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Drug Prices Gone Wild: 10 Old Drugs, 10 New Pricetags

Medically reviewed on Apr 29, 2017 by L. Anderson, PharmD

Groceries or Medicine? That is the Question.

Let's face it - the cost of certain drugs is wildly out of control. It's not just the newer expensive biologics for rheumatoid arthritis, or the life-saving drugs for hepatitis C virus, it's often the commonplace drugs we all use.

From antibiotics to asthma medications, the pharmacy bill can take your breath away. Even many generics are no longer affordable.

The American public is fed up, according to a 2016 poll. Add in stories about patients skipping meals, or cutting their doses in half, just to be able to afford both food and drugs; everyone is feeling this price grip. To better understand these issues, here are 10 drugs with major sticker shock, and the circumstances surrounding their price hike.

Pyrimethamine (Daraprim)

This drug has made headlines in 2016, and Daraprim certainly fits the bill of an old drug. Originally developed in 1953, Daraprim (pyrimethamine) is used to treat toxoplasmosis, a serious infection especially dangerous in pregnancy and those with a weak immune system like cancer and AIDS patients. In fact, Daraprim is the only US-approved medication for toxoplasmosis.

Drug company Turing Pharmaceuticals and CEO Martin Shkreli acquired Daraprim in 2015 and hiked its price from $13.50 a tablet to $750, over a 50-fold increase. Although Shkreli is no longer with Turing, the high price tag has stuck.

Tiopronin (Thiola)

Daraprim is not the only drug whose price has drastically spiked. Shkreli was also the former CEO of Retrophin, a pharmaceutical company that markets a drug called Thiola (tiopronin), acquired in 2014. Thiola is another old drug from the 1980's. It's used to prevent painful kidney stones, and reduce the number of procedures to remove them, in the rare disease cystinuria. It used to cost about $1.50 per 100 milligram (mg) tablet until Retrophin marked it up to about $30 per pill. The problem here: the average dose is 400 to 1200 milligram (mg) per day, which means it takes from 120 to 360 pills - and $3,700 to $11,000 US dollars - to treat this chronic, lifelong condition every month.

Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)

Asthma patients get especially hard hit by high drug prices. Albuterol, a bronchodilator drug from the 1980's, is the go-to rescue inhaler to treat asthma exacerbations. Kids often need several inhalers to keep at home and at school for emergencies. It used to be generic - and affordable - at about $15 per inhaler. However, as happens with many drugs, new formulations or delivery devices are created that reset the patent life. With albuterol, chlorofluorocarbon (CFC) propellants had to be removed for environmental reasons. Sure, we're all happy to save the ozone, but this action left asthma patients gasping for breath often paying over $50 to $80 per inhaler cash price.

Colchicine (Colcrys, Mitigare)

Colchicine is used to prevent or treat acute attacks of gout. Colchicine is such an ancient drug - circa 1950's - that proper studies had never been done to validate its effectiveness and safety. FDA asked that many of these "grandfathered" drugs be re-evaluated. In 2009, URL Pharma was granted approval and 3 years of marketing exclusivity for their new brand of colchicine, called Colcrys.

Guess what happened next? Colchicine prices soared over 50 percent, from less than a dime to almost $4.85 per tablet. Today, Colcrys runs about $7.50 per tablet, and the generic, now available, is not much cheaper, at roughly $6.50 per tablet depending upon the pharmacy you use and if you have a discount coupon.

Doxycycline (Monodox, Vibramycin)

Doxycycline is a widely used antibiotic to treat everything from Lyme disease to sexually transmitted diseases. It was originally developed by Pfizer in 1967 under the brand name of Vibramycin. A generic has long been available, and it used to be quite affordable. However, there was a temporary shortage due to raw materials, and according to one report, the price of the 100-mg dose went up over 6,000 percent (from $.06 per dose to $3.65), while the 50-mg dose rose over 2,000 percent in 2013. Prices have lowered since then, but still remain high, at roughly $3.00-$4.00 per generic capsule. Freely available discount coupons on the Internet can considerably lower these prices.

Cycloserine (Seromycin)

Multidrug-resistant tuberculosis (TB) is a difficult battle. Every year about 90 people are diagnosed with this potentially lethal infection. Cycloserine is one of many options used to treat this disease. Approved in 1964, cycloserine had been supplied by a nonprofit company known as The Chao Center since 2007. The Chao Center sold cycloserine in August 2015 to Rodelis Therapeutics based out of Ireland. Prices shot up from $16.50 to $360 per capsule. Realizing the unfortunate health implications, The Chao Center was able to re-acquire cycloserine from Rodelis to control the cost and now the drug is at roughly $5 per capsule with online coupons.

