Is Merck Price Gouging With Gardasil HPV Vaccine? The Most Expensive Vaccine Ever.

(This article was revised on 12/06/2007 to reflect new data that has been released about Gardasil.)

If you’ve watched TV or picked up a magazine in the past 6 months, you’re probably drowning in advertisements for the “cervical cancer vaccine.” And besides the millions (and millions and more millions) of dollars Merck is pumping into advertising the product, the controversy spawned by vaccinating young, assumingly not-sexually active, girls has pushed the product to the forefront of the media (I’m not intending to get mixed up in that controversy, other than to say that getting a vaccine – by itself – is not going to stimulate young girls – or women - to become sexually active). All this education and promotion is a good thing, because it encourages women to get vaccinated against a disease that is a killer.

I am in an education field that deals directly with genital warts and cervical warts (for the purposes of this article I am going to refer to genital warts as all types that don’t reside on the cervix and cervical warts as those types that do and can lead to cervical cancer). Nationwide, we have a serious problem with both classes of warts. You can go to any scholarly site on the internet, the governmental databases, or search any university library and find enough data on the prevalence of genital and cervical warts to match Merck’s hype. HPV is easily transmitted and extremely prevalent across various demographics. The question is not if we as a society need this vaccine, or if women should get vaccinated for genital warts, but if the behavior of Merck in pricing the product.

Understandably, when Gardasil was released, like most people in the health care field, I was pleased. We finally got a vaccine HPV vaccine.

The Cost of Gardasil – Money Doesn’t Grow on Trees

I was blown over when the Merck Pharmaceutical Reps I initially spoke with announced the street price of the product.

Complete effectiveness requires three doses of vaccine. Our local chapter of Planned Parenthood charges approximately $180 for the first dose and $165 for the second and third doses. That brings the total to $510. Our local average across different types of provider is: $500 +/- $50. Any new drug takes hundreds of millions of dollars to bring it to market, and in Merck’s defense they need to recover some of this money through sales. Likewise, it is usually more expensive to produce a pharmaceutical initially than it is over the long haul (for a variety of reasons). The Merck Drug Reps I spoke with were quick to point out that money doesn’t grow on trees.

The Effectiveness of Gardasil-

“HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases” (directly from Merck). Merck accurately and prominently states that, “GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer.” (Author’s note: not all cases of cervical cancer are caused by HPV infections). There are about 26 other strains that infect the genitalia.

Recently a new study of the vaccine (by Dr Darren R Brown at Indiana University School of Medicine) of 11,000 women, showed that the vaccine is 38% effective against 10 other strains of HPV that are thought to cause 20% of cervical cancer. Gardasil is 45 per cent effective again types 45 and 31.

This means that the same vaccine that was released onto the market produces antibodies with cross-reactivity to other types of Human Papilloma Virus.

There is every reason to suspect that Merck will be testing Gardasil in women older than 26 and in men. Hopefully these tests will indicate that Gardasil is safe and effective in these groups also.

Merck Gardasil Marketing and Business Strategy – Money Does Grow on Trees.

If all this number talk is mind-boggling, it’s supposed to be. It distracts you from one of the real issues that Merck would rather not have you ponder.

Merck is directly responsible for pricing this product. And it is a product that every woman (and actually every man) needs. Nobody wants cervical cancer or genital warts and Merck knows people flock to it no matter what the price is. When I expressed my concerns to Merck Pharmaceutical Reps about the price of the vaccine, they immediately counter with, “most insurance companies are paying 100% for it.” Soon, with the legal changes that are likely forthcoming, they will be able to add, “and if not, (insert any federal or state agency here) will.”

So the consumer is left thinking, “Great, I can be vaccinated for free,” and the consumer doesn’t complain as Merck has saved them from a horrible disease – and at no charge. Merck bills the proverbial money tree, the insurance companies and feds, $500 and nobody questions this payout. It is clear that the bean-counters at the insurance companies have done the proper calculations and have figured that preventing genital and cervical warts with a vaccine is cheaper than having to treat the diseases (that’s one major factor if/when insurance companies decide to cover a vaccine). And they are right, treating genital warts isn’t cheap, and an initial diagnosis can cause hundreds (or thousands) of dollars in DNA typing, colposcopy, cervical biopsies, specialist visits, etc. This doesn’t even begin to cover pain and suffering, emotional issues, and a host of intangible negatives from getting a viral sexually transmitted disease. HPV cases are regular occurrences in most clinics that offer gynecology services, and for those that have it, insurance is bearing most of the costs.

Drive the customer to want your product, have it mandated by the public health system, have a third party pay you for it. I actually don’t have any problem with this – especially with a vaccine that is going to save so many lives and prevent suffering. My problem is, based on the potential market and the forthcoming vaccination laws requiring the product for huge groups of people, that right now Merck, the only company with an approved HPV vaccine, has the opportunity to price gouge $500 per person for Gardasil.

You may be thinking, “As long as I don’t have to pay for it, I don’t care.” Well you may not be paying for it out of your pocket, but your insurance company or your taxes are (or will soon be) paying for it. If you’re like most of us you directly pay taxes and insurance costs with each paycheck. Every excess dollar that Merck makes (above what is a reasonable profit for them, after all they do have to make a profit here), is money that your insurance company doesn’t have available to pay for your other vaccines, for other mediations, or for better health care for you.

You Should Get Vaccinated for HPV and You Should Vaccinate Your Children

If you have read this far and you are thinking that I am suggesting that you don’t get vaccinated for HPV – or you don’t vaccinate your kids for HPV, you are missing my point. This is a great vaccine that could save your or your children’s life, thousands of dollars in health care costs, and a lifetime of suffering. Call you doctor, Planned Parenthood, or local public health service, and make an appointment to get Gardasil as soon as you are through reading this.

I am not urging a boycott of the product. I am not suggesting that insurance companies and federal agencies shouldn’t mandate this as a public health measure. I believe it is a necessary vaccine in the same way that polio, hepatitis B, and all other vaccines are. In the long run it is the best public health choice. Genital warts and cervical warts can easily be classified as epidemics – and not just in those populations who have multiple partners and are typically seen as sexually promiscuous. You can have sex with one person and get HPV. Right now the vaccine is only approved for use in women between the ages of 9 and 26. If the vaccine proves effective in women of other ages and men, then I think those people should be vaccinated, too.

Yes, people should get vaccinated for HPV, but I also think that along with that it is time to start demanding some explanations from Merck about the pricing of this product. Likewise, our insurance companies and federal and state agencies need to look deeper into this. If they enact laws that make the vaccine mandatory, they have even more accountability for ensuring that Merck is acting responsibly.

When you meet somebody from Merck ask them when are they going to lower the price of this product. When you get vaccinated tell your doctor that the vaccine is too expensive even if your insurance company is paying for it. If you are in the health care field, when a Merck rep comes to speak with you, tell them the price of Gardasil is too high. Ask your state and federal legislators to look into this.

If we are paying $500 dollars to vaccinate every person for against “cervical cancer”, it begs an even scarier question. How much will the next breakthrough vaccine cost us?

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Tags: cervical cancer, discount, gardasil, genital warts, hpv vaccine, insurance companies, mandated, merck, price gouging