한국혈우재단은 바이엘의 유전자재조합 혈우병치료제 ‘코지네이트FS’ 처방을 놓고 “내주 의약심의 위원회를 열어 결정할 것”이라고 밝혔다.
29일, 재단 관계자는 ‘혈우재단 의약심의 위원회에서 약품처방 결정이 날 경우’라고 전제하면서 “‘코지네이트FS’의 약품코드를 잡는데 다소 시일이 걸리지만 늦어도 1월 중에는 처방이 될 것”이라고 밝혔다. 그러면서도, 처방에 대한 판단은 의약심의위원회 선생님들이 하기 때문에 알 수 없다고 했다.
재단의원은 서울 경기를 포함한 수도권 환자들과 지방 일부 환자들까지 이용하고 있는 최대 규모의 혈우병 ‘치료제 처방’ 의원이다. 이에 따라, 재단의원에서 특정 약품을 처방하겠다고 할 경우 ‘치료제의 대 이동’ 불가피 할 것으로 보인다.
특히, 한국혈우재단 의원장은 지난 2006년 자신의 약품 처방 소신에 대해 “안전성과 효능이 동등하다고 하면 특정 약을 사용해야하고 싼 약을 써야하는 것이 내가 치료하는 기준”이라고 밝힌바 있다. 이같은 발언을 해석해 보면, 박스터의 ‘애드베이트’를 바이엘의 ‘코지네이트FS’로 전량 교체 처방하는 것이 재단 의원장의 처방 소신에 부합한 것으로 풀이될 수 있다.
그럼에도 이같은 해석은 단지 ‘해석’으로만 끝날 가능성이 높다. 이유는 한국혈우재단의 후원수익은 대부분 녹십자에 의존하고 있고, 녹십자는 박스터와 ‘공급판매’ 계약 관계를 가지고 있다. 따라서 박스터의 매출이 혈우재단의 후원수익과 직간접적으로 연관되어 있을 수 있기 때문이다.
‘처방 안한다’...어떤 명분으로?
다수의 환자들은 혈우재단에서 ‘코지네이트FS를 처방한다는 것이 가능하냐?’고 반문하고 있다. 그러면서 ‘재단에서 코지네이트FS를 처방할 것인가? 말 것 인가?’가 궁금한 것이 아니라, ‘어떤 명분으로 코지네이트FS를 처방하지 않거나, 어떤 명분으로 최소(?)의 환자에게만 처방할 것인가’라는 점에 주목하고 있다.
과거, 환자들은 ‘혈액제제(그린모노)에서 유전자재조합제제(리콤비네이트)로 교체해 달라’며 복지부와 투쟁을 펼친 바 있다. 그러나 혈우재단에서는 혈액제제인 ‘그린모노’를 ‘안전성과 효능이 동등하다’고 판단했고 이같은 내용으로 복지부에 문건으로 의견을 전달했다.
이같은 상황에서 하물며, 유전자재조합제제를 놓고 만약, ‘2세대’ ‘3세대’를 구분하면서 처방의 기준으로 평가한다면 환자들의 반발은 매우 심할 것으로 보인다.
특히, ‘싼 약’을 강조하면서 뚜렷한 소신(?)을 밝혀왔는데, 이제 와서 더 비싼 가격의 치료제를 처방한다는 것도 다소 무리가 따를 것으로 보인다.
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