Clozapine and the Mandatory Monitoring System

To the Editor: Dr. Salzman, in his Sounding Board article (Sept. 20 issue),¹ has identified key aspects of what he generously characterizes as an “unusual” marketing strategy employed by Sandoz in tying the availability of the new antipsychotic agent clozapine (Clozaril) to its own monitoring and distribution system (the Clozaril Patient Monitoring System, or CPMS). This logistically cumbersome system accounts for some $7,000 of the exorbitant $9,000 annual cost per patient for Clozaril. The Department of Veterans Affairs (VA) has developed an alternative monitoring system with an automatic computerized lockout feature that prevents the dispensing of clozapine to a patient.