prepared and written by Jules Levin, National AIDS Treatment Advocacy Project (NATAP)
When Crixivan was approved in March of 1996, Merck announced they were unable to manufacture adequate supplies to make it available through normal channels of distribution. As you know, in order to keep track of the demand (number of prescriptions) and supply of Crixivan, the special temporary system was arranged where Stadtlander's Pharmacy was the only source for most of the public.
Originally, Merck had said that by December 1996, normal channels of distribution would be in place. Unfortunately, Merck is now saying they are unable to do this. Merck has been meeting with community representatives this week to explain the new plan. This memo is a report to you of what Merck has told the community this week. They announced on Friday November 1st, that the current system will remain in effect until February or March of 1997, although they were unable to predict exactly when the new program will begin.
Once this new system is put into place, you will be able to buy Crixivan in many pharmacies who will participate in a more loosely designed tracking system. Crixivan will continue to be available from Stadtlanders. Merck says that, generally, once this new system is implemented the price for Crixivan should remain about the same as it is now whether you buy it from your local pharmacy or from Stadtlanders.
Merck said that increasingly large supplies are being manufactured every month, and by December 1996 they expect to be producing enough supply for 150,000 individuals to receive Crixivan monthly worldwide. They said that approximately 60,000 individuals within the USA and 25,000 outside the USA in 40 countries are currently receiving Crixivan.
Estimates from a few different sources are that about 10 to 20,000 individuals may be using ritonavir and about 25,000-35,000 using saquinavir in the USA. Merck estimated that about 100,000 individuals may be using a protease inhibitor. Although, I have heard lower estimates from other sources of how many individuals in the US are using a protease inhibitor. Some are using the combination of two inhibitors--ritonavir+saqinavir.
In this Expanded Tracking System, participants will include local pharmacies throughout the USA. Pharmacies will join an online system, as part of their current online system, where Merck will be able to continue tracking prescription demand for Crixivan, although more loosely than the current system. For those pharmacies without an online computer system, Merck says they will arrange to receive orders by phone or fax from such pharmacies. The responsibility for re-imbursement will be with the pharmacy. A third party will contract with Merck to create and monitor this new tracking system.
Merck will be attempting to include alternative providers in this system. For example, certain AIDS clinics around the USA who dispense AIDS medications need to be included in this system. Merck requested assistance from the community in being able to adequately notify alternative providers of the opportunity to participate. If you have suggestions, you can e-mail me at JuLev@aol.com; or fax me at (718) 624-8399.
It seems as though a well-designed distribution system for state and federal prisons is lacking. Ideas are welcome from state and federal prison officials as well as community-based organizations.
When ready, a notification will be sent from Stadtlanders to every person receiving Crixivan
The distribution system for Crixivan outside the USA will remain the same. There are a variety of different tracking systems in place outside the USA for the same purpose of keeping track of supply and prescriptions.
Related articles: Crixivan availability
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Last modified 8/20/96
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