I was not aware of this. Pretty interesting. From Roche's conf. call:
Next question is from Matthew Weston, Credit Suisse. Please go ahead.
Matthew Weston
You decided a number of years ago to not enter the U.S. market with subcu Herceptin or Rituxan because at the time you were mindful of the significant financial incentives that doctors received under the AFP Plus reimbursement regimen. Why are you confident that the dynamic is going to be different in hematology where doctors rely on AFP Plus on both factor VIII and particularly on bypass agents for a very substantial portion of their personal income?
I mean, maybe a couple of things on -- just to answer your question on subcutaneous in the United States with Rituxan and Herceptin. There is this threshold between physician reimbursement for administration fees and overall benefit to patients and overall benefit to practice. Now what happened by the way, just to put it into complete context with Rituxan, two things happened. Number one, some of the reimbursement rates for the second hour and beyond infusions adjusted over the course of our thought process, to suggest that in fact with a much shorter induction time -- so, the first hour is obviously the most lucrative hour for physicians and then the second and third hour becomes less lucrative in the United States. And so there’s a real benefit in fact, if you can reduce the infusion time to a subcu and get it down to a period of time where you can actually process a number of patients, probably potentially more than one or two in an hour. If you can imagine, you can do the math.
So that changed a bit and also the regulatory openness to being able to do a bridging strategy with Rituxan and Herceptin has also changed and adjusted. So that’s what led us to looking at Rituxan. And I have to say, I think it’s off to a very good start in the U.S., again because the benefit it brings overall to the system. And we’ll be looking as well at Herceptin, and as you know from the last half year the Perjeta and also the Perjeta Herceptin combination for a subcu. So that will continue. So that’s one thing that I would say.
