London HIV clinics will be permitted to prescribe the new antiretroviral FTC (emtricitabine, Emtriva ) following an agreement last month between its manufacturer Gilead and the London HIV consortium that represents funders and prescribers in London.
Emtriva received marketing approval in 2003 and was initially priced above the UK price for GlaxoSmithKline’s Epivir (3TC, lamivudine), its main competitor. Although Gilead had argued that Emtriva offered greater value than Epivir because of analyses suggesting that failure of an FTC-containing regimen resulted in a lower incidence of the M184V mutation common to FTC and 3TC, clinicians were unconvinced.
The London HIV Consortium warned Gilead that its product would not be used for first-line therapy unless the company was prepared to match the discounted price charged for Epivir, a closely related product manufactured by GlaxoSmithKline. After negotiation, Gilead agreed to reduce the price of Emtriva for all London hospitals to a level that matches the price charged forEpivir.
The decision is a sign of the increasingly tough stance being taken by primary care trusts in London as they seek to contain rising drug costs. HIV commissioners have asked clinicians to evaluate all new products in order to help determine whether they are useful and whether higher prices charged for those products reflect genuine added value.
Commissioners are understood to be seeking a saving of more than £1.5 million in drug costs in this financial year, chiefly through demanding that companies offer to all hospitals in London the best prices, previously available only to some large treatment centres in the capital. Recent negotiations with Gilead over a London-wide price for tenofovir will result in savings of nearly £900,000.