US pharmacy benefit manager (PBM) Express Scripts has partnered with a compounding pharmacy firm to provide a low-cost alternative to Turing’s Daraprim.
Starting within the next few days, Imprimis Pharmaceuticals will start producing a compounded oral formulation of pyrimethamine – the active ingredient in toxoplasmosis therapy Daraprim – combined with the B vitamin leucovorin at a price of just $1 per capsule.
Turing sparked a storm of protest earlier this year when – under the management of new chief executive Martin Shkreli – it increased the price of Daraprim from $13.50 per dose to $750. The move focused attention on the issue of escalating medicine costs and led to increased scrutiny of pharma company pricing policies by US lawmakers.
Shkreli pledged to reduce the cost of the drug as the backlash grew, and said last week it would provide hospitals with a 50% discount on the list price and make sample starter packs – for emergency use – available at no cost. However, it declined to reduce the list price of the drug.
Compounding pharmacies like Imprimis specialise in making off-patent medicines to order, often focusing on low volume formulations that would not be cost-effective for larger drugmakers to include in their product ranges.
The new deal will five Express Scripts’ customers access to a drug that it maintains has been “priced out of reach for people with HIV, pregnant women and others with weakened immune systems”.
Physicians will be able to send a patient-specific prescription for the combination formulation of pyrimethamine and leucovorin to Imprimis, according to the PBM, which said the compounding pharmacy “is now a part of the Express Scripts … network”.
Steve Miller, chief medical officer at Express Scripts, said the company is also planning to share the compounded formulation with other healthcare payers “to make sure all appropriate patients around the country have access to the treatment they need at the lowest possible price”.
The move has the backing of the HIV Medicine Association and Infectious Disease Society of America, which said in a prepared statement that their members “have reported significant challenges obtaining pyrimethamine for their patients” since the Daraprim price increase in August.
For its part, Turing maintains that as Imprimis’ alternative formulation is not FDA approved it is “potentially unsafe and ineffective”, although compounded drugs are an established part of the US healthcare system and regulations tightening quality requirements were adopted in 2013.
Express Scripts‘ latest move is just one example among a number of measures adopted by PBMs to curb medicine costs, alongside excluding costly brands from formularies if cheaper alternatives are available and introducing tiered access with expensive drugs held in reserve.