more than 730 grams (for which
Burroughs Wellcome charges wholesalers about $2500) in a single
calendar year will receive up to 730 grams additional at no cost
for the remainder of the year. This program begins January 1;
therefore patients who are using continuous high-dose acyclovir
and paying for their own medication should immediately register,
through their physician or other health-care provider, so that
their acyclovir use can be monitored and credited toward the cap.
Health-care professionals can call Burroughs Wellcome at
800/722-9294 for more information about this program and how to
register patients.

Unfortunately this program is only for patients who do not
have third-party coverage for their acyclovir use.

The cost of acyclovir has become an issue, especially during
the last year, because more people are using high doses
continuously after a major study in Europe and Australia reported
finding survival benefit in some patients. (Youle, M. Double
blind, placebo controlled trial of high dose acyclovir for the
prevention of cytomegalovirus (CMV) disease in late stage HIV
disease. VIII International Conference on AIDS, Amsterdam July
19-24, presentation number MoB 0056.) Most patients use acyclovir
occasionally or temporarily. But the new use can cost $5000 per
year or more, creating severe financial hardship or making the
drug unavailable to patients for whom it was prescribed. The U.
S. patent on acyclovir does not expire until 1997.

AIDS treatment activists from several organizations had
negotiated with Burroughs Wellcome for ten months seeking price
relief; according to Andrew Zysman, M. D., of ACT UP/Golden Gate,
the company rejected an overall price cut but agreed to a price
cap. Activists were not told the amount of the cap, or that
patients with third-party coverage for the drug were ineligible,
until the day the program was announced to the press, so they
were unable to advocate for important changes.

"There are two problems with the policy," said Dr. Zysman.
"The cap, while a start, does not go far enough. A workable
solution would be an annual cap of $2000 per patient, which would
continue to generate great profits, while making acyclovir more
accessible.

"Second and most disappointing, the cap only applies to
people without insurance. Activists are concerned about the cost
of AIDS care not only to uninsured individuals, but also to the
bankrollers of health care in America, the government and private
insurers. Many physicians, for example in public health
settings, are unable to suggest the use of acyclovir because it
would bankrupt their clinic's budget; hence patients will not be
able to benefit.

"We believe Burroughs Wellcome has made a grave error,
acting neither in its own interests nor in the interests of the
HIV community. A lower price cap, applied to all patients
irrespective of insurance coverage, would affect physicians'
attitudes about the cost-benefit ratio of acyclovir, and would
create more widespread usage, generating greater, not lesser
profits for Burroughs Wellcome."

Dr. Zysman has heard that Burroughs Wellcome did plan for
the cap to cover all U. S. patients, but that pharmacists'
representatives argued that their prescription-monitoring
software was not set up to track such use. He also heard that
activists were kept out of these negotiations because the company
feared running afoul of regulations on the disclosure of "inside
information" which could affect stock prices.

Note: Burroughs Wellcome replied that it already provides a
26 percent rebate to Medicaid, and effective January 1 will
provide comparable discounts to state AIDS programs, sexually
transmitted disease clinics, community and migrant health
centers, homeless programs, public housing clinics, and mental
health, tuberculosis, and family planning clinics.