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Epidiolex-GW

GW Pharma’s Enormous Price for Epidiolex

By Marguerite Arnold
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Epidiolex-GW

In a fascinating early August conference call with Seeking Alpha, British-based GW Pharmaceuticals finally revealed their retail price point for CBD-based drug, Epidiolex, as it goes into distribution in the U.S.

The drug is designed for the treatment of certain kinds of childhood epilepsy – although not all kinds. Also notable of course, is that GW Pharma’s “other” drug for treatment of resistant epilepsy failed in late stage trials in Eastern Europe earlier this year. It also knocked off 5% of the price of the company’s stock.The company is estimating it has a potential patient pool of between 25,000- 30,000 patients in the U.S.

British Advocacy Over Access And Pricing

The ineffectiveness of GW Pharma’s drugs for many patients (along with the cost charged for them) was responsible for pre-empting the entire access discussion in the UK this year. The mother of an epileptic British child tried to import a personal store of cannabis oil (produced by Canadian LP Tilray) only to have it confiscated at the airport this summer. Her son ended up in the hospital shortly thereafter.

The national uproar this caused pushed forward the country’s new medical cannabis policy– indeed drug rescheduling is due to go into effect in October. Conveniently, right as Epidiolex goes on sale in the U.S. (where cannabis remains a Schedule I drug).

The company is estimating it has a potential patient pool of between 25,000- 30,000 patients in the U.S.

Price Tags and Politics

What is the price of Epidiolex? $32,500 per patient, per year. If that sounds high, the company insists it is pricing the drug to be “in line” with other drugs for this segment of the market.

The majority of this cost will not be picked up by private health insurers but rather the federal governmentActually, according to industry analysis, this is about 70% more than the price of one comparable drug (Onfi), and slightly more expensive than Banzel, the two competing (non-cannabinoid based) medications now available in the U.S. for this market.

Here is the other (widely unreported) kicker. The majority of this cost will not be picked up by private health insurers but rather the federal government, which is also not negotiating with GW Pharma about that high price  (unlike for example what is going on in Europe and the German bid).

Why the difference?

Two reasons. The first is that Epidiolex has obtained “orphan drug” status (a medication for a disease that affects fewer than 200,000 patients in the U.S.) The second is that the majority of the insurance that will be picking up this tab is Medicaid. The patient pool will be unable to afford this. As a result, the bulk of the money will remit not from private insurance companies but rather federal taxpayers. And, unlike in say, Germany, none of this is pre-negotiated in bulk.

Epidiolex-GW
What is the price of Epidiolex? $32,500 per patient, per year.

Co-payments are expected to range from $5 to $200 per month per patient after insurance (read: the government) picks up the tab. This essentially means that the company plans to base participation at first at least on a sliding scale, highly subsidized by a government that has yet to reschedule cannabis from a Schedule I in the U.S.

Creating, in other words, a new monopoly position for GW Pharmaceuticals in North America.

A Hypocrisy Both Patients And The Industry Should Fight

The sordid, underhanded politicking that has created this canna monster is hardly surprising given the current political environment in both the U.S. and the U.K. right now. The people who benefit the most from this development are not patients, or even everyday shareholders, not to mention the burgeoning legitimate North American cannabis industry, but in fact highly placed politicians (like British Prime Minister Theresa May). Philip May, the PM’s husband’s firm is the majority shareholder in GW Pharma. Her former drugs minister (with a strong stand against medical cannabis) is married to the managing director of British Sugar, the company that grows GW Pharma’s cannabis stock domestically.

So far, despite a domestic outcry over this in the UK (including rescheduling), there has been no political backlash in the United States over this announcement. Why not?

Look To Europe For A More Competitive Medical Market

This kind of pricing strategy is also a complete no go in just about every other market – including medical-only markets where GW Pharma already has a footprint.

For example, German health insurers are already complaining about this kind of pricing strategy for cannabis (see the Cannabis Report from one of the country’s largest insurers TK – out earlier this year). And this in an environment where the government, in fact, does negotiate a bulk rate for most of the drugs in the market. Currently most German cannabis patients are being given dronabinol, a synthetic form of THC which costs far less.

