The Italian Competition Authority (ICA), the country’s antitrust enforcer, has fined two Swiss drugmakers, Hoffmann-La Roche Ltd. and Novartis AG, more than $250 million for colluding to direct eye patients away from the companies’ drug Avastin to their more expensive Lucentis drug. The ICA found that since 2011 the two companies arranged to portray the cheaper Avastin as more dangerous than Lucentis in order to influence the prescriptions of doctors and health services.
Medical doctors use both drugs, which are based on a similar active ingredient, to treat eye problems such as age-related macular degeneration. But it should be noted that only Lucentis was specifically approved for such a use. The ICA fined Novartis, which has the rights to market the drugs outside the United States, €92 million ($126 million). Roche, which markets the drugs stateside, must pay about €91 million. The ICA claims the two drugmakers’ intrinsically linked economic interest gave rise to the arrangement. Roche collects royalties from the sales of Lucentis and Novartis holds a 30 percent share in Roche.
The ICA said that “Roche and Novartis set up a complex collusive strategy.” It also said that, in steering patients toward the more expensive drug, the Italian National Health Service incurred additional expenses of more than $60 million in 2012. Genentech, a Roche subsidiary since 2009, first marketed Avastin in 1997 as a treatment for cancer. But the drug was later used off-label to treat macular degeneration. Lucentis, also a Genentech product, was approved in 2006 specifically to treat eye conditions for which Avastin was previously used. In 2003, Genentech granted Novartis exclusive rights to distribute the drug outside of the United States.
Although they are similar, the two drugs differ considerably in cost. For example, an injection of Avastin costs about $100, while an injection of Lucentis costs more than $1,200. The ICA began investigating Novartis and Roche in February 2013, following complaints from an association of private Italian hospitals and the Italian Ophthalmologic Association. Local governments and an Italian consumer association were also involved in the investigation.
The efforts to portray Avastin as more dangerous than Lucentis intensified, according to the ICA, as researchers published studies indicating that the two drugs were equally effective at treating eye conditions. For example, a 2011 study published in the New England Journal of Medicine, revealed that Avastin and Lucentis had “equivalent effects” when used on the same schedule over the course of a year.
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