According to the Times:
The drug, which will be called Kadcyla but was known as T-DM1 during its development, extended the median survival of women with advanced breast cancer by nearly half a year in a clinical trial.
Genentech, which developed the drug, said it would cost about $9,800 a month, or $94,000 for a typical course of treatment. That is about twice the price of Herceptin itself, which is also made by Genentech, but it is similar to the price of some other new cancer drugs.
Many tough questions flow from just those two paragraphs.
This seems to mean that patients will get to live “nearly half a year” extra if they or their insurance company (or Medicare if the patient is 65 or older) pays $47,000 — the difference between the cost of the new drug and the one a breast cancer victim would otherwise take.
Most state laws require insurance companies to pay for any approved cancer drug at whatever the drug company sets as its average sales price, plus a 6 percent profit for the hospital or doctor that dispenses it. Federal law requires Medicare to do the same. So how much will the potential widespread adoption of this treatment add to the national medical bill?
Of course, the benefits are clear: an extended life and, apparently, more mild side effects than the alternative treatments. But a reporter unafraid to step onto this minefield would also ask experts to talk about whether anyone should be making the kind of cost-benefit analysis that would consider whether that money could be spent more effectively on other healthcare needs. But even before getting to those delicate issues about the value of life, there’s the question of how the drug company arrived at that $94,000 treatment price? Why does it have to be that much?
Which leads to the question of how much the approval of the new drug at $94,000 per treatment in the US will add to the profits of Roche, the $45 billion global drug company that distributes it — and if that’s a fair result compared to the pricing regulations in effect in other countries that would limit those profits.
The Times story reports that Genentech, the California-based biotechnology pioneer that is now a subsidiary of Roche, “developed the drug.” However, according to the Times, “The linker and toxin used in Kadcyla were developed by ImmunoGen, based in Waltham, Mass., which will receive royalties on sales of the drug. This is the first approved product for ImmunoGen, which has been working on antibody-drug conjugates for three decades.”
That makes me want to know more not just about ImmunoGen but also about the scientists there who actually invented the treatment. Was the same person or team really working away at this for “three decades”? Let’s meet them and describe their struggle to create this treatment.
Then let’s go back to the money story. Did the ability of Genentech and Roche to manufacture, market and distribute the drug around the world make it irresistible for ImmunoGen to sell off the rights to its invention in return for royalties? How much might the royalties turn out to be? Is this an Instagram-like payday for the folks in that Waltham lab?
And what did ImmunoGen and Genetech have to invest in research and development before they hit paydirt? What were the costs and processes involved in gaining FDA approval?
In short, I’d really love to see a narrative — with all the people, as well as all the numbers — telling us the story of the new wonder drug and how it brings to life all the issues involved in modern healthcare.