Hi this is dr. william o’neill i’m the executive dean of clinical affairs at the leonard miller school of medicine university of miami yes f en tis available in our medical center and i recently had a visit with the regional rep from lille that started to give me what they’re going to be using is their cans sales pitch when they go out and try to market this drug
To physicians well it’s you know it’s address lis the the sales pitch so this is wonderful and they tried to denigrate clopidogrel and try to prove that the medication was more effective and i had to sort of drag out the price right now most pharmacies caught a charge to people that actually have to pay for the pill three dollars a pill for plavix which i think is
Outrageous and now lily is going to compound the problem because they’re going to charge five dollars and forty cents for patients that have to buy the new drug afyon well they really are they’re really are relying on the oppressive grill versus clopidogrel in patients with acute coronary syndromes or the timmy triton study and in fact their marketing brochure
I’m just showing it is actually basically a copy of the new england journal of medicine article and then inside this brochure which they’re going to be handing out to all the colleges so basically the overwhelming sales sales strategy is to identify the superior superiority of the triton study where as you know there was a mild in improvement in net benefit for
The patients in terms of a decrease in the major adverse events i think if you carefully look at the study the real question is what’s the bang for the buck because the majority of the benefit is seen in a decrease in peri procedural mi that occurs on day one after that there’s very marginal benefit i think that this trial design itself was somewhat suspect well
Given the fact that it’s going to be so much more expensive for the patients to take i’m going to really have very little use for the drug maasai’s what a huge problem it is here in miami we have a large group of patients that are indigent a very large group of patients that are working poor and in those people they have to actually pay for the drug out-of-pocket
And and to double the price of this double the out-of-pocket expenses is just going to be a huge economic burden and i really can’t see that that huge burden is going to be worth the very very small decrease in risk in absolute sense of the numbers of sub acute thrombosis that would occur in the chronic follow-up i think you can eke you can accomplish equally
What this study did by loading patients before the angioplasty procedure with clopidogrel at the right dose i think you can accomplish the equal decrease in ck release that this drug accomplished by loading the patients ahead of time with 600 milligrams of clopidogrel that’s the current recommendation load at 90 minutes or more before the angioplasty procedure
You’ll have adequate antiplatelet effect i think that fe and it does provide some better bioabsorption i think it’s observed very much quicker and the reason that this study was positive was that they had more optimal antiplatelet relief at the time of the angioplasty but with different loading strategies i think you’d probably accomplish the same thing there
Is the risk that you’re going to have an increase in bleeding in patients and i don’t i don’t honestly think that they can recommend who those patients are going to be i think older patients patients with previous tiaa or stroke small body weight are probably going to have too much of a concentration of the drug and so you’re going to have an increase in risk and
Bleeding for those patients so i’m still scratching my head trying to figure out who if any patient would have a specific benefit from this drug overcliffe it oh girl so i think that this drug may have some advantage and i’m quite interested in potentially figuring out which patients might have benefit versus clopidogrel but the overwhelming issue is that we’re
Told that there’s a crisis in america with a huge increase in medical costs we’re told that the pharmaceutical industry is going to decrease cost by 80 billion dollars over the next year and so over the next 10 years and so the timing for lilly to double the price of this medication right at the at the current point in time when people have economic trouble when
The country’s struggling with health care costs i think is basically just the height of arrogance it’s just like the auto executives flying to washington in their corporate jets it doesn’t make any sense there’s not that huge an incremental safety advantage over this drug there’s a huge increase in potential risk of bleeding in the wrong patients and so for them
To have this huge premium on this drug i think is silly i think that they could have gotten a very good market share but i’m quite certain that many other physicians are going to be incensed by the fact that they doubled the price of this medication for patients that can hardly afford to take a clip integral now
Transcribed from video
The controversial price for Effient By The Healthcare Channel
