Schering-plough has long taken heat for packaging, or “bundling,” its hepatitis C (HCV) treatment, interferon (Intron A, an injectable) and ribavirin (Rebetol, a pill). Dubbed Rebetron, this combo has been the standard HCV treatment for years, though other interferons have entered the race. And with bundling, of course, patients wishing to use Schering’s ribavirin -- the one and only such anti-hep nucleoside analog -- with a different brand of interferon have had to buy Intron A they don’t want.

When Schering’s new pegylated interferon (PEG-Intron) was green-lighted for use with ribavirin, many patients were doubly delighted: First, PEG-Intron is injected just once a week rather than the three-times standard; second, the drugs were unbundled, finally making ribavirin available separately. But be careful what you wish for: Shrewd Schering had an ace up its sleeve. It unbundled the two drugs, all right -- and proceeded to price ribavirin higher!

The average wholesale price for one month’s high-dose Rebetol is $1,653. Yet Rebetron costs $1,511 -- that’s $142 less. Why so pricey? “In reality, there was no price for ribavirin alone. There was a price for Rebetron,” says Schering rep Robert Consalvo. "That therapy had a therapeutic value, and this new therapy has a new therapeutic value.“ Who ”new“? So, the two-product package costs less -- and presumably has a lower ”therapeutic value" -- than the one product alone? Welcome to Wonderland, where less is more.

Well, Alice, consider the bright side. You only have to take Rebetol for a year. And with a full supply running you some $18,000 -- that’s not even counting the price of a competitor’s interferon -- a year of anti-HIV meds looks downright cheap. That’s just the comparison Schering makes. “In the long run,” says Consalvo, “the cost of lifetime HIV therapy is a lot more than one year of PEG-Intron or ribavirin.”

If this logic fails to compute, the Hepatitis C Action & Advocacy Coalition’s James Learned has a tip: You can legally buy “compounded,” or homemade, ribavirin for $150 to $225 monthly from Fisher’s Specialty Pharmacy in Pittsburgh (call 888.347. 3416). Money talks. Is Schering listening?