GW logo-2On top of this, there are also moves afoot by the German government to begin to bring the costs of medical cannabis and medicines down, dramatically. And this too will impact the market – not only in Europe, but hopefully spark a debate in every country where prices are also too high.

The currently pending German cultivation bid for medical cannabis has already set an informal “reference” price of at most 7 euros a gram (and probably will see bid competitors come in at under half that). In other words, the government wholesale price of raw, unprocessed cannabis flower if not lightly processed cannabis oil is expected to be somewhere in the neighbourhood of 3-4 euros per gram come early next year. If not, as some expect, potentially even lower than that.

Processed Cannabis Medicine vs. Whole Plant Treatment

The debate that is really raging, beyond pricing, is whether unprocessed cannabis and cannabis oil is actually “medicine.” At the moment, the status quo in the U.S. is that it is not.

GW Pharmaceuticals, in other words, a British company importing a CBD-based derivative, is the only real “medical cannabis” company in the country, per the FDA. Everyone else, at least according to this logic, is placed in the “recreational camp.” And further, hampered still, with a lack of rescheduling, that affects everyone.

If that is not an organizing issue for the American cannabis industry, still struggling with the many issues inherent in the status quo (from insurance coverage and banking to national distribution across state lines) leading up to the midterms, nothing will be.

New Colorado Edibles Regulations Effective October 1st

By Aaron G. Biros
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Back in April of 2016, the Colorado Legislature passed HB 1436 in an effort to make infused products less appealing to children. On October 1st, 2017, the new law goes into effect, which will prohibit the sale of edibles in the shape of a human, animal or fruit.

The THC universal symbol

Colorado has a history of regulating the market like this, with laws designed to limit the dosing, consistency and appeal of edibles to children. In 2015, regulators placed a 100-milligram cap on THC in infused products, separated into 10-milligram servings. In 2016, regulators began requiring the THC stamp on edibles, a symbol with a clear representation of what the product contains.

Some in the industry are welcoming of these new laws, while others think it might be overregulation. Regardless, manufacturers that have previously produced things like fruit candies or gummy bears now need to update their processes to use non-descript shapes for their products in order to stay compliant.

incredibles logoBob Eschino, founder and president of Incredibles, an infused product manufacturer in Colorado, says these rules are not very effective at preventing kids from obtaining edibles, but it could help. “I believe consumer protection comes from CRP [child-resistant packaging], proper labeling, education and safe storage,” says Eschino. “CDPHE said themselves that stamping or shaping the products is the least effective way to prevent accidental ingestion. It’s a step that will add to consumer protection in a small way, but every little bit helps for now.” There are a number of more effective measures that regulators in Colorado take to prevent edibles from getting in the hands of children, such as child-resistant packaging, prohibiting advertising of cartoon characters, requiring opaque packaging and warning messages on labels.

Products like infused gummy bears will no longer be permitted for retail; Photo: Tamara S., Flickr

According to Peggy Moore, partner of Love’s Oven, an infused product manufacturer, and board president of the Cannabis Business Alliance, the major change companies need to make to stay compliant is ordering new molds. “Depending on the quantity ordered, molds can cost $10,000 or more to fabricate and produce.,” says Moore. “If a company was not using molds previously there is also training that may be required to orient production staff on technique for making molded confections.” She says there are still plenty of options for manufacturers to use like botanical shapes (a cannabis leaf, for example), circles, squares, rectangles and other shapes.

Her company, Love’s Oven, makes caramels, baked goods, crackers and other non-descript shapes already. “At this point I am not aware of any manufacturers who are not already compliant with this rule in advance,” says Moore. “The most common solution is to move to a square, circle or other shape utilizing molds. “ Moore believes it is a producer’s duty to make products that are not enticing to children. “Regardless of the industry (alcohol, cannabis, pharma) I think we should exercise great caution to not produce products that are targeting children,” says Moore. “While I would love to see manufacturers self-regulate in this regard, clearly some guardrail regulations are needed at this point.”

In addition to the rule on using non-descript shapes, HB 1436 prohibits the use of additives in retail cannabis products that are designed to make it addictive, more appealing to children or misleading consumers. The rule does, however, exclude common baking and cooking ingredients. There is also a stipulation that permits local fire departments to perform annual fire inspections at cannabis cultivation facilities.