When last we checked in with the internet’s least-liked human being, the CEO of Turing Pharmaceuticals was backpeddaling on his promise to lower the cost of the AIDS and cancer fighting drug Daraprim, and hiding it ahead of the Thanksgiving holiday in the hopes that fewer people would notice (it worked relatively well). CEO Martin Shkreli, you’ll recall, increased the price for Daraprim from $13.50 per pill to $750 — a 5000% or so mark up for a sixty-two-year-old medication. Shkrelli brought renewed attention to the skyrocketing prices of generics thanks to (ab)using restricted distribution to deny samples to generics manufacturers.
But there may be a small ray of sunshine in what’s an otherwise dismal tale of greed. Prescription drug manager Express Scripts has indicated that the company will soon promote use of a compounded medicine that contains the same active ingredient as Daraprim, and offer it at a fraction of the price. Express Scripts manages prescriptions for tens of millions of Americans and will be pushing the compounded alternative made by Imprimis Pharmaceuticals. The new compounded alternative includes Daraprim?s active ingredient, pyrimethamine, as well as leucovorin, included to treat side effects.
“Compounded drugs are customized formulations made by pharmacies for particular, named patients. That requirement restricts how directly Imprimis can compete with Turing. For instance, hospitals cannot stock the compounded version to use for patients coming to the emergency room.
Imprimis, which is publicly traded, is not allowed to make a direct copy of Daraprim. So its capsule contains both pyrimethamine and leucovorin, a drug that is often prescribed with Daraprim to ease certain side effects. If a doctor writes a prescription for Daraprim, Express Scripts or pharmacies cannot substitute the compounded drug produced by Imprimis. So physicians will have to write a prescription specifically for the compounded drug and fax it to Imprimis.”
It’s a bit of a cumbersome tap dance (so glad we’re still using faxes in the age of gigabit fiber), but at least it’s an alternative. Impremis has stated it plans to offer the compounded drug for as low as 100 capsules for $99. Express Scripts in turn will help speed delivery of the cheaper option, working with the Infectious Diseases Society of America and the HIV Medicine Association to inform medical professionals about the alternative. Turing has so far responded by telling media outlets that “in addition to being potentially unsafe and ineffective, the compounded product is unnecessary.”
Granted, the actual impact may still be low; Express Scripts states it only had 350 patients who used Daraprim last year. Still, it’s the principle of the thing, and it’s nice to see the market — even if it has to jump through hoops to do so — giving Shkreli and Turing a few quick kicks to the shins.
When Turing Pharmaceuticals jacked up the price of a toxoplasmosis-fighting drug (commonly used by AIDS and cancer patients) to $750/pill (a previous company sold it for $1/pill), CEO Martin Shkreli defended the move, saying the money would be dumped into research for a new and better drug. Of course, this is the usual defense offered by any pharmaceutical company that institutes a rate hike, but these claims are rarely followed through on. (And when they are, the R&D costs tend to be very overstated.)
Daraprim has been on the market since the 1950s and does its job well. The patent has long expired but the FDA’s policies make it difficult for anyone to formulate a generic version of this “sole supplier” drug. When there’s no competition, it’s a seller’s market, and Martin Shkreli is making the most of it.
Turing CEO Martin Shkreli became “the most hated man in America” last month after raising the cost of the drug, commonly used to treat parasitic infections in immunocompromised patients, from $13.50 per pill to a staggering $750 per dose, claiming the company’s exorbitant price hike was justified. Now Imprimis will offer their alternative to those who need Daraprim for less than $1 per tablet.
Imprimis is now offering customizable compounded formulations of pyrimethamine and leucovorin in oral capsules starting as low as $99.00 for a 100 count bottle, or at a cost of under a dollar per capsule. Compounded medications may be appropriate for prescription when a commercially-available medicine does not meet the specific needs of a patient.
There’s more detail in the disclaimer towards the end of the press release.
Imprimis’ finished compounded drug formulations do not have an FDA-approval label for recommended use. Imprimis compounded formulations are not FDA approved and may only be prescribed pursuant to a physician prescription for an individually identified patient consistent with federal and state laws governing compounded drug formulations.
So, those looking for a cheaper variant of Daraprim will have to find a physician willing to prescribe a drug that doesn’t have the FDA’s blessing for this particular use. The compound will likely work as well as Daraprim, but it does open doctors up to additional liability. That being said, some doctors may be willing to do this as the only other option for some patients will be no medicine at all.
The other problem is that the FDA could come down aggressively on pharmaceutical companies who market drugs for non-FDA-approved purposes. Imprimis is exploiting a loophole in the system, albeit one much more easily closed than the FDA’s loophole-esque sheltering of “sole supplier,” off-patent drugs — the sort that most often see astronomical price hikes post-acquisition.
