Wednesday, June 16, 2004

DVT.net: The Warm and Fuzzy Front for the Lovenox Cash Cow

"Look honey, there's a commercial on television about a site for DVT treatment and prevention. What do you want to bet it's a thinly veiled advertisement for a certain pharmaceutical company that has tens of thousands of our hard-earned dollars?"

This may not have been the exact text of a one-sided conversation in our house a couple weeks back, but it conveys the basic idea.

DVT stands for Deep Vein Thrombosis. The media like to popularize the coined term "Economy Class Syndrome" as an alternative to DVT. Put simply...blood clots. Most DVT's appear during surgery, pregnancy, or long flights, but there are other potential causes such as medications (steroids, birth control pills), trauma, etc.

In 1993, my wife had a DVT that resulted in a pulmonary embolism (PE). Fortunately, she survived, and we found out she had a blood clotting disorder that could be triggered by a number of foods/medications. For the rest of her life, she will be on some kind of anti-coagulant to control the condition and decrease the possibility of another DVT/PE.

During and shortly after her hospital stay, the Doctors attempted to use Heparin to control the clotting. To their surprise, her condition did not respond well to Heparin therapy.

Most of the time, the anti-coagulant is Warfarin Sodium, better known as Coumadin. Coumadin has been around a long time starting out its life as a rat poison. Given that there are no patents encumbering its use, Coumadin is relatively inexpensive. Unfortunately, it is also difficult to manage, slow acting, sensitive to minor changes in Vitamin K, and teratogenic.

We were introduced to Lovenox 6 or 7 years later when she had to have minor, outpatient surgery. Unlike Coumadin, the pharmaceutical company Aventis still has patents on Lovenox, and they use them to their financial advantage charging around $100/day (on average) for the medication in the United States.

Some insurance companies will cover Lovenox, some won't. Some will cover it at the normal medication rate (90/10, 80/20, etc.), but others will classify it specially and cover it at a rate lower than other medications. This is fine for a one week dose due to outpatient surgery, but when you have to go on Lovenox for 2 years to attempt to have a child, it can be a real problem.

Needless to say, that's what we did. Originally, we were covered at 90/10 through Cigna. Of course, 10% of $3000/month is still a lot of money. When insurance time rolled around for her company, though, our insurance changed to Blue Cross Blue Shield (BCBS). Now, don't get me wrong. BCBS is about as good an insurance company as you can find, but my wife's company selected a plan that classified Lovenox at a 70/30 tier. Consequently, we had to cover 30% of $3000/month. At $1000/month for a year, it was all we could do to stay out of the red.

Now, back to Aventis...a few points:


  • Lovenox Patents: The only remaining patents are 4,692,435 and 5,389,618. There are currently two generic manufacturers (Amphastar and Teva) trying to get approval from the FDA to create Lovenox generics. Aventis, as of August 2003, sued both, but they decided not to try to protect patent 435.

  • Patient Assistance, according to Aventis in 2002, has such low income requirements that most Americans would not qualify. How many of you out there can add $300, $1000, or even $3000 per month to your expenses without a problem?

  • During the two years my wife used Lovenox, we found a Canadian Pharmacy that would sell us Lovenox for 1/3 the cost of the drug in America. Given the dangers of not having Lovenox when needed, her Doctor's unwillingness to help, and the FDAs occasional crackdowns on medication shipments, we decided not to buy the drug in Canada.



So what does this have to do with DVT.net you ask? Did you not notice the little Aventis logo in the upper right corner of the site? Aren't they just the most helpful bunch you've ever met?

Don't get me wrong. I appreciate the work Aventis has done bringing Lovenox to market. In fact, Lovenox played a huge role in allowing us to have a child. The problem here is that Aventis demonstrates significant greed in its pricing and business tactics.

If over 100 million people have been treated with Lovenox as they claim, did it really need to cost $50 for each syringe in the United States?

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2 Comments:

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