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February 20, 1991

Public Pressure Ends 'Bundled' Drug Program, But How Much Cost Will Drop Remains Unclear

JAMA. 1991;265(7):837-838. doi:10.1001/jama.1991.03460070015004

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ANTITRUST SUITS and acts of Congress have pressured the Sandoz Pharmaceuticals Corp of East Hanover, NJ, into "unbundling" its powerful schizophrenia drug clozapine (Clozaril).

The change "should make this breakthrough therapy far more widely available," says David Winter, MD, vice president for scientific and external affairs at Sandoz.

Whether clozapine will get to the majority of patients who could benefit but now cannot afford it is still unclear. Despite its ability to turn some institutionalized patients into productive citizens, only about 7000 people in the United States are taking it.

The "no blood, no drug" rule remains, requiring weekly blood tests for agranulocytosis, a potentially fatal side effect seen in up to 2% of patients. But these tests and distribution of the drug will no longer be done solely by Caremark Homecare Inc of Lincolnshire, Ill.

Many state Medicaid programs do not cover clozapine because the bundled, Caremark package costs