But for now, it’s the market system at work — the same market system Shkreli used as a justification for raising Daraprim’s price. Zero competition led to Turing’s $750/pill price. A little competition might push Shkreli to drop Daraprim’s retail price lower than he actually wanted to. (And, again, no price drop has been instituted at this point.) But given Shkreli’s past use of the FDA as his unofficial partner in stock-shorting moves, it’s far more likely he’ll be asking the agency to eject his new competitor from the playing field.
Martin Shkreli — founder of Turing Pharmaceuticals and overnight poster boy for everything that is wrong with the pharmaceutical industry — spent a lot of yesterday defending his 5000% price hike on Daraprim, a drug that treats victims of toxoplasmosis. That the drug has a nexus with cancer and AIDS sufferers (basically anyone with a diminished immune system) made the price increase seem even more unconscionable.
Dr. Wendy Armstrong, professor of infectious diseases at Emory University, questions Turing’s claim that, after more than 60 years of physicians using Daraprim, there is a need for a better version of the drug.
“I certainly don’t think this is one of those diseases where we have been clamoring for better therapies,” says Armstrong.
Next, there’s the inherent ridiculousness of this assertion, which portrays Turing’s plans for Daraprim as a reverse pyramid scheme, in which future “investors” will benefit from the gouging of those who got in on the ground floor.
On top of that, Shkreli claims the drug is still underpriced, despite having been sold for $1/pill before its acquisition by the company Turing acquired it from.
While it’s true that drug research and development can be expensive, it is nowhere near as costly as this price hike would indicate. Shkreli tossed out the easily-debunked claim that it costs $1 billion to bring a new drug to market. The actual cost is considerably lower (~$55 million), according to research using the same data drug companies provided to backup their claims of $1.3 billion in R&D costs per new drug.
Data also shows pharmaceutical companies spend far more on marketing than research and development. They have to. Most “new” products on the market aren’t actually new. They’re just variants on what’s already available. It’s tough to sell a “new” drug that doesn’t outperform a competing product, hence the increased marketing expenditures.
Shkreli also used a variant of “everyone else is doing it” to defend the price jump. He pointed to the existence of other cancer drugs costing “over $100,000” per treatment as justifying Turing’s price increase. But being slightly less exortionate than competitors isn’t the same thing as being “good.”
Shkreli has little interest in being good, no matter what altruistic assertions he makes. His former company — from which he was ousted over accusations of stock price manipulation — also jacked up the price on an essential drug just because it could.
When Retrophin acquired rights to Thiola, the drug cost about $1.50 per pill. [Patients take multiple pills per day.] Now, Retrophin has decided to charge more than $30 for the same Thiola pill. Retrophin says it has plans to change the Thiola dose and develop an extended release version of the drug, but I have seen none of those changes yet. To my knowledge, Retrophin hasn’t yet done any of this work — except to drastically increase Thiola’s price.
And indeed, Retrophin never did. From a 2015 presentation, it’s generating sales for Retrophin, but nowhere in it is any indication the company is actually working towards an extended-release version of the drug.
I asked Shkreli about this and he claimed the company ditched the R&D plans after it ousted him. Maybe this is true, but it doesn’t exactly instill any confidence in Shkreli’s latest claims that price hikes are being done with an eye on increased R&D spending. Instead, they look like nothing more than the normal deflection performed by drug companies after controversial price increases.
Other circumstantial evidence does little for consumer confidence. Not only is Shkreli being sued by his former company for fraudulent behavior, he’s previously been taken to court (by Lehman Brothers) for a $2.3 million loss he incurred (but never repaid) when his bet on a market decline went south. The complaint accuses him not only of failing to pay Lehman what was owed, but of pushing through the transaction without actually possessing the funds to cover the original purchase.
Shkreli also has a history of thriving on market failure. He has made money shorting pharmaceutical stocks while simultaneously engaging in questionable behavior. Here’s a “treatise” he wrote detailing the negative aspects of one company’s research efforts, which clearly states at the top of each page (for legal reasons) that he stands to personally gain if the company’s stock price drops.
DISCLAIMER: The authors of this article have a conflict of interest and will benefit financially if the stock price of VTL falls. The authors reserve the right to change their investment if the price of VTL changes dramatically. Please read the Disclosure at the end of this paper for more information.
(This was tracked down from a deleted tweet by Martin Shkreli. Other Twitter users had commented on it, so it was recoverable from Google cache. Here’s a screenshot, because the cache won’t stay live for long.)
