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    Out-of-control drug pricing requires creative solutions

    Henry Rosevear, MDHenry Rosevear, MD

    Urology Times Blogger Profile

    Dr. Rosevear is a urologist in community practice in Colorado Springs, CO.

     

    I am usually not a fan of televised congressional hearings, but the highlights from Martin Shkreli’s appearance before the House Committee on Oversight and Government Reform are priceless. It’s like watching ESPN’s “Not Top 10 Plays” show; it makes you want to cry, laugh, and scream all at the same time. And like most health care-related stories recently, thanks to my beautiful twins, it affects me too.

    Also by Dr. Rosevear - VA Choice: Not what the doctor ordered

    Some background first. Martin Shkreli is the former CEO of a pharmaceutical company named Turing Pharmaceuticals. (While CEO, Shkreli was charged with fraud related to a hedge fund he owned and subsequently resigned.) Turing recently purchased the rights to a drug called pyrimethamine (Daraprim). Daraprim, for those who don’t treat patients with HIV on a regular basis, is the sole and best treatment for toxoplasmosis. Toxoplasmosis is a condition resulting from infection with a common parasite. (It’s the reason, during your OB residency, that you told pregnant moms to avoid cats.)

    This is where the story gets interesting. Daraprim is not new, and in fact has been off patent since the 1950s, but it remains the only drug that works well against toxoplasmosis. Why isn’t there a competitor? First, the FDA’s certification process for generic medications is, not surprisingly, a bit complicated and second, few companies apply given the small market (translation: limited profit potential) for drugs such as Daraprim.

    Urologists have direct and personal experience with a similar situation. Remember the recent BCG shortage? It turns out that in 2012, Sanofi stopped production of BCG when the FDA found mold in its facilities. That left one manufacturer of BCG, Merck. Merck then ran into production problems, creating the shortage we all remember. During the BCG shortage, many of us switched to generic mitomycin C as the best, if inferior, alternative. But did anyone realize that exactly as we were switching to mitomycin C, that drug underwent a significant cost increase? It turns out that between 2000 and 2013, the average wholesale price of mitomycin C ranged between $312 and $392, but during the BCG shortage, the price increased significantly and is now almost $800.

    Read - Medicine and the market: New data show the price ain’t right

    Why the sudden increase in price for this generic drug? Coincidence? Or is it related to the fact that only two companies make mitomycin C and good alternatives are lacking (and were especially lacking when BCG was in short supply? Call me cynical, but I’m not voting for the coincidence theory.

    Next: FDA Safety and Innovation Act

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

    2 Comments

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    • Anonymous
      You seem surprised/perturbed that Synagis costs more than a prostate removal operation? It took scientists years to develop that drug; anyone can train to cut out a prostate. Also, Turing just did what any capitalist would do; increase price to what the market will tolerate. If people complained urologists charged too much, would you lower your rates?
    • Anonymous
      Duplicate post, delete please.

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