Company reneges on promise to cut price of toxoplasmosis drug

BMJ 2015; 351 doi: (Published 30 November 2015) Cite this as: BMJ 2015;351:h6472
  1. Owen Dyer
  1. 1Montreal

Turing Pharmaceuticals, the company that drew condemnation from all sides in the United States two months ago when it bought the toxoplasmosis drug pyrimethamine (Daraprim) and raised the price by over 5000%,1 has abandoned a commitment to lower the drug’s list price by Christmas, instead opting to reduce the price charged to hospitals and offering expanded support to patients who lack health insurance or financial resources.

The changes were dismissed as “window dressing” by the HIV Medicine Association. “This medication can be made for pennies. They need to reduce the price to what it was before,” said the virologist Carlos Del Rio, the group’s chairman, in a statement.

Turing bought the rights to pyrimethamine in August for $55m (£37m; €52m) and in September announced a price hike from $13.50 a pill to $750. The drug, approved in 1953, is used to treat parasitic infections and is most commonly used in the US to treat toxoplasmosis encephalitis, which can endanger immunocompromised patients.

The price hike brought widespread opprobrium on Turing’s chief executive, the former hedge fund manager Martin Shkreli, 32, and triggered promises from several presidential candidates to tackle the issue of rising drug prices. A senate hearing on the issue is due on 9 December, with Turing’s case expected to feature prominently.2

Shkreli responded at first with defiance, calling one journalist a “moron” and refusing to lower the price. But within days he seemed to back down, saying in several interviews that a “modest” reduction in price would be implemented by Christmas. Although he agreed to lower the drug’s list price, he argued that it was not the main factor in determining the cost to patients.

The new pricing leaves the list price unchanged but halve the price charged to hospitals. Eighty per cent of treatment for toxoplasmosis encephalitis begins in hospital, the company said. But the HIV Medicine Association contended that most patients go on to take several weeks’ treatment at home after discharge from hospital. The new hospital price is still 25 times higher than the price charged for pyrimethamine earlier this year.

Turing announced that it is strengthening its support programs for low income and Medicare patients. The company will also offer sample starter kits to physicians to allow them to begin treatment immediately and will make smaller 30 pill bottles to reduce the cost to hospitals of stocking the infrequently used drug. No patient will face out-of-pocket expenses of over $10 per prescription, the company pledged. Instead the bulk of the cost will be borne by insurers and in some cases taxpayers.

Del Rio said, “While Turing continues to promise that all patients who need Daraprim have access to it, physicians will be forced to continue looking for less expensive alternative therapies for their patients with toxoplasmosis.” New guidelines on treating toxoplasmosis from the Centers for Disease Control and Prevention’s AIDSinfo service discuss alternative treatments in case pyrimethamine is unavailable.3

Turing’s announcement came after a major compounding pharmacy chain, Imiprimis Pharmaceuticals, began selling a compounded version of pyrimethamine for $0.99 a pill. Orders for the drug are pouring in, its chief executive, Mark Baum, told the broadcaster CNN.


Cite this as: BMJ 2015;351:h6472


  • Observations: What’s happening to cheap generic drugs? (BMJ 2015;351:h5329, doi:10.1136/bmj.h5329)


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