Fighting the Dollar
Like an '80s flashback over the high price of AZT, a new drug price war has erupted. It began in late September, when activists from ACT UP/Philadelphia and elsewhere stormed the corporate headquarters of DuPont Pharmaceuticals to protest the high price of Sustiva, the newest anti-HIV drug to gain FDA approval. Initially, DuPont set the price of Sustiva at $10.95 per day, or $3,942 per year, placing it in the middle price range of anti-HIV drugs in its class, they said-a fair price.

But activists said the figure only applied to major institutional buyers; in reality, the price for consumers, or average manufacturer's price (known as AWP), was set 20 percent higher, at almost $5,000 a year. That made it unaffordable for cash-strapped state AIDS Drug Administration Programs (ADAPs), which serve the majority of people with HIV. Activists worried private insurers won't cover Sustiva.

The protest worked-a little. Facing a barrage of criticism, DuPont officials tentatively offered ADAPs an extra 5 percent discount for Sustiva on top of the normal 15 percent discount AWP given to ADAPs. That's about $3,150 a year for the drug. Medicaid programs will get an "AWP minus 12 percent" deal, while Veterans Affairs will pay the Federal Supply Price (or FSP), which is set at $2,995 a year for Sustiva.

As of late October, some ADAP programs had added Sustiva, but others with large HIV caseloads-including those in California, Texas, and New York-had not. ADAP officials are especially worried that treatment-experienced people will need to take Sustiva with more costly protease inhibitors.

Meanwhile, as the slugfest over Sustiva rages on, Agouron, maker of the protease inhibitor nelfinavir (Preveon), announced a 4.65 percent increase in the base price of its drug. Activists are all over this one, too. And at press time, the rumor mill whispered that newcomer Ziagen's price may be as high as Sustiva's, so expect more sparks to fly.

-Anne-christine d'Adesky