Bayer's rejection of request for affordable Nexavar for Fathi Helmi Aboseda (Egypt)

Today we received news from Nina Mahmud that her father-in-law, Fathi Helmi Aboseda, has passed away in Egypt. Mr. Aboseda was suffering from liver cancer. Earlier this year, Nina Mahmud had contacted Bayer and KEI asking for help in finding affordable copies of sorafenib, a drug for liver and kidney cancer sold by Bayer under the trade name Nexavar, a drug that was extending and improving the quality of his life. The price of Nexavar in Egypt was $900 per week, and Mr. Aboseda had used his entire life savings to buy the drug.

In an April 5, 2014 letter, which we are publishing here, for the first time, Bayer rejected her plea.

After Bayer rejected the request for a discount on the price of Nexavar in India, several persons, including three persons in India and two people in Egypt, found a way to bring a few months of generic copies of sorafenib to Nina's family in Egypt. This turned out to be quite difficult.

  • The India compulsory license for the patents on sorafenib did not permit sales outside of the territory of India, following pressure from the United States, including personal interventions from President Obama, Vice President Biden, two secretaries of Commerce, the head of the USPTO, the US Department of State under Hillary Clinton and John Kerry, and Michael Froman, now head of the USTR.
  • DHL refused to ship the generic versions of the drug from India to Egypt, without an original copy of a prescription from an Indian doctor and a certificate of drug registration from the Egyptian drug regulators.
  • Egypt wanted the drug registered in Egypt before issuing a compulsory license on the patents in Egypt.
  • It was difficult to get timely visas for people from India or Egypt to make a plane trip to deliver the drug.

All of these barriers were overcome, but it was quite difficult , and not something that can scale. These cases remind us why intellectual property and trade policy are important.

Below are the correspondence between Nina Mahmud and Bayer, as well as some video interviews we did with Nina during her February 2014 trip to Washington, DC.

Our thoughts are with the Aboseda family, knowing this is a great loss for them.

Jamie

Bayer's April 5, 2014 response to Nina Mahmud, rejecting request for affordable Nexavar for Fathi Helmi Aboseda.

---------- Forwarded message ----------
From: Joseph Philip Hendrik Smits
Date: Sat, Apr 5, 2014 at 12:47 AM
Subject: Nexavar
To: "nina.a.mahmud@gmail.com"

Ms. Nina Mahmud

Dear Ms. Mahmud,

The president of Bayer Corporation in the U.S., Philip Blake, reached out to me regarding your February 14, 2014, correspondence and asked me to reply to you on his behalf.

We have great sympathy for what you and your family are experiencing.

We have consulted with our colleagues in Egypt and learned that our company's endeavors to put in place a Patient Access Program in cooperation with the Egyptian authorities are still underway, and we will continue to work closely to establish a program for Nexavar in Egypt. We are optimistic that the necessary measures to provide all patients with the medications they require will be implemented soon.

Please understand that as an ethical company we cannot interact directly to provide patients with pharmaceutical products.

In your letter, you also reference the topic of innovation which is closely linked to the topic of Intellectual Property. As Intellectual Property is the lifeblood of the biopharmaceutical industry, please allow me to explain the following.

We realize and accept the responsibility we have to make our medicines accessible and affordable to the widest number of patients possible. Furthermore, we are committed to finding sustainable and effective ways to improve access to our medicines. In fact, we work with aid organizations and governments on different health-related programs.

But we can only continue to do so and to develop innovative medicines for the unmet medical needs of patients if our business model stays intact. And a key element of this model is the intellectual property right linked to such an innovative medicine which we therefore can't compromise.

With kind regards, Philip Smits, MD, General Manager Bayer Healthcare Middle East

Nina Mahmud's February 14, 2014 letter to Philip Blake, President of Bayer Corporation in the U.S.

February 14, 2014

Dear Mr. Philip Blake,

My name is Nina Mahmud and my father ­in ­law is Fathi Helmi Aboseda. He is dying from Liver Cancer and needs Nexavar. He lives in Alexandria, Egypt where Nexavar is sold for $1,724 US dollars for 2 weeks supply of medication. The cost of Nexavar has already depleted the family’s life savings and cannot afford his next bottle of Nexavar. Currently, he only has enough Nexavar
to last him through this Saturday, February 15th, 2014.

