Prescription for fairness…equitable prices

One of the biggest dangers of chemotherapy is the destruction of a cancer patient’s immune system. Chemotherapy drugs target cells that divide rapidly, such as cancer cells, but also most cells in the human body, including bone marrow. As bone marrow cells are destroyed during treatment, the body makes fewer red and white blood cells and fewer platelets. As a result, the body is less able to fight infection and is therefore more susceptible to disease.

Toxoplasmosis is a disease caused by a parasite commonly found in cat feces or contaminated food. The Mayo Clinic estimates more than 3 million U.S. cases of the disease each year, but most generally healthy Americans will never need treatment. Those who need treatments are typically those with weakened immune systems, such as cancer patients, pregnant women or those with HIV/AIDS.

Daraprim is the drug used to treat toxoplasmosis; it also helps prevent malaria. It has recently come into the news because its price was raised more than 5,000 percent on Sept. 20, a month after it was acquired by a new company: Turing Pharmaceuticals.

On Sept. 19, Daraprim cost $13.50 per pill. The next day, it cost $750 per pill. This radical price increase, according to the Infectious Diseases Society of America, which wrote a letter to Turing CEO Martin Shkreli after the announcement, would make the cost of treating a patient with Daraprim hundreds of thousands of dollars per year and could be unsustainable in some areas. As recently as 2010, Daraprim cost only $1 per pill, according to the Chicago Tribune. Cheap generics are still available internationally, though Daraprim holds a monopoly in the U.S.

Pyrimethamine, of which Daraprim is the trade name, is on the World Health Organization’s List of Essential Medicines, meaning it is considered one of the most important medications needed in any basic health care system. Many argue that, given the drug’s importance, raising its price so exorbitantly is unethical and immoral.

After massive backlash from media, politicians, health organizations and biotechnology companies, Shkreli has said he will lower the price of Daraprim, though he has not said what the new price will be. Even if the drug is lowered back to $13.50, which by all accounts is unlikely, this situation raises great concerns about the rising prices of prescription drugs in America.

Turing is hardly the first pharmaceutical company to dramatically increase the cost of a formerly affordable drug. In February 2015, Valeant Pharmaceuticals International purchased two life-saving heart medications — Nitropress and Isuprel — and increased their prices by 525 percent and 212 percent, respectively, according to an April 2015 article in the Wall Street Journal.

Both drugs are commonly used and were relatively affordable prior to February 2015. The increases led to a congressional investigation in August, led by Sen. Bernie Sanders, I-Vt., and Rep. Elijah Cummings, D-Md. The House Committee on Oversight and Government Reform became involved earlier this week, on Monday, Sept. 28. At least 18 members of the committee wish to subpoena Valeant CEO J. Michael Pearson to testify before Congress in order to determine the reasoning behind the “massive price increases,” according to Fortune magazine.

The costs of many brand (non-generic) drugs have been soaring, but even generic drugs are not free from the issue of price gouging. In 2013, Doxycycline, a generic antibiotic used in the treatment of Lyme disease, pneumonia, cholera and some sexually transmitted diseases (STDs), saw its prices increase substantially from certain suppliers.

Mylan Pharmaceuticals raised the price of Doxycycline to $165 per month, even though other companies, including Watson Pharmaceuticals, offered it for less than $5 per month. Depending on where prescriptions were filled, some people did not have access to the cheap option and were forced to pay nearly 4,000 percent more than they might have previously.

The Los Angeles Times investigated that price increase and the unavailability of cheaper options in a March 2013 article. The Times’ David Lazarus interviewed Jeffrey McCombs, a University of Southern California professor of pharmaceutical economics and policy, who said the price charged by suppliers “has nothing to do with the actual cost of producing the generic,” though drug pricing is “a very murky world.”

The U.S. has the highest prices for prescription drugs in the world — we spent more than $370 billion in 2014. Our annual costs are approximately 40 percent higher than those of the next highest spender: Canada. In 2014, Americans filled 4.3 billion prescriptions, an average of more than 13 per person. Additionally, nearly 20 percent of Americans between the ages of 19 and 64 — roughly 35 million people — chose not to fill a prescription because they lacked the funds to do so.

The University News Editorial Board believes that the federal government must step in, in order to reign in astronomical drug prices that are forcing Americans to choose between their health and their financial security. There are three specific actions we support, though we believe there are numerous other potential moves that could help alleviate some of the monetary burden.

The first course of action our government must take is to allow Medicare to negotiate better prescription drug prices from pharmaceutical companies. Currently, Medicare has no bargaining power when it comes to dealing with setting drug prices. The Prescription Drug Affordability Act of 2015, co-sponsored by Sanders and Cummings, has been introduced in both houses of Congress and would allow just this.

“It is unacceptable that the top three pharmaceutical companies made a combined $45 billion in profits last year and spent more on sales and marketing than they did on research and development,” Sanders said in a Sept. 29 Senate-floor speech.

The second action that must be taken is government prohibition of “pay-for-delay” deals, in which brand drug companies pay generic drug makers to stay off the market, in order to maintain a monopoly over supply and cost of brand drugs. The Federal Trade Commission has said such anticompetitive deals result in roughly $3.5 billion in higher drug costs annually.

A third step that must be taken is to increase penalties for drug companies convicted of fraud. Again, according to Sanders, almost every large pharmaceutical company in the U.S. has been convicted, either civilly or criminally, of fraud, including “off-label promotion, kickbacks, anti-monopoly practices and Medicare fraud.” These companies are made to pay large fines but do not see any impact on exclusivity (monopoly) periods, which is a problem. Fraud is a big deal and should be treated as such. The punishment must be more than a slap on the wrist.

The biggest takeaway from the recent case with Turing Pharmaceuticals and Daraprim should be that the time to tackle prescription drug price gouging has come. The actions outlined above would be a solid start to addressing the problem at the federal level and easing some of the burden placed on the American public. Drug companies should not be allowed to raise prices to exorbitant rates in order to increase profits and send stock prices soaring, at the expense of public health. Doing so is immoral and unethical, and we must take a stand to stop it while we still can.

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