Wall Street Journal Examines Pricing History of Thalidomide, Cancer Drug Used Off-Label to Treat AIDS-Related Wasting

The Wall Street Journal on Monday examined the pricing history of thalidomide, a medication whose "reincarnation as an AIDS and cancer treatment shows how the political environment and drug companies' perception of what the market will bear drive decisions on drug prices" in the United States. FDA in 1998 approved thalidomide -- which in the 1960s gained "worldwide notoriety" for causing birth defects in the fetuses of pregnant women who had taken the drug to treat morning sickness -- to treat leprosy after facing pressure from AIDS advocates who wanted access to the drug, according to the Journal. The approval gave physicians the opportunity to prescribe the drug off-label for AIDS-related wasting. In clinical trials, Thalomid -- which is manufactured and marketed by the drug company Celgene -- reduced weight loss in AIDS patients but also temporarily increased the amount of HIV in patients' blood, according to the Journal. The drug's original price was set at about $6 per capsule. However, other medications to treat HIV infection began to enter the market and virtually eliminated AIDS-related wasting as a serious problem in the United States, the Journal reports.

Move to Cancer Drug, Higher Pricing
Through clinical testing, Celgene realized Thalomid's potential as a cancer drug, and physicians began to prescribe the medication off-label to treat cancer, according to the Journal. Since 1998, the price of Thalomid has risen from $6 per 50 milligram capsule to $29.44 per 50 milligram capsule this year, the Journal reports. "When we launched it, it was going to be an AIDS-wasting drug," Celgene CEO John Jackson said, adding, "We couldn't charge more or there would have been demonstrations outside the company." Cancer patients and advocacy groups have shown little interest in fighting for lower drug prices, and the "sky is virtually the limit," according to the Journal. However, Jackson said that medications' high prices do not harm patients, the Journal reports. "Either people are wealthy enough to pay or health insurance pays or our company gives the medicine away for free," he said. But some observers believe that between oncologists complaining about runaway drug prices and CMS exerting increased pressure on drug pricing for prescription medicines for seniors, changes in the political environment surrounding cancer drug pricing might soon change, according to the Journal (Anand, Wall Street Journal, 11/15).

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