New York Times
March 12, 2006
A Cancer Drug's Big Price Rise Disturbs Doctors and Patients
By ALEX BERENSON

On Feb. 3, Joyce Elkins filled a prescription for a two-week supply of
nitrogen mustard, a decades-old cancer drug used to treat a rare form
of lymphoma. The cost was $77.50.

On Feb. 17, Ms. Elkins, a 64-year-old retiree who lives in Georgetown,
Tex., returned to her pharmacy for a refill. This time, following a
huge increase in the wholesale price of the drug, the cost was
$548.01.

Ms. Elkins's insurance does not cover nitrogen mustard, which she must
take for at least the next six months, at a cost that will now total
nearly $7,000. She and her husband, who works for the Texas Department
of Transportation, are paying for the medicine by spending less on
utilities and food, she said.

The increase has stunned doctors, who say it starkly illustrates two
trends in the pharmaceutical industry: The soaring price of cancer
medicines and the tendency for those prices to have little relation to
the cost of developing or making the drugs.

Genentech, for example, has indicated it will effectively double the
price of its colon cancer drug Avastin, to about $100,000, when
Avastin's use is expanded to breast and lung cancer patients. As with
Avastin, nothing about nitrogen mustard is changing but the price.

"Nitrogen mustard has been around forever," said Dr. Len Lichtenfeld,
the deputy chief medical officer of the American Cancer Society.
"There's nothing that I am aware of in the treatment environment that
I am aware of that would explain an increase in the cost of the drug."

Nitrogen mustard, also known as Mustargen, was developed more than 60
years ago and is among the oldest chemotherapy drugs. For decades, it
has been blended into an ointment by pharmacists and used as a topical
treatment for a cancer called cutaneous T-cell lymphoma, a rare form
of cancer that mainly affects the skin.

And once a company sets a price, government agencies, private
insurers, and patients have little choice but to pay it. The Food &
Drug Administration does not regulate prices, and Medicare is banned
from considering price in deciding whether to cover treatments.

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Many patients who rely on expensive drugs are stuck in a bind. Don
Schare of Saratoga, Calif., said he paid $1,260 last month for 200
grams of nitrogen mustard cream, about 10 times what he paid for his
prior prescription. Mr. Schare, 69, said he was covered by the new
Medicare Part D drug program as well as supplemental insurance from
AARP, but that neither of his plans covered Mustargen.

"It's an obscene gesture on the company's part to raise something by a
factor of 10," Mr. Schare said.

Jeffrey Malavasic, 58, a retired railroad worker in Florence, Ore.,
said he had decided to fill only half of his Mustargen prescription
when he learned of the price increase. He used the drug sparingly in
the past and will be even more frugal, he said...