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Price of Daraprim Increases From $1 to $750 a Tablet

2015-09-20

The New York Times (NYT) carried a story today that may shock you: Turing Pharmaceuticals has acquired the antibiotic Daraprim (pyrimethamine), the drug of choice for toxoplasmosis, and raised the price again.  The drug, which was raised from $1 to $13.50 a tablet recently over the last few years, was further increased to $750 when it was acquired by Turing.  This price increase is bad news, but only for the estimated 8,000 people who will receive prescriptions in the next year, down from 12,700 a couple of years ago.

Pyrimethamine was first marketed 62 years ago and has long been considered a “generic” drug, although it is made by only one company currently.  It is used in combination with sulfadiazine in severe cases of toxoplasmosis, a parasite infection that can invade the brain and cause abnormal behavior in addition to serious complications in the fetus.   Toxoplasmosis is carried by cats and can be picked up by handling infected cat feces.  It is considered most dangerous when it invades immunocompromised patients or pregnant women, causing fetal abnormalities or stillbirth.

Pyrimethamine was originally made by Glaxo Smith Kline, but they sold the rights to CorePharma in 2010, which is when the price went from $1 to $13.50.  A year ago, Impax Laboratories bought CorePharma for $700 million, and in August of this year, Impax sold the rights to pyrimethamine to Turing for $55 million.  Yearly sales of pyrimethamine went from $667,000 to $6.3 million even as the number of prescriptions stayed at about 12,700.  In 2014, sales increased to $9.3 million, even as prescriptions shrank to about 8,800, again simply due to more price increases.  If another 8,000 prescriptions are written over the next year, sales could easily exceed $100 million; recommended dosage for acute toxoplasmosis is two to three tablets a day for one to three weeks, followed by a reduced dosage of one tablet a day for four to five weeks– meaning a single treatment course could represent 50 to 100 tablets, or as much as $75,000.  This is aside from the cost of the sulfadiazine used as an adjunct.

The drug can also be used, one tablet a week, as malaria prophylaxis.  A rich traveler might spend several thousand dollars to use this drug for prophylaxis.

This price increase is part of a pattern: many, many generic drugs have seen enormous increases over the past few years, with few or no excuses given for the increases.  The chief executive of Turing claims that he will use the money earned to develop better alternatives to pyrimethamine, but there is little chance of that actually happening and experts say there is little demand for a better drug despite the occasionally serious side effects.  There is no priority to developing a better drug because pyrimethamine is so little used; as noted, there are perhaps ten thousand patients a year in the US who might need it.

In any case, the drug is now on a controlled distribution basis; many hospitals cannot afford to stock it, which will cause delays in beginning treatment.  Controlled distribution makes it more difficult for other companies to produce generic copies, because they will have trouble getting samples to compare for the necessary equivalency tests.  Medicaid and some public hospitals will be able to get the drug at a large discount, but Medicare will have to pay full price because of laws passed by Congress in creating Part D of Medicare that make it illegal for the government to bargain on price.

This price increase is part of a pattern: many, many generic drugs have seen enormous increases over the past few years, with few or no excuses given for the increases.  The chief executive of Turing claims that he will use the money earned to develop better alternatives to pyrimethamine, but there is little chance of that actually happening and experts say there is little demand for a better drug despite the occasionally serious side effects.  It is only rarely used, primarily in immunocompromised or gravely ill patients.

The chief executive of Turing was fired last year from another drug company he created in 2011, Retrophin, because the board complained that he was using it as his private piggy bank to reimburse customers of his hedge fund who had lost money.  Retrophin had the same strategy of buying up neglected drugs and raising their prices.  I won’t use the chief executive’s name because I don’t like his attitude or his behavior and I think he should be sent to prison for this.  Unfortunately, there are no specific laws that make fleecing the vulnerable, sick public a crime.

The only solution to this problem is for Congress to pass laws that make this sort of behavior illegal and to create an agency that develops and produces “orphan drugs” as a public service.

 

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