Pyrimethamine is recommended in combination with other therapies as first-line treatment for toxoplasmosis in HIV-infected patients. The CDC has labeled toxoplasmosis as a "neglected" parasitic infection and elevated its priority as a public health issue. If left untreated, toxoplasmosis in patients with weakened immune systems can have very severe consequences, including seizures, life-threatening illnesses such as encephalitis, and even death. However, as of June 2015, pyrimethamine, a potentially life-saving therapy, is no longer available in community pharmacies in the United States; it is only available through a special pharmacy program.
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The effect of the overnight price hike of the toxoplasmosis drug pyrimethamine (Daraprim), recently acquired by Turing Pharmaceuticals, resonates even beyond its mere 2,000 users. In recent years, the cost of other generics such as doxycycline and cycloserine have climbed so steeply that some patients revert to not filling these prescriptions. While there are alternatives for these products to treat their respective illnesses, there is currently no effective alternative for toxoplasmosis apart from pyrimethamine.
Given the price hike from $13.50 to $750 per pill, and the drug’s availability only through a special pharmacy program in the United States, access to pyrimethamine is limited. In addition, patients with HIV and other infectious diseases, as well as pregnant women, are especially at risk for toxoplasmosis. Patients can become infected if they come in contact with cat feces that contain the Toxoplasma gondii parasite, eating or drinking contaminated food or water, using utensils or kitchen tools that have come in contact with raw meat harboring the parasite, eating unwashed fruits and vegetables, or receiving an infected organ transplant or transfused blood. According to the IDSA, the cost of combination treatment for toxoplasmosis, including pyrimethamine, is at least $336,000 per year. Although Turing Pharmaceuticals says they will use the increased profits from pyrimethamine to research better treatments, for now, patients who need this drug are medically and financially at risk due to the extreme price hike.  |
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Generic drugs were initially expedited for market in 1984 as a means of providing cost savings to consumers; however, the price hikes over the past few years have made access to these supposedly cheaper therapies more difficult for some patients. Earlier this year, legislation was introduced into Congress proposing that drug manufacturers pay a rebate to Medicaid when the price increase for generics exceeds inflation. Sen. Bernie Sanders (I-VT) and Rep. Elijah Cummings (D-MD) introduced the Medicaid Generic Drug Price Fairness Act in the Senate and the House, respectively. In addition, the Office of the Inspector General of the Division of Health and Human Services is currently investigating generic price increases.
Despite the effort put forth to increase awareness of this issue in the legislature, experts are still divided on how to rein in rising costs. The CEO of Generic Pharmaceutical Association, Ralph G. Neas, denies the rising costs of generics as a problem, stating that "the price of brand drugs has almost doubled, but the price of generic drugs has been cut roughly in half”, based on the Express Scripts 2013 Drug Trend Report. Neas believes that encouraging more timely reviews of generic drug applications at the FDA will provide consumers with more options, and will help lower the price of currently marketed generic drugs.
So what can we do about these price hikes? Are these price hikes, like the one recently seen with pyrimethamine, artifacts of corporate greed? How can pharmacists advocate on behalf of patients in hopes of preventing similar action by other companies? How much is too much when a life is on the line?
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