But he’s also been accused of actions that are more than simply treading the edge of legality. A heated Twitter exchange implies Shkreli talked the FDA out of a drug approval — something that hurt the company producing the drug, but paid off for Shkreli’s stock short.
Shkreli’s history does little to back up his assertions of altruistic goals and a future full of well-funded research and development. Instead, it shows someone who’s willing to exploit every last dollar out of something and leave its dessicated corpse behind.
On top of that, share prices for several drug companies fell the day the Daraprim price hike went viral. That this may have worked out well for Shkreli can’t be ignored, considering his prior experience with shorting pharmaceutical companies. Maybe this was part of the plan: Short pharma stocks. Jack price up on newly-acquired drugs. Play the villain while cashing in on the market decline.
That’s all speculation, of course. What is certain is that Martin Shkreli is not THE problem. (He’s not even “Big Pharma,” even though several editorials have placed him in this group.) He’s part of the problem, but his specific actions are more about exploiting obscure drugs that competitors aren’t interested in. His actions shed little light on the genesis of high drug prices.
The original issue is patents. That has been mostly ignored by legislators and opinion pieces during the most recent push for some sort of drug pricing controls. And it will continue to be ignored because Daraprim’s price hike is completely unrelated to patent monopolies. Turing’s exclusive license for Daraprim includes only the use of the trademarked name. The patents have expired. Anyone can make it, but no one’s been particularly interested in offering an alternative. (Maybe this will change now that a company has a chance to take on the villain du jour…)
But it’s patents that make drugs unaffordable in the first place. New drugs are given, at minimum, 20 years of competition-free sales. That’s two decades (at least) where drug companies can charge whatever they want because no one else can offer a competing product. Companies — like Shkreli — will claim they need this exclusivity to recoup “massive” research and development costs. But this simply isn’t true. Pharmaceutical companies enjoy massive profit margins, much more than would be expected if they were faced with meaningful competition. The lie is exposed when patents expire. Prices fall dramatically once the market is opened, including that of the original manufacturer’s.
So, if the government really wants to tackle the problem of overpriced drugs, it needs to start with the protections it grants that allow this to happen. But this seems unlikely to happen because drug companies have significant “buying power” when it comes to legislation, no matter how many people come forward to testify about being priced out of essential treatments.
Shkreli, however, is specializing in finding “orphan drugs” — drugs for rare conditions that are no longer under patent protection (which would raise the acquisition price significantly) but which have seen little to no competitive movement over the years. His decision to implement a 5000% price increase, despite minimal costs (and benefiting from R&D performed 60 years ago), is one he can make because there’s no market force in place to stop him. So, he may be the poster boy for everything that’s wrong with the pharmaceutical industry, but he’s not really indicative of the ongoing problem.
What he is, however, is an opportunist with a hedge fund background and a history of market exploitation. Any claims of altruism or searches for better treatments should be met with intense skepticism.
When pharmaceutical companies defend outrageously-priced medicines, they often claim these massive profit margins are there to help them recoup the money dumped into research and development. But that has nothing to do with the high prices. R&D costs are consistently lower than companies portray them. The real reason for exorbitant drug prices is a monopoly granted by patents, which lock out all competitors for years. And when the patent nears expiration, pharma companies extend their monopoly by doing questionable things — like testing high-powered, opiate-based painkillers on children — just to extend the patent protection for another few months.
None of that, however, explains this: (h/t to Techdirt reader pixelpusher220)
Turing Pharmaceuticals of New York raised the price of Daraprim from $13.50 per pill to $750 per pill last month, shortly after purchasing the rights to the drug from Impax Laboratories. Turing has exclusive rights to market Daraprim (pyrimethamine), on the market since 1953.
Daraprim fights toxoplasmosis, the second most common food-borne disease, which can easily infect people whose immune systems have been weakened by AIDS, chemotherapy or even pregnancy, according to the Centers for Disease Control.
In this case, any research and marketing costs have long since been recouped (or at least amortized). The patents behind the drug — all granted between 1951 and 1954 — should be dead. Conveniently for Turing (and other rights holders before it), no company is offering a generic version.
Every time the drug has changed hands (and it’s done it more than once), the price has gone up. But no other company has increased the price quite as much as Turing Pharmaceuticals has. Perhaps that’s because Turing spent a significant amount of money to acquire an exclusive marketing license, but with none of the attendant patent exclusivity.
Impax Laboratories, Inc. (NASDAQ: IPXL) today announced that it has sold its U.S. rights to the Daraprim brand to Turing Pharmaceuticals AG for approximately $55 million.
