from the AIDS Treatment Data Network
    ribavirin availability

    Hepatitis C Action & Advocacy Coalition (HAAC)
    530 Divisadero Street, #162
    San Francisco, CA 94117
    Email: HAAC_SF@hotmail.com

    June 26, 1999

    SAFE AND RELIABLE ACCESS TO "UNBUNDLED" RIBAVIRIN AT 20% OF SCHERING'S PRICE

    Dear Members of the Hepatitis C Patient and Health Care Communities:

    HAAC is pleased to inform you that, beginning July 9,1999 and barring any unforeseen difficulties, a safe and reputable alternative source of ribavirin USP will be available at 20% the cost of the drug when purchased from Schering-Plough. Fisher's Specialty Pharmacy Services (SPS) in Pittsburgh is compounding ribavirin USP by individual prescription. It is NDC # 63370-219-55, properly labeled, with a patient information leaflet that includes all known side effects, warnings and recommended precautions.

    The cost is $1.25/ 200mg capsule. At the common dose of 1,200mg a day, the monthly cost for ribavirin from Fisher's SPS will be only $225. This is 80% less than Schering's price of $1,040. Ribavirin has only been available packaged with Schering's interferon (Intron A) as part of the Rebetron kit. Fisher's will work with you and your insurance provider. Contact them at:

    Fisher's Specialty Pharmacy Services
    3904 Perrysville Avenue
    Pittsburgh, PA 15214
    Phone: (412) 231-3777
    Toll Free Phone: (888) 347-3416
    Toll Free Fax: (877) 231-8302
    Web address: http://www.spsdrug.com

    Rebetron, owned by Schering-Plough, is a two-drug kit for HCV treatment that consists of Schering's brand of injectable interferon (Intron A) bundled in a single package with Rebetol (ribavirin), an oral antiviral. Ribavirin is largely ineffective as an HCV monotherapy, but does increase the effectiveness of interferon.

    Schering is limiting individual treatment options by refusing to make ribavirin available separately. This unprecedented "bundling" impedes research and doctors' ability to make needed dosing adjustments or to use ribavirin in appropriate off-label combinations with other available interferons. Some of these interferons may be more effective in combination with ribavirin than Intron A is, and different people may experience milder side effects on a different interferon. Schering's bundling scam forces patients to buy more drug than needed, wastes valuable medication, and hides the inflated price of Rebetol (ribavirin), which is 350% above that of any other drug in its class.

    Schering has repeatedly cited safety and clinical concerns to defend its bundling practice in the U.S., yet the company sells ribavirin separately in Europe as laws there prohibit this kind of exploitative practice. Schering has ignored repeated community calls to unbundle these drugs. The FDA has expressed its willingness to unbundle the packaging of Rebetron but cites its lack of regulatory authority to do so. The American Medical Association has cited its concerns about the ethics of this marketing practice. Representatives Christopher Smith (R-NJ), Frank Pallone (D-NJ) and Nancy Pelosi (D-CA) have requested congressional hearings into this matter. HAAC and our allies continue to pursue these hearings, as the availability of ribavirin through Fisher's SPS does not put an end to Schering's selfish bundling. Nor does it prevent any pharmaceutical company from attempting a similar marketing scheme in the future for treatments for hepatitis or any other disease.

    Schering's marketing practices have been unethical and exploitative. Therefore, in consultation with your doctor, if combination treatment with ribavirin and interferon is indicated, HAAC urges you to consider purchasing ribavirin from Fisher's SPS. If you and your doctor still believe that Intron A is the best interferon for you, it is available separately. But now, just as in Europe, you and your doctor have other appropriate off-label dosing and treatment options available to meet your individual medical needs. The other interferons on the market are Amgen's Infergen, Roche's Roferon, and Glaxo Wellcome's Wellferon. There is not as much published data yet for combination treatment using ribavirin with these other interferons; however, many individuals have worked with their doctors to create alternative combinations to Rebetron. Clinical trials of many of these combinations are ongoing or will soon begin.

    We encourage you to report to the Food & Drug Administration and to the Federal Trade Commission any implied or overt oral or written attempt by any drug company to pressure you or your doctor. This includes such tactics as the punitive withholding of research or community education grants, impeding access to treatments, monetary inducements, or any other attempts to dissuade use or even discussion of other HCV treatments.

    The Hepatitis C Action & Advocacy Coalition (HAAC) is a national, independent HCV patient advocacy group. We do not accept money from any pharmaceutical company or pharmacy, including any of those mentioned in this notice. Our goal is to help put the control for treatment choice, access and flexibility back into the hands of patients and their physicians.

    For a related story, please go to the excellent site: http://www.hivandhepatitis.com

    Brian D. Klein, HAAC/SF email: HAAC_SF@hotmail.com
    James Learned, HAAC/NY email: James_Learned@prodigy.net

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    Last modified: 6/30/99
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