Cancer drug costs and desperation: a reality for Americans

This blog post concerns real people who are desperate, angry, and facing terminal illness because of the cost of a cancer medication. A woman named Lisa recently placed a comment on a blog post we wrote back in March 2013 called “The Price of Gleevec: A Tale of Two Supreme Courts.”  We noted at the time that the Indian Supreme Court told drug company Novartis to go fly a kite in its effort to stop lower cost generic versions of Gleevec, a cancer medication, from being sold in India, and that the U.S. Supreme Court was hearing arguments against a practice known as Pay-to-Delay involving a different medication.

But this post is not about policies and intellectual property or patent rights, the rightness or wrongness of India’s looser patent laws, pay-to-delay, personal drug importation or online pharmacies. It’s just about a woman’s husband and others who have cancer and can’t afford the medicine they need to get better or live.

Lisa gave me permission to re-publish her comment as a blog post here. I have made very, very slight edits, as you can see if you look at the original comment.

Lisa wrote:

This is very interesting news and gives us a little hope. My husband has Chronic Myeloid Leukemia (CML). He has been on Gleevec (here in So. California for the past 12 years. I thought I should mention Gleevec here in the U.S. is $10,600.00 a month for 400mg (30 pills). I thought should mention this because your prices listed here in the U.S. are inaccurate. That would bring the total cost to $126,000 a year.

We are going broke, will probably lose our home and my husband will probably never be able to retire (even though his body is breaking down from 40+ years of a very physical job as a pipe fitter. I (the wife), am permanently disabled. We will die homeless before this drug ever comes within an affordable price.

Many children and adults are cutting their pills in half, which defects the purpose. They too, will die before seeing Gleevec reach an affordable price here in the U.S.

All the countries you listed in the article, do NOT accept U.S. insurance companies and/or ObamaCare.

Why doesn’t anyone bring this to the press? Why does Congress and ObamaCare turn a blind eye? How many hundreds have to die before this drug and options are researched. I have written many letters to Norvartis, only to be ignored. I have written to Media Outlets only to be ignored. Now I am desperately asking for your help in bringing this to the media and anyone that will listen. We and many others are scared out of our minds. We are really loosing hope and it is tearing families apart. Some patients are becoming suicidal, because they don’t know how they are going to afford the next month supply of Gleevec. Novartis (GREEDARTIS) should be ashamed of themselves. You should research the substantial increases (quarterly), since the drug first went on the market. It will blow you mind! What if this was your child or loved one?

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At the beginning of this year, we brought you the story of Lu Yong, a Chinese citizen with Leukemia who was facing severe financial hardship due to the $3,783 monthly cost of his cancer medication, Gleevec. Mr. Lu found out he could order Veenat, a generic version of Gleevec, from India for a more affordable $640 a month. Soon thereafter he started helping fellow Leukemia sufferers – a thousand of them – access Veenat, in effect helping save their lives. Mr. Lu was rewarded by being charged with selling counterfeit drugs and credit card fraud!

The problem was that Veenat, an entirely genuine, legally manufactured and effective medication approved in India, is designated as “counterfeit” and unapproved in China. The credit card fraud charge was brought because Mr. Lu used other patients’ credit cards to order their medicine.

So, our earlier blog post on this story was called “Low Cost Counterfeit Drugs Save Lives in China…What?!” Seem like a stretch? Not really. Medication deemed “counterfeit” was in fact saving lives. A Chinese court seemed to agree, determining that Mr. Lu’s action should not be construed as “selling counterfeit drugs” since the medication was genuine. Additionally, because his use of other people’s credit cards was to help them, it was not “criminal behavior.” For more read about it in Chinese Radio International.

Lu Yong is a prescription access hero and we applaud him rancorously. Kudos to the Chinese legal system as well.

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Low Cost Counterfeit Drugs Save Lives in China…What?!

I wish I was joking about the racy headline above. The United States is not the only great power in which citizens go without medication because of cost. The cancer drug Gleevec (imatinib), made by Novartis, costs 23,500 yuan, or about U.S. $3,783, per month, in China. Gleevec is not covered by health insurance in China so people there must pay for it out of pocket. Ten years ago, Lu Yong was diagnosed with chronic myelocytic leukemia and was prescribed Gleevec. After facing bankruptcy due to his drug costs, Lu discovered a generic version of Gleevec, called Veenat, and began purchasing it by mail-order from India where it is an approved drug, at a cost of only 3,000 yuan, or about $482, per month — 87% less than the brand name drug.

Lu’s condition improved quickly using  the generic version. He began to help people with leukemia who he met online obtain Veenat. Now, according to the English edition of Caixin, an independent Beijing-based media outlet, he is facing criminal charges for credit card fraud and selling counterfeit medication. The same story was covered by official Chinese media under the headline “Leukemia patient prosecuted for buying pills overseas.” Lu has helped 1,000 people with leukemia obtain treatment. Three hundred of them are petitioning the authorities to have his name cleared.

The medications involved are real and clearly life-saving! So why is Lu being prosecuted for counterfeit drugs? Under Chinese law, any drug not specifically licensed for sale in China, even a genuine medication lawfully manufactured by an authorized drug company, is considered counterfeit.

The charge of credit card fraud was based on Lu’s using a foreign credit card to make the purchases. Lu said he did so because using domestic Chinese bank-issued credit cards for international purchases is nearly impossible.

Lu was not charged for procuring his own cancer medication. The charges were for directly facilitating the purchase of the drug for 1000 people, who consequently regard Lu as a hero.

