Glaxo offers program to boost employer antiviral stockpiling

Sep 3, 2008 (CIDRAP News) – GlaxoSmithKline, maker of the antiviral drug zanamivir (Relenza), today launched a program designed to help businesses stockpile the drug as a strategy to protect employees in the event of an influenza pandemic.

In a press release, the company said its Pandemic Readiness for Employers Program (PREP)  is intended to remove some of the cost and storage barriers that make it difficult to stockpile zanamivir. Though oseltamivir (Tamiflu) is considered the first-line treatment in a pandemic, some health experts advise countries and businesses to diversify their stockpiles because of concern that viral mutations may cause resistance to antiviral medications.

On Jun 26, Roche, the maker of Tamiflu, unveiled its program to support employer antiviral stockpiling. Both companies' programs permit employers to reserve a supply of the antiviral, to be stored and maintained by the manufacturer and delivered only when needed. Roche said its program would not only help businesses prepare for a pandemic, but also bolster sagging demand for the drug, which could help maintain production capacity that would be needed in a global health emergency.

Both antivirals are in the US government's strategic national stockpile, which contains 80% oseltamivir and 20% zanamivir. Relenza is in a powder form that is inhaled from a breath-activated plastic device and is intended to be taken twice a day.

Chris Viehbacher, president of Glaxo's North American pharmaceuticals division, said in the press release, "We are committed to helping employers and other business leaders prepare for an influenza pandemic and its impact on the health of their employees and the operational integrity of their organization."

Experts urge diverse stockpiles
In the press release, Anne Moscona, MD, an antiviral expert and professor of pediatrics and microbiology at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, underscored the importance of keeping a diverse antiviral stockpile. "We are coming to understand that our concerns for the past few years about resistance of pandemic influenza viruses to antivirals were justified," she said. "The recent article in Nature, further explaining the mechanism for this emerging resistance, reinforced the importance of diversifying your antiviral stockpiles in order to help protect the broadest number of employees."

In the May 14 issue of Nature, British researchers identified certain mutations in the H5N1 avian influenza virus that make it resistant to oseltamivir but leave it sensitive to zanamivir. They advised nations not to rely on oseltamivir alone when preparing for an influenza pandemic.

In June the US Department of Health and Human Services (HHS) released preliminary guidance on antiviral use and stockpiling, which recommended that businesses providing essential goods and services strongly consider antiviral prophylaxis for critical workers. Though HHS stopped short of establishing a requirement or expectation that employers stockpile antiviral drugs, it warned that employers shouldn't depend on antivirals from the government's limited stockpiles.

Glaxo spells out two options
Glaxo's stockpiling program for employers offers two options. One is a preferred pricing plan that allows businesses to buy zanamivir at a discount price that includes free storage. Jeff McLaughlin, a senior manager in product communications at Glaxo, told CIDRAP News that the discount is 31% less than the wholesale price.

After 5 years, companies that enroll in the program can buy replacement units for the expired drug units at the same 31% discount, he said. Each unit represents one treatment course, and the minimum order is 500 units. Repeat customers must buy the same number of units as the initial purchase.

The second option—the reservation plan—is intended to reduce employers' up-front expenditure and allow them to lock in a price for future zanamivir purchases, Glaxo said in its press release. An annual fee of $6 per unit reserves and stores the drug for the life of the contract, which can span up to 10 years and can be canceled without additional cost. Companies will receive their orders when they request them or when the World Health Organization (WHO) raises its pandemic alert level to stage 4 (sustained human-to-human transmission).

Glaxo's reservation plan is similar to Roche's employer Tamiflu stockpiling plan. At $6 per treatment course, Roche's annual fee is the same as Glaxo's.

Like the preferred pricing plan, the minimum order for the reservation plan is 500 units, McLaughlin said. Both of the plans, for now, are available only to US-based businesses, he said.

Birch Holt, business continuation manager at Target Corp., based in Minneapolis, told CIDRAP News that Glaxo's new stockpiling  is innovative. "That should help the pricing side, but there are many other consideration besides just price," he said.

See also:

Jun 26 CIDRAP News story "Roche unveils plan to boost employer antiviral stockpiling"

Collins PJ, Haire LF, Lin YP, et al. Crystal structures of oseltamivir-resistant influenza virus neuraminidase mutants. Nature 2008 Jun 26;453(7199):1258-61 [Abstract]

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