Drug Prices Gone Wild: 10 Old Drugs, 10 New Pricetags
Medically reviewed on Apr 23, 2018 by L. Anderson, PharmD.
Groceries or Medicine? That is the Question.
Let's face it -- the costs of many drugs are wildly out of control.
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 recent poll. Add in stories about patients skipping meals, or cutting their doses in half, just to be able to afford both food and drugs, and 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.
This drug has made headlines, and pyrimethamine (Daraprim) certainly fits the bill of an old drug.
Originally developed in 1953, Daraprim is used to treat toxoplasmosis, a serious infection especially dangerous in pregnancy and in those with a weak immune system like cancer and AIDS patients. In fact, Daraprim is the only US-approved medication for toxoplasmosis, in combination with sulfadiazine. However, other drugs that may be used include trimethoprim-sulfamethoxazole (Bactrim, Septra), clindamycin and atovaquone (Mepron).
Drug company Turing Pharmaceuticals and CEO Martin Shkreli acquired Daraprim in 2015 and hiked its price from $13.50 to $750 per tablet. Although Shkreli is no longer with Turing, the high price tag has stuck. In March 2018, Shkreli was sentenced to 7 years in prison for securities fraud linked with his former pharmaceutical company Retrophin.
Daraprim is not the only drug whose price has drastically spiked. As mentioned, 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 can get especially hard hit by high drug prices.
Albuterol used to be available generically - and much more affordably - 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 $90 per inhaler for the cash price.
View the Drugs.com Price Guide to search for costs and other cost savings options.
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.
Guess what happened next? Colchicine prices soared over 50%, from less than a dime to almost $4.85 per tablet. Today, Colcrys runs about $5.00 to $7.50 per tablet depending upon pharmacy and discounts, and the generic, now available, is not much cheaper, at roughly $4.50 per capsule. Mitigare, a capsule, is also roughly $6.50 per capsule.
Patients typically need 30 to 60 tablets or capsules per month of the 0.6 mg strength for gout prevention, which can run from $135 to $270 for the generic formulation.
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 back in 2013.
Prices have lowered since then, and now run about $1 to $2 per generic capsule. Freely available discount coupons on the Internet can considerably lower these prices. It's important to check pharmacy prices, as your bill could vary considerably. And be sure to ask for the true generic, not a branded-generic, which could run you much more.
Multidrug-resistant tuberculosis (MDR-TB) is a difficult battle. Every year about 90 people are diagnosed with this potentially lethal infection. This form of TB does not respond to, at the very least, isoniazid and rifampicin, the two most powerful anti-TB medicines. Based on CDC data, MDR-TB accounted for 0.4% and 1.2% of culture-confirmed TB cases among U.S.-born and foreign-born persons, respectively.
Cycloserine is one of many options used to treat this disease. Originally approved by the FDA 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 impact, The Chao Center was able to re-acquire cycloserine from Rodelis to control the cost. However, it appears The Chao Center was owned by the Purdue Research Foundation, but is now a separate entity after being sold and has been renamed the Purdue GMP Center (PGC).
According to the Drugs.com pricing guide, cycloserine prices now run roughly $50 per capsule, but can vary depending upon pharmacy and discounts.
In August 2015, FDA approved Taro's Keveyis (dichlorphenamide) to treat a very rare genetic disease known as periodic paralysis that leads to episodes of muscle weakness or paralysis, often in legs and arms. It can be due to alterations in the potassium levels in your blood. Most attacks range from 30 minutes to several hours. This disease only affects about 4,000 to 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 $9,000 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.
Keveyis is made by Strongbridge Biopharma.
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 you roughly $250 to $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.
Transparency in the pricing of pharmaceutical products has a long way to go.
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 safety recalls and manufacturer 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 $0.50 to $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 in adults. However, some types of scorpions can lead to severe nerve toxicity, especially in kids. Parts of the Southwest U.S. -- Arizona, New Mexico, and California -- can harbor these creatures.
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 shipped to the U.S., with a higher cost, about $4,400 per vial. Plus you might need 3 to 5 doses of the anti-venom. If you bought this in Mexico, it would only set you back about $100, according to Kaiser Health News. Hospital bills and administration fees will boost that fee even more.
Advice? Just be sure to check your boots before you slide them on.
Emflaza (deflazacort), from PTC Therapeutics, is nothing if not controversial.
Emflaza is a decade's old corticosteroid, but FDA-approved in February 2017 to treat Duchenne Muscular Dystrophy (DMD) in patients 5 years of age and older. The drug is dosed based on the weight of the child.
It's price, as reported by GoodRx, is running from $1500 for 30 tablets of the lowest strength, to roughly $8200 per 30 tablets of the highest strength. This price may vary, as well, from city-to-city and from pharmacy-to-pharmacy.
However, 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, prednisone is not specifically FDA-approved for DMD.
PTC has stated they will "engage with key stakeholders" to "understand" how to make Emflaza available for those patients who need it. Through the PTC Cares program, case managers can help answer questions for patients and provide patient assistance for those who need this drug.
- Emflaza. Frequently asked questions for patients and families. PTC Therapeutics, Inc. 2018. Accessed April 23, 2018 at https://www.emflaza.com/wp-content/uploads/2018/01/EMFLAZA-Frequently-Asked-Questions.pdf
- Gold J. Treating A Scorpion Sting: $ 100 In Mexico Or $ 12,000 In U.S. Kaiser Health News. Accessed April 23, 2018 at khn.org/news/treating-a-scorpion-sting-100-in-mexico-or-12000-in-u-s/
- Tuberculosis — United States, 2016. Morbidity and Mortality Weekly Report (MMWR). March 24, 2017. U.S. Centers for Disease Control and Prevention. Weekly/Vol. 66 / No. 11. Accessed April 23, 2018 at https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6611a2.pdf
- Davies B. Retrophin Assailed for 'Exorbitant' Price Hike. Accessed April 23, 2018 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. Sept. 20, 2015. Accessed April 23, 2018 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 April 23, 2018 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. Drugs.com. Accessed April 23, 2018 at https://www.drugs.com/newdrugs/fda-approves-keveyis-dichlorphenamide-primary-hyperkalemic-hypokalemic-periodic-paralysis-4241.html
- Sagonowsky E. Payer snubs PTC's Emflaza, signaling pricing trouble ahead of launch. April 14, 2017. Accessed April 23, 2018 at http://www.fiercepharma.com/pharma/policy-report-washington-s-largest-healthcare-purchaser-snubs-ptc-s-emflaza
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.