When people can’t afford to obtain life-saving medication locally, the U.S, and all countries, should consider themselves morally obligated to expressly permit their citizens to obtain it internationally.

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A few weeks back we wrote about drug affordability problems related to high deductible Obamacare silver plans. A new report finds problems across all four tiers for patients requiring expensive specialty drugs. Many plans have co-insurance rather than a fixed co-pay for these medications, which means patients pay a percentage of a drug’s price rather than a flat fee. In fact, over 50% of bronze, silver, and gold plans studied had co-insurance rather than fixed co-pays for specialty drugs. That compares to only 38% for platinum plans.

According to Wellmark, “Specialty drugs are prescription medications that require special handling, administration or monitoring. These drugs are used to treat complex, chronic and often costly conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.”


Pamela Morris, of Zitter Health Insights, said “A lot of times, if someone has coinsurance their first exposure to OOP [out of pocket costs] is at the pharmacy, where they may be unsure if they’ve met their deductible or if the costs are purely coinsurance.”

So how big could this price shock be? Let’s look at Tecfidera, a sample oral Multiple Sclerosis drug. The cash price is around $6,000 for 60 capsules of the 120 mg dose. Even if your co-insurance is 25%, that’s $1,500. You can purchase the same amount for $1,200 from an international online pharmacy. Still expensive, but a $300 savings is nothing to scoff at. And it’s likely that the co-pay would be even more than 25% in which case the international savings could be much higher.


Gleevec, a medication used to treat certain types of leukemia, is around $29,000 for 90 pills. That will cost you $7,500 if your co-insurance is only 25%. Using an international online pharmacy, you can purchase 90 pills of generic Gleevec for $725 from a Canadian pharmacy. This may even be cheaper than using Novartis’s patient assistance program for brand name Gleevec. The program has strict eligibility requirements but is worth pursuing if you believe you’re eligible.

We’re sorry to report that many specialty meds may not be safe to order from an international online pharmacy. Some might be extremely temperature sensitive, others are administered in a clinical setting, only sold by specialty pharmacies, and some aren’t even approved for sale outside the U.S. For some specialty drugs, the savings might not even be that great, as prices are high globally!

We promise to research all avenues of savings for these medications and report back to you soon…

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A group of over 100 doctors recently banded together to declare that “lower drug prices [are] a necessity to save the lives of patients who cannot afford them,” as written in their article in Blood, the medical journal published by the American Society of Hematology. We couldn’t agree with them more.

The doctors, experts in chronic myeloid leukemia, focused particularly on the drug Gleevec (imatinib), which costs around $100,000 annually per patient in the United States. Gleevec costs around $35,000 internationally.

There is nothing politically or economically radical about their position. In fact, they acknowledge the societal and political pressures that affect drug pricing, as well as the necessity of profits by drug companies to fund future research. They simply seek fair pricing.

Unfortunately, cancer medication prices are dramatically increasing and are not “fair.” To quote the Blood article: “imatinib may have set the pace for the rising cost of cancer drugs. Initially priced at nearly $30,000 per year when it was released in 2001, its price has now increased to $92,000 in 2012 (1), despite the fact that all research costs were accounted for in the original proposed price….”

Such protests can work; last year doctors at Sloan-Kettering Memorial Hospital pressured Sanofi into effectively halving Zaltrap’s initial market price of $11,000 by offering discounts. We hope that these precedents mobilize more doctors to hop on the bandwagon to further publicize that high drug prices in the U.S. are a serious threat to the public health.

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Americans interested in generic drug prices and pharmaceutical patent law have been closely following the U.S. Supreme Court as it hears arguments in a case over “pay-for-delay”  –  the practice of brand-name drug-makers seeking greater profits by paying off generic manufacturers to delay introduction of low-cost generic drugs. If “pay-for-delay” tactics are declared unconstitutional, then generics would reach pharmacy shelves faster, translating to lower prices for consumers, health insurers, and taxpayers.

The Court’s decision isn’t expected until June, but last Monday the Supreme Court of another country rendered another decision related to generics that may affect American prices. India’s Supreme Court ruled against the drug company Novartis’ patent claim on Gleevec, a cancer medication. Since India’s decision allows drug companies to continue manufacturing generic versions of Gleevec, called imatinib mesylate, prices will remain exceedingly low in India and low-income countries that import Indian pharmaceuticals.

So how much cheaper is generic Gleevec in Indian pharmacies than brand name Gleevec in American pharmacies? The New York Times reported that a one-year supply of brand name Gleevec in the U.S. is a staggering $70,000. The generic in India is only $2,500!

Additionally, even though Gleevec is under patent in other high-income countries like it is in the U.S., it is far less expensive internationally. At a local New York City pharmacy the price for 30 pills of Gleevec (400mg) is $6,980. The same brand name Gleevec (400 mg) from a Canadian pharmacy is just under $3,700. The same drug (but marketed by Novartis as Glivic), can be ordered online from Turkey for $2,979.  That’s a potential savings of $4,000 a month! If you choose to buy Gleevec or any medication online, to protect your health, stick to verified online pharmacies, such as those approved by

In the wake of the Indian Supreme Court’s decision, it would not be surprising if Novartis reacts by raising Gleevec prices here in America to bolster profits.  Governments of other high-income countries probably won’t allow Novartis to raise prices on Gleevec, due to price controls. This is patently unfair to Americans, who should not have to pay so much more for the same medication than citizens of other high-income countries.

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