“Can you believe this Binh?” the Director of Pharmacy—Dr. R—said in disbelief, “100 tablets of Daraprim now cost roughly $90,000!” The intern’s office/hideout is adjacent to directors’, and he would often stop by for a chat—or in this particular case, to share his troubling concerns in light of the recent drug price spike turmoil.
Overnight, the price of a single dose Daraprim soared from $13.50/dose to a whopping $750/dose—accounting for approximately 5,000% increase. The price adjustment was shortly announced after Daraprim–a parasitic dihydrofolate reductase inhibitor—was acquired by Turing Pharmaceuticals in August. Daraprim—synthesized some six decades ago—is indicated for the treatment and prophylaxis of malaria, toxoplasmosis, and opportunistic-infections in HIV/cancer patients. Currently, the costs to manufacture a single dose of Daraprim in the US is $1 and only $0.05-$0.10 in India. Turning Pharmaceuticals argues that the estimation failed to include marketing and distribution expenses—but $749 is a tad bit extensive for that, don’t you think?
We had a patient in ICU diagnosed with toxoplasmosis—a parasitic infection that affects approximately 22.5% of Americans and can be quite lethal in the immunosuppressed (cancer, HIV, transplant patients) and pregnancy population. The treatment of choice for toxoplasmosis is no other than Daraprim—along with sulfadiazine and leucovorin calcium for one to three weeks. Daraprim is clearly the most efficacious medication to date and undoubtedly, a popular choice among physicians—but not practical for the following reasons:
- Due to the colossal cost associated with acquisition of Daraprim, even if patient’s health insurance agrees to cover the medication, the patient is still responsible for an extensive amount to be paid out of pocket. Not to mention that insurance authorization processes can be rigorous and time consuming.
- Daraprim is extremely hard to stock due to its recent implementation of the Daraprim Direct Program, requiring hospitals to set up direct contracts with the company for purchase—which will undoubtedly take time and unnecessary paperwork.
Our job was to recommend a substitution; and to convince the physician that our alternative recommendation is the best option— at the moment—for our patient. Dr. H suggested the use of high dose Bactrim DS, to be administered intravenously or orally based on 5 mg/kg of Trimethoprim twice daily. Fortunately, the physicians accepted our proposal and initiated therapy promptly.
The Infectious Disease Society of America (IDSA) and HIV Medication Association (HIVMA) immediately responded to Turing Pharmaceuticals’ recent pricing strategy with much disapproval and dismay, stating that the “cost is unjustifiable” and “unsustainable for the health care system”.
Turing Pharmaceutics’ CEO, Martin Shkreli, ignorantly believed that his company was “charging the right price” and went on to justify the company’s enormous profit margins as a mean for financing future research and development. He continued on to preposterously compare his company’s acquisition of Daraprim to that of an automobile company purchasing an Aston Martin at the price of a bicycle, then reselling it at a fair price of a Toyota. We all can agree to disagree with Mr. Shkreli, correct? Because Daraprim is only tailored to a small percentage of the population—other manufacturers hesitate to manufacture a cheaper alternative—granting Turing exclusive access. Turing Pharmaceuticals bought this vintage drug, re-branded it, and transformed it into a profitable, super expensive, specialty drug. You don’t need a doctorate in pharmacy or an economic degree to realize Turing’s brilliant—yet dishonorable and unethical—business strategy.
Annually, only about 2,000 people are diagnosed with toxoplasmosis that requires treatment but if you don’t stop to think for a second Daraprim’s and similar price hikes won’t affect you—think again. Daraprim is just one of the many antique drugs being utilized by startup companies as a buy and flip project to maximize profits. If drug pricing issues remain unaddressed—systemically—the tax payers will wind up picking up the tabs for people who cannot afford the overpriced medications and an unexpected increase in health insurance premiums as an effort to offset costs could take place.
This leads to my final point—our government lack thereof and desperately need an established, unified healthcare system with the ability to cap off drug prices. Capping drug prices can act to deter drug manufacturers from abusing the system. Recently, presidential candidate Hillary Clinton suggested a $250 monthly cap on consumer’s out of pocket amounts. Her drug prescription reform also include the elimination of “corporate write-offs for direct-to-consumer adverting”, “stopping drug manufacturers from spending government grants on advertising”, and “to allow Medicare to negotiate down prescription drug costs.” Bernie Sanders, the beloved senator from Vermont and 2016 presidential candidate, also suggested similar reforms. Moreover, Sanders’ plan will allow legal importation of lower cost drugs from Canada and to pass bills that will require pharmaceutical companies to publicly disclose their research and development costs, as well as profits.
feature photo credits: blogs.wsj.com/health/2010/05/17/brand-name-drug-prices-rose-97-last-year-aarp-says/
Credit: reddit post titled: I made this for any NYC restaurant owner to use. by Fmello.