RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:RE:Italy That risk of out-of-pocket costs is normally quite small in the US. If a Medicare recipient does not have supplemental insurance that covers most of the 20% Medicare does not cover, then they typically get price breaks from the drug manufacturer as the drug maker is interested in at elast getting the 80% of the drug's price that Medicare wil cover. Now, my wife is on Medicare and she has to take a drug that costs $20,000 per month. Our cost is $612 per month and we have the suplemental insurance that covers most of the 20% difference. I can't get anyone to explain to me why we are responsible for $612 per month which is ridiculous, but that is healthcare right now in the US. There is also the "donut hole" which is effectively a co-pay for Medicare patients after they incur a certain amount of costs and that is a $2-$3,000 hit each year for people with significant health costs.
So,pricing differences may have an impact but it is not usually a large one on the decision to a certain medicine in the US. Although some doctors might choose the lower priced drug in certain situations just because they are outraged at high drug prices. But doctors should be prescribing the best drug without any cost consideration and then let the patient work out the discounts with their insurance company.
scarlet1967 wrote: I am not familiar with the insurance policies in
the US but it seems there is a risk for out of pocket costs for patients.
So the drug's price might put off some patients. Here in Canada and in The UK as far as I know any IM administration has to be done by trained health care providers maybe that's not the case in the US or other European countries. I recall also Paul mentioned some patients are pill fatigue that's why some newer ART under development are monthly injectables. So one can argue there is a market for Trogarzo but evidently mush smaller than what company is predicting.
https://www.healthline.com/health/medicare/medicare-out-of-pocket-maximum SPCEO1 wrote: Covid was still an issue in the US in September and the competition was unchanged. So, any pick-up is a helpful sign given the conditions Trogarzo is facing but the trend is still a negative one in the US. Maybe European sales will ramp up faster than US sales will fall off, that certainly seems possible. And maybe the negative trend was just from the intial impact of Viiv's drug and the remaining Trogarzo patients will stick with Trogarzo. But TH has an uphill fight with Trogarzo and there is a new Delta variant impacting the UK and France apparently that might prove troublesome over the winter.
palinc2000 wrote: Read Dubuc s comment on Trogarzo's pick up since the start of the 4 th quarter
16:47 Sales of Trogarzo for the quarter were down seven point eight percent compared to last year and came in six point six million dollars. As mentioned in the past, Trogarzo with new prescriptions had been more impacted by COVID as patients have been more reluctant to visit healthcare facilities. Sales were also impacted by the entry of a new competitor in the multidrug resistant market. We are encouraged by the new prescription numbers we're seeing since the start of the fourth quarter SPCEO1 wrote: I should have noted that the always questionable sales estimator from Bloomberg shows US Trogarzo sales picked up a little in September while Egrifta sales slipped from August's level.
SPCEO1 wrote: I suspect TH will struggle to make the right call with Trogarzo simply because Paul is a sales guy and he is sure he can come up with a plan that will get those Trogarzo sales headed higher. And, who knows, maybe he can. He seems to be having some limited success with reinvigorating Egrifta sales so maybe we should give him the benefit of the doubt for now. But he is in a difficult battle against much superior forces (Viiv and GILD). So, sucking as much cash flow as possible out of Trogarzo is likely the best option and that may actually be their plan with IV Push and IM hoped to slow the decline of sales of Trogarzo. To me, the early indications of the lower US Trogarzo sales tells me it is not clear spending on a new version of Trogarzo is going to help much. I doubt Taimed is interested in buying the marketing rights to Trogarzo back from TH or that there is another drug company who would be interested in buying those rights either, at least at a reasonable price. So, maximizing cash flow of this declining asset is likely best.
It is going to be a while before Taimed has the next version of Trogarzo through phase III (in phase II now) and it is not clear at all that it will be a superior product once it reaches the market. Nor is it certain that Taimed would accept TH as their marketing partner for the new drug (TH has a right of "first offer", but it is not clear what that means in practicality).
qwerty22 wrote: It's really hard to see where the upside is with Trogarzo. It definitely feels like a moment where the company should be re-asssessing their relationship with this drug. It's not just the cost of the IM trial, it continues to be a pre-occupation of the analysts and I'd agree with you it seems more like to be generating negative headlines rather than positive ones. Maybe they believe they can keep the short term story around Trogarzo neutral and maybe reap some rewards from a longer term relationship with Taimed, idk.
SPCEO1 wrote: If it is only a 13% discount, that is better than I would have expected. Actually much better. And since the deceline in US sales of Trogarzo has been faster than I expected, that is very helpful as TH tries to hold the line with Trogarzo total sales. Previously, I thought Trogarzo sales in the US would fall off only marginally and that total Trogarzo sales would grow. Now I am not as confident in that a s US Trogarzo sales seem to have been hit harder than I was expecting by Viiv. With new competition from GILD on the horizon as well, the outlook is not great for Trogarzo. The more MDR drug options there are, the greater the chance a patient will be willing to move to a pill from an injection since by abandoning Trogarzo, their body will likely develop a resistance to it. I was counting on that to keep all the Trogarzo patients TH could accumulate before Viiv's pill hit the market in place, but it looks like some patients are willing to give up one of the few (sometimes only) treatments that is working for them for the convenience of a pill.
I can't see the IV Push helping a whole lot with both Viiv and soon GILD offering pill options and wonder why TH is even bothering to pursue the IM version. Seems like there is a good chance any money spent on the IM version by TH is not going to get a great return.
That same competition will be undermining Trogarzo in Europe as well. TH apparently has about 20 people working out of Ireland supporting one small drug with some difficult competition on the horizon. Perhaps the idea is to build a European presence so they are ready if TH-1902 zips through to approval quickly, as it might. But one has to wonder about the ROI on Europe right now. Maybe there is a bigger plan that we are presently unaware of to get more drugs for Europe to sell in the meantime, but it seems to me that TH may be outrunning its headlights in Europe. From what I can see competitively, the most sensible approach to Trogarzo right now would be to milk as much cash flow from it as possible and not invest more in it.
scarlet1967 wrote:
Wino115 wrote: I think we can go with Paul's "...it was a good price..." ! Certainly not US levels, but probably not below 50%. It had always sounded to me like they thought they could get 75-80% of US price and the Viiv product provided a bit of an umbrella to that as well.
SPCEO1 wrote: I think I will need to hire an Italian lawyer to actually figure out what the annual revenues from one Italian patient on Trogarzo for a year might be! They also mentioned discounts but it is not clear to me what those discounts might be and there seemed to be other circumstances that might impact the price. But figuring all that out seems like a lot of work and that you need to know someone familiar with Italian drug pricing to get an accurate answer.
scarlet1967 wrote: "packaging: «200 mg - concentrate for solution for infusion -
intravenous use - vial (glass) - 1.33 ml (150 mg / ml) »2
vials - AIC n. 048255018 / E (base 10);
reimbursement class: H;
ex factory price (excluding VAT): euro 2,000.00;
retail price (VAT included): € 3,300.80.”
I don’t know what the reimbursement H class means versus retail price but 2000 euros equals US $2328. Compared with the US pricing excluding VAT(tax in Italy 22%) it seems it’s about 13% cheaper in Italy.
“The cost for Trogarzo intravenous solution (200 mg/1.33 mL) is around $2,671 for a supply of 2.66 milliliters.
The annual list price for every two-week infusions is $118,000.”