• by Thom Forbes , April 26, 2013

The American medical establishment, in general, and pharmaceutical companies, in particular, find themselves increasingly besieged for high prices (and often less than optimal results). But a new attack on the high cost of drugs by more than 100 oncologists in Blood, the journal of the American Society of Hematology, is “unprecedented,” according to Dr. John LaPook’s report on the “CBS Evening News” last night.

LaPook’s story kicks off with an interview with a young man who has a blood marrow cancer called chronic myeloid leukemia (CML). He tells the camera that he’s “not on their approved list … which left me with a $5,000 a month co-pay” –- or half the actual market price.

Indeed, the price of Gleevec, a drug manufactured by Novatis, has tripled in the dozen years it has been on the market even as the 10-year survival rate of patients who take it for CML has soared from 20% to 90%. Novartis tells LaPook it has financial assistance programs and that the majority of patients pay less than $100 a month to get it. It also recognizes that “sustainability of health care systems is a complex topic and we welcome the opportunity to be part of the dialogue,” in a statement issued to the New York Times yesterday.

But 120 physicians from around the world, led by Hagop Kantarjian, MD, chairman of the leukemia department at The University of Texas MD Anderson Cancer Center, paint a different picture. The doctors choose to focus on CML “because it is now considered a highly curable disease, thanks to the emergence of powerful, targeted CML therapies known as tyrosine kinase inhibitors,” according to a news release issued by the American Society of Hematology.

“Patients with CML have a much better outlook today than ever before, thanks to advances that have greatly improved survival rates,” Kantarjian says. “But these patients now face dire financial struggles as they try to maintain their treatment regimen with the drastically inflating cost of care. And this issue likely extends to patients with other types of cancer who require ongoing treatment to maintain therapeutic benefit.” 

When Gleevec came on the market in 2001, it carried an annual price tag of $30,000. “‘We agree with those who say the price we have set for Gleevec is high. But given all the factors, we believe it is a fair price,” Daniel Vasella, Novartis' CEO at the time, wrote in Magic Cancer Bullet, a 2003 book he penned about his company's wonder drug,” CNNMoneyTech’s Stacy Cowley reports.

“An annual course of Gleevec now wholesales for more than $76,000 in the U.S., according to Novartis,” writes Cowley. “The retail price that patients or their insurers pay is typically much higher.”

“One of the doctors who signed the commentary is Brian Druker, who was the lead academic developer of the drug and is now director of the Knight Cancer Institute at Oregon Health and Science University,” Ed Silverman points out on Forbes.com. “‘If you are making $3 billion a year on Gleevec, could you get by with $2 billion?’ he tells the New York Times. ‘When do you cross the line from essential profits to profiteering?’”

The professional rebellion against Big Pharma seems to be rapidly picking up steam.

“Some of the doctors who signed on to the commentary said they were inspired by physicians at the Memorial Sloan-Kettering Cancer Center in New York, who last fall refused to use a new colon cancer drug, Zaltrap, because it was twice as expensive as another drug without being better,” Andrew Pollock reports in the New York Times.

Three of those doctors wrote about their decision in a Times op-ed piece. Its manufacturer, Sanofi, cut the price in half within weeks of publication although, it maintained, “we believe that Zaltrap is priced competitively as used in real-world situations.”

But one of the doctors who wrote the article said it was no better than an existing drug that’s cheaper, Genentech’s Avastin, and possibly less toxic. And another said the whole incident reflected a larger problem: “that overall there was little relation between drug prices and the value they provided,” the Times’ Pollack reported at the time.

“Normal markets wouldn’t behave like this,” Dr. Peter B. Bach, director of the Center for Health Policy and Outcomes at Sloan-Kettering told Pollack. “You couldn’t introduce something twice as expensive and no better and still sell it.”

Kantarjian, the lead author of the Blood article, wrote an op-ed with two colleagues that was published in the Washington Post in February. 

“Of the 12 new cancer drugs approved by the Food and Drug Administration last year, 11 were priced above $100,000 annually,” they said. “Yet only three were found to improve patient survival rates and, of these, two increased survival by less than two months. All this shows little or no correlation between drug efficacy and ‘just price.’”

The fact 120 physicians from around the world are publicly taking on Novartis about a drug that has proven to be extraordinarily effective indeed takes the argument to a different level.