Turing, of course, realizes this price jump — which puts one month’s supply in the new vehicle range ($45-50,000) at minimum — is going to be tough on those expected to pay for it, but claims to have support in place to help absorb some of the ridiculous increase.
A Turing spokesman, Craig Rothenberg, said the company is working with hospitals and providers to get every patient covered. This includes free-of-charge options for uninsured patients and co-pay assistance programs.
For inpatient procurement, institutions can no longer order from their general wholesaler. Instead, they must set up an account with the Daraprim Direct program. Once enrolled, orders may be placed with the company until 6 pm Monday through Friday and will be delivered the next business weekday, because there is no weekend delivery at this time.
For outpatient procurement, patients can no longer obtain the medication from their community pharmacy. All prescriptions must be transmitted to a single dispensing pharmacy: Walgreens Specialty Pharmacy. Upon insurance verification and co-pay collection, the prescription will be mailed to the patient’s home, and most prescriptions can be mailed overnight.
This presents a problem for hospitals. Although the drug is low-use (it combats the effects of toxoplasmosis — something that can cause serious issues for those with weakened immune systems, like cancer/HIV patients), it still is needed often enough that the two access routes just aren’t enough.
My institution recently encountered a difficult scenario in which pyrimethamine was attempted to be obtained through the Walgreens Specialty Pharmacy. The patient in question was currently homeless, and therefore did not have a home or address to which the medication could be delivered. Additionally, the manufacturer did not yet have a system in place to address the situation.
This could have been extremely problematic, but fortunately, my institution is affiliated with a Walgreens Specialty Pharmacy and contracted to provide bedside delivery to patients prior to discharge. The patient was able to receive the pyrimethamine as an inpatient.
Turing, of course, defends the increased price by claiming the exorbitant profit margin will result in increased R&D. But let’s take a closer look at what its spokesman is actually saying.
Rothenberg defended Daraprim’s price, saying that the company will use the money it makes from sales to further research treatments for toxoplasmosis.
Translation: this money will be dumped into finding another variation to patent, thus locking out potential competitors and allowing Turing to continue charging whatever it wants for the medication.
They also plan to invest in marketing and education tools to make people more aware of the disease.
Translation: we will market the hell out of this new drug.
This sort of thing isn’t exclusive to Turing. It’s standard MO for all pharmaceutical companies. Rather than engage in meaningful competition, these companies are awarded lengthy monopolies on drugs and treatments by the US government. Turing is no different than Amedra — part of the holding company acquired by Turing along with the Daraprim rights. But when Amedraacquired the rights from GlaxoSmithKline, it somehow managed to keep its price hike to a couple of dollars, rather than several hundred.
Since founding Turing last year, Shkreli has taken a page from what made Retrophin a high-profile–and controversial–player among small biotech companies. Retrophin’s stated goal was ferreting out value in biopharma by acquiring assets with potential in rare and neglected diseases, a process that can mean acquiring an underused drug and jacking up its cost to take advantage of rare disease pricing.
In September 2014 Retrophin acquired the rights to thiola, a drug used to treat the rare disease cystinuria. It was with Shkreli as CEO that Retrophin introduced a 20-fold price increase for Thiola, despite no additional research and development costs incurred by obtaining these rights.
Turing is basically Retrophin 2.0, or more accurately, Shkreli being Shkreli. Shkreli may have still been helming Retrophin at this point, had his own company not ousted him. In August, his former company also sued him, alleging financial impropriety.
It appears that Shkreli is a bit too comfortable operating in gray areas. The market-related shadiness alleged in the lawsuit appears to be just part of Shkreli’s everyday business affairs.
In an uncommon move, Shkreli himself led the Series A financing, and Turing isn’t naming any of its other backers, calling them “preeminent institutional equity investors” and leaving it at that. In a filing with the SEC last week, Turing counted 34 individual participants in its funding round but reported raising just $62.7 million.
This reported total of the funding round didn’t match the claimed total ($90 million). Shkreli had an answer for the missing funding. And that answer was “Shut up.”
A spokesman for the company declined to explain the $27.3 million difference, and further questions about the company’s financials were met with a terse email from Shkreli asking FierceBiotech not to contact Turing again.
The unasked question has its answer: why did Turning flip the switch on a 5000% price increase? Because it can. And it’s not just the people being prescribed Daraprim that will eat the cost. It will be every customer of every health insurer that covers the rest of the cost of these prescriptions. These additional expenses will eventually result in higher health insurance premiums. And while Turing is offering to help out those with little to no insurance, these costs — whether they’re absorbed by health care institutions or the government itself — will be passed on to the general public as well.