He and his twin brother own a market and he earns approximately $280 a month. To afford the next bottle of Nexavar we have to sell the family business which may take a few months and will only provide 9 months of Nexavar. This is the family business that would have been passed down to the next generation for their future means of income. After that we will have nothing left to sell.

Fathi started Nexavar on December 4, 2013 and as of last week his lab values have returned to normal range and his tumors have shrunk. However, he will not survive long off of Nexavar. Fathi is the father of Mohamed (my husband), Maged, Mai and Maha and the grandfather of 3 beautiful children, Omar (4 years old), Eiad (2 years old) and Amir (1 year old). He also helped raise his 5 nephews and nieces when their mother died at a young age. He is married to Nadia, the love ­of­his ­life, for 39 years.

I am asking Bayer to immediately sell Nexavar in Egypt at a price that people can afford. It is not realistic to provide a 1 month supply of Nexavar at $3732 US dollars in a country where the average earning is less than a $100 US dollars a month.

If there's truth to Bayer Pharmaceuticals mission and value statement then they need to immediately make Nexavar affordable to everyone.

If Bayer is a ‘science for a better life’ then allow the opportunity for a better life to everyone regardless of socioeconomic status or country of residence.

If Bayer is a ‘world­class innovation company’ then let that innovation be accessible to people in both the developing and industrial countries.

If Bayer’s ‘scientific achievements aim to help improve people’s lives by addressing the great challenges of our time’ then help improve the great challenges in everyone’s lives.

If Bayer’s aim is to ‘discover and manufacture products that will improve human health worldwide by diagnosing, preventing and treating diseases’ then do so and make Nexavar accessible and affordable to everyone.

Steps that Bayer can take to make Nexavar accessible and affordable to everyone include: (1) selling Nexavar at prices that are affordable, in each county where the drug is sold, and/or, (2) for countries where Bayer is clearly not serving everyone in a country, license the relevant patents to generic drug companies, so they can make and sell generic versions at a price point that better reflects peoples’ incomes, in that country.

Bayer is very wrong to block every effort to expand access to affordable supplies of Nexavar, and to price Nexavar only “ for Western patients who can afford this product." Please do not let my children lose the opportunity of having their grandfather in their lives simply because Nexavar is too expensive for us to afford.

I would like to schedule a meeting with you and your staff to follow up on the concrete steps that Bayer can take to address the the pricing policies that currently strip people of all of their assets, their life’s work, and their ability to provide for their spouses, children and other dependents, and which even make access impossible, and which have terrible negative impact on their health and life expectancy.

Sincerely,
Nina Mahmud
954­254­0636
nina.a.mahmud@gmail.com

September 22, 2014 message from Nina Mahmud, regarding the death of Fathi Helmi Aboseda.

From: Nina Mahmud
September 22, 2014.

to: Claire, Manon, Jamie, ip-health

Hello Mr. Love,

I want to let you know that my father-in-law passed away last Friday approximately 4pm Eastern time. He finished the medication a few weeks ago and soon after everything started to fail. He was admitted to the ICU last week and hospice last Thursday. Everything happened very quick. You know it's inevitable but you can never be fully prepared.

I have spent the last few months trying to figure out how I can thank you and everyone who played a role in helping my father-in-law access medication. You gave us time and that's been priceless for the whole family. I don't know how to repay that, but know you, Manon, Claire and everyone are in my thoughts and prayers every night (except Bayer of course. I give them the evil eye daily). Everyone is still in shock and grieving. I hope to talk to you soon. I am currently without a cell phone but will call you when I get one.

I know my father-in-law is watching over us all from Heaven including the KEI family.

Have a beautiful week and be blessed,
Nina

Sent with Love

Playlist of interviews with Nina Mahmud, during her February 2014 visit to Washington, DC, to confront Bayer at an ITC hearing on India.

https://www.youtube.com/playlist?list=PLLw9jWaZPEpzj9_OW4LKlxD5pvPto71xO

More context

Bayer CEO Marijn Dekkers explains: Nexavar cancer drug is for "western patients who can afford it.” http://keionline.org/node/1910

Transcript of Bayer CEO Marjin Dekkers quote at the December 3, 2013 FT Event, regarding India compulsory license of Nexavar. http://keionline.org/node/1924

http://keionline.org/cancer

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