Genzyme's Dilemma: Its Cheap Cancer Drug Wants to Cannibalize a Potential MS Blockbuster

Genzyme (GENZ)'s potential new treatment for multiple sclerosis may be too cheap, and the company could be looking for a way to raise the price if it wants to take maximum advantage of the hugely lucrative MS market. That's the obvious conclusion from Genzyme's latest clinical test of Campath, which it currently sells for chronic lymphocytic leukemia, a blood cancer.

Genzyme believes that if the FDA approves Campath for MS, it will dominate the market: Michael Panzara, the clinical development chief on the product, said on Wednesday that new results show that Campath "promise[s] to be the most effective drug in MS."

For CLL, Campath is a modest moneymaker for Genzyme. A single patient can spend in the region of $50,000 a year on the drug at current prices, according to Scott Roberts, a vp at PriceSpective, a Philadelphia drug pricing consultancy.

The problem for Genzyme is that just eight infusions of the drug has the effect of staving off MS symptoms -- progressive, irreversible paralysis -- for up to four years. Those eight infusions could cost patients less than $10,000, keeping them out of wheelchairs. At that price it's the equivalent of giving it away for free. Competing MS drugs often command upwards of $30,000 per year for treatment, Roberts says.

In Genzyme's MS tests, Campath has been administered in 12mg doses. Currently, Campath sells at wholesale for about $5,105 per 3-pack of 30mg ampules intended for CLL treatment, Roberts says. An MS patient might need just one or two of those packs to get a full treatment.

The problem is further compounded by the fact that currently Campath only makes about $112 million a year for Genzyme. As a full-price MS treatment it could make many times that. If it's kept at the same price as the CLL doses, investors will scream about money being left on the table. (Genzyme did not immediately return a call for comment.)

If Campath is approved for MS, Genzyme would face several choices, both moral and economic:

It could rebrand Campath as an MS drug and sell it in MS-dose-sized ampules for thousands of dollars more. But that would lead to an uproar from MS sufferers who would know they're being exploited. And it might lead to doctors splitting up 30mg ampules intended for CLL patients and diverting the supply to MS patients.
It could leave Campath at the same price for CLL -- but that would destroy the existing MS drug market and drug companies are generally loathe to implode lucrative disease categories when they present themselves.
It could withdraw the drug completely for CLL but promise to continue supplying those patients free of charge, and then relaunch Campath as an expensive MS-only product. That might prevent MS patients migrating to diverted CLL doses, but it would also be controversial.

"It would raise scrutiny from various stakeholder bodies," says Roberts of the last option. "It's not illegal, but it would be a public relations bump in the road."

Genzyme might want to take a look at the dilemma faced by Genentech, which sells the cancer drug Avastin and the macular degeneration treatment Lucentis. They're both effectively the same drug, but Avastin costs about $60 per dose for eye treatment and Lucentis costs $2,000. Genentech has gone to lengths to prevent macular degeneration patients -- who go blind if not treated -- from getting their hands on Avastin. And everyone agrees that Genentech's position is an example of the corporate rapaciousness that brings the drug industry into bad repute.

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Image: An Australian MS awareness ad, click to enlarge.

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