Imagine driving to the gas station, filling your tank and being told the total is $200,000. That is about parallel to the price increase instituted by Turing Pharmaceuticals for their newly-acquired toxoplasmosis drug, Daraprim (pyrimethamine).
One day this 60-year-old drug was selling for a modest $13.50 per tablet. The next day it was commanding an impressive $750 a pop. For a medication that requires from two to four tablets daily and a treatment that can run from several weeks to indefinitely (for the immunocompromised), this increase can put the cost of therapy into the hundreds of thousands of dollars per year.
How can this happen? The answer isn't complicated. Through a strategic purchase of the patent rights to Daraprim from Impax Laboratories on Aug. 10, Turing found themselves the sole owners of this life-saving molecule. With no competition to help control prices, the sky is literally the limit.
As reported by authors of a New England Journal of Medicine article last year, "manufacturers of generic drugs that legally obtain a market monopoly are free to unilaterally raise the prices of their products." And that is what they did.
Of course, Turing CEO Martin Shkreli has come under fire for what many say is hard to describe in any other way than "price gouging."
"This cost is unjustifiable for the medically vulnerable patient population in need of this medication and unsustainable for the healthcare system," according to a statement released by the Infectious Diseases Society of America and the HIV Medicine Association.
Some of the comments aimed at him on social media have been far less cordial.
But Shkreli disagrees with his critics and claims the price increase was a necessary part of the company strategy to remain profitable and allow the drug to continue to be available for every patient who needs it.
"This isn't a greedy drug company trying to gauge patients; it is us trying to stay in business," he remarked. Additionally, in a statement that seems aimed to deflect the impact of this price increase on the industry he said "this is still one of the smallest pharmaceutical products in the market."
Carl Rothenberg, spokesman for Turing, says the increase will help fund further research into the study of toxoplasmosis, which could lead to new and more effective therapies. "There has been no innovation in dealing with toxoplasmosis," he said.
Turing has also instituted a patient assistance program to help ensure that no patients who are in financial need are left without access to the drug.
But although toxoplasmosis may not be as common as diabetes or hypertension, the market is far from insignificant. Upwards of 60 million people in the U.S. may be carriers of toxoplasmosis, an infection often transmitted by improperly handled meats or from exposure cat litter or cat feces.
Those most severely impacted by the infection are typically patients with weakened immune systems such as people with HIV or cancer. Still, since many patients who carry the parasite are asymptomatic and do not need treatment, it is probably fair to say the overall market is comparably small.
In my opinion, if Daraprim had just been approved today by the FDA, it would probably not have caused much of a stir to hear it being priced at $750 per pill. It is well tolerated and remarkably effective, which may be part of the reason so little additional research has been done since its approval in 1953. But Daraprim is considered a generic, an industry that has gotten consumers and payers used to prices closer to the $4 per month range.
It is unknown whether the $750-per-pill price will help improve production and relieve some of the drug shortage problems that have been going on. Wendy Armstrong, medical director of the Ponce de Leon Center in Atlanta said "we've frankly been unable to obtain a supply of this medication for a few months."
Will the increased price alleviate the supply problem? Only time will tell.
In the meantime, Turing and Shkreli are taking a lot of heat. They have, at the very least, ensured that politicians will now make such generic price increases part of their platforms. And while the PBMs who manage 70 percent of the patient lives in our country are surely upset at the Daraprim maneuver, it is hard for them to garnish much sympathy as their own millionaire CEOs are forced to pay a bit more from their own profits to help patients.