Coverage: Express Scripts looks to work around Turing’s price hike

Drug-benefit manager Express Scripts is teaming up with drug compounder Imprimis to help create alternatives to Daraprim, a drug used to treat HIV and AIDS.

Daraprim made headlines earlier this year when the company that produces it, Turing Pharmaceuticals, jacked its price to $750 per pill from $13.50 per pill. The price hike created a firestorm of debate about pharmaceutical pricing measures, with Turing CEO Martin Shkreli receiving the majority of the blowback.

Jonathan Rockoff of The Wall Street Journal had the day’s announcement:

Drug-benefit manager Express Scripts Holding Co. said it is making arrangements with a drug compounder for patients to receive a lower-priced alternative to the expensive anti-parasitic pill Daraprim, whose price jumped more than 50-fold earlier this year.

Turing Pharmaceuticals AG raised the price of Daraprim after buying the U.S. rights to $750 a pill, up from $13.50. Since then, the company and its chief executive, Martin Shkreli, have come under fire from patient advocates and Democratic politicians criticizing dramatic price hikes for some medicines.

Express Scripts said Tuesday it has arranged for patients to get the drug for $1 a capsule from San Diego-based drug compounder Imprimis Pharmaceuticals Inc., which makes customized medicines by mixing pharmaceutical ingredients.

Among the steps Express Scripts took is adding Imprimis to its network of approved pharmacies and giving Imprimis’s compounded drug a reimbursement code.

“We’ve made it very simple for doctors and patients to access this lifesaving medicine at a reduced cost,” Steven Miller, chief medical officer at Express Scripts, said in an interview. He said St. Louis-based Express Scripts could start processing prescriptions as early as this week.

Meg Tirrell of CNBC laid out more details of the partnership:

Under the partnership announced Tuesday, Express Scripts added Imprimis to its pharmacy network and says it will work with organizations including the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) to communicate the availability of the Daraprim alternative to physicians. The announcement falls on World AIDS Day.

“We have the ability to buy the same exact chemicals and make the exact same formulations that are clinically relevant,” Mark Baum, CEO of Imprimis, told CNBC.

At $1 per pill, Imprimis’ Baum said the company will turn a profit. Imprimis has already filled dozens of prescriptions, he said, all being paid out of pocket so far. Express Scripts said it plans to start processing prescriptions as early as this week.

Andrew Pollack of The New York Times explained this solution does come with some limitations:

Turing, which is run by the former hedge fund manager Martin Shkreli, set off a furor in September after it acquired the rights to Daraprim and raised its price overnight to $750 a pill from $13.50.

Daraprim, known generically as pyrimethamine, is the treatment of choice for toxoplasmosis, a parasitic infection that can be serious for babies and people with AIDS. While there is no patent protection on such an old compound, there are no generic versions approved for sale in the United States, in part because the market is small.

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.

Robert Mclean of CNN Money showed how big of an impact Turing’s price hike had on users’ wallets:

Daraprim has been on the market for over 60 years and is used by some AIDS and cancer patients to treat a specific type of infection.

But Turing hiked Daraprim’s price earlier this year from $13.50 a pill to $750. Martin Shkreli, Turing’s outspoken 32-year-old CEO, was widely blasted in public.

Previously, Turing Pharmaceuticals said it will offer hospitals Daraprim at up to 50% off the list price. It said hospitals are the first to use Daraprim to treat 80% of patients who have parasitic toxoplasmosis encephalitis, the most common form of toxoplasmosis in the United States.

The typical Daraprim dosage is between 50 mg and 75 mg a day for one to three weeks and can be followed by an additional 25 mg a day for four to five weeks if needed, according to the FDA. So even with the discount, a normal course of treatment for toxoplasmosis could cost between $5,200 and $36,700.