Dichlorphenamide (Keveyis)

In August 2015, FDA approved Taro's Keveyis to treat a rare disease known as periodic paralysis that leads to episodes of muscle weakness or paralysis. This disease only affects about 5,000 people in the US. Dichlorphenamide is an old drug discovery; it was originally approved in 1958 as the brand Daranide, an oral carbonic anhydrase inhibitor used to treat glaucoma; now that brand has been discontinued. Initial doses for paralysis, 50 mg twice a day, now cost $8,800 or more for 60 tablets. Keveyis is distributed through a specialty pharmacy channel as are most high priced orphan drugs for rare conditions. The pharmacists at the specialty pharmacy can help you work with your insurance, the manufacturer's patient assistance program, or can offer other suggestions.

Clomipramine (Anafranil)

Clomipramine is a tricyclic antidepressant drug used in the treatment of obsessive compulsive disorder (OCD). It was originally FDA-approved in 1989, so it's not exactly an ancient drug, but it's now available generically from several manufacturers. However, for unknown, maybe secretive reasons prices can vary wildly in the marketplace for many drugs, including this one.

For example, the cash price can run over $500 for 60 capsules of the 50 mg strength. However, using prescription coupons you can find online may save you hundreds. But beware - some coupons may only work at specific pharmacies, so do your homework on the phone and get the right coupon before heading to the pharmacy.

Digoxin (Lanoxin)

Digoxin is a product originally derived from the digitalis plant and is used treat congestive heart failure (CHF) and heart rhythm problems. The brand Lanoxin was approved in 1975, and the generic was the target of a price hike between October 2012 and June 2014. The cause? Lack of digoxin marketplace competition seemed to be the culprit. Concerned generic manufacturers pulled out of production after a series of problems with FDA drug recalls and safety site inspections. At that time, the prices soared to over 630 percent. From 2012 to 2014, the generic heart pill went from 11 cents to $1.10 per pill. Currently it seems the price is hovering at around $1.00 per pill, but prices can fluctuate. This is another drug where freely available Internet coupons might save you some serious cash at certain pharmacies.

Centruroides scorpion antivenom (Anascorp)

Most scorpion bites in the US are not serious and there is a low risk of death. However, some types of scorpions can lead to severe nerve toxicity, especially in kids. Intravenous scorpion-specific F(ab')2 equine antivenom (Anascorp) is now recommended for all serious bites. Rare Diseases Therapeutics gained FDA-approval of the initially Mexican-made drug in 2011. Ironically, the US drug is still made at the same Mexican company that developed it, but with a higher US cost, about $3,400 per vial, which will only set you back $100 in Mexico. Hospital bills and administration fees will boost that fee even more. Advice? Just be sure to check your boots.

Deflazacort (Emflaza)

Emflaza (deflazacort) from PTC Therapeutics is nothing if not controversial. Emflaza is a decade's old corticosteroid FDA-approved in February 2017 to treat Duchenne Muscular Dystrophy (DMD) in patients 5 years of age and older. It's price as reported by GoodRx is running from $7500 to $7900 per 30 tablets. This price may vary, as well, from city-to-city and from pharmacy-to-pharmacy.

As reported by FiercePharma, Washington State’s Health Care Authority (HCA) stated another commonly used oral corticosteroid -- prednisone -- cost 5 cents per tablet and it will be its preferred corticosteroid for DMD patients. The HCA said it was a lower cost, and "equally effective" option.

However, PTC has stated they will "engage with key stakeholders" to "understand" how to make Emflaza available for those patients who need it.

Finished: Drug Prices Gone Wild: 10 Old Drugs, 10 New Pricetags

Looking Ahead: New Drug Approvals for 2017

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Sources

  • Davies B. Retrophin Assailed for 'Exorbitant' Price Hike. Accessed 1/31/2017 at http://www.thestreet.com/story/12873639/1/retrophin-assailed-for-exorbitant-drug-price-hike.html
  • Carroll J. Why would Martin Shkreli hike an old drug price by 5000%? Only a 'moron' would ask. Accessed 1/31/2017 at http://www.fiercebiotech.com/story/why-would-martin-shkreli-hike-old-drug-price-5000-only-moron-would-ask/2015-09-20
  • Mayo Clinic Center for Tuberculosis. Accessed 1/31/2017 at http://centerfortuberculosis.mayo.edu/the-latest-on-tb
  • FDA Approves Taro’s Keveyis™ (dichlorphenamide) 50 mg Tablets for Primary Hyperkalemic and Hypokalemic Periodic Paralysis. Accessed 1/31/2017 at http://www.marketwatch.com/story/fda-approves-taros-keveyistm-dichlorphenamide-50-mg-tablets-for-primary-hyperkalemic-and-hypokalemic-periodic-paralysis-2015-08-10
  • GoodRx.com. Emflaza. Accessed April 29, 2017 at https://www.goodrx.com/emflaza
  • Sagonowsky E. Payer snubs PTC's Emflaza, signaling pricing trouble ahead of launch. April 14, 2017. Accessed April 29, 2017 at http://www.fiercepharma.com/pharma/policy-report-washington-s-largest-healthcare-purchaser-snubs-ptc-s-emflaza
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