Perspective

‘Opportunistic greed’: ID groups criticize Nostrum for nitrofurantoin price spike

The Infectious Diseases Society of America and HIV Medicine Association strongly criticized Nostrum Laboratories Inc. today for quadrupling the price of the antibiotic nitrofurantoin from approximately $500 to more than $2,300 per bottle, saying it was unethical, irresponsible and unnecessary.

Nostrum is the only manufacturer of the liquid formulation of nitrofurantoin and “costs pennies to produce,” the groups said in a statement. They compared the price hike to raising the price of bottled water during a hurricane.

“To more than quadruple the price of an antibiotic drug developed more than 6 decades ago reflects opportunistic greed in its most indefensible form,” they said. “It is important to note that Nostrum Laboratories, which packages and markets the drug, had no role in its discovery, development, or production.”

Nitrofurantoin, which is available in pill and liquid form, is commonly used by ID physicians to treat urinary tract infections, and the liquid form is critical for patients who struggle taking pills, the groups noted. They said the price hike will limit access to an effective antibiotic, which could result in increased drug resistance, making treatment of infections even more challenging.

The IDSA and HIVMA compared the situation to the Daraprim price hike in 2015 and said it “reflects cynical opportunism rather than investment and innovation.”

“We believe that developers of new antibiotics should receive fair returns on their investments,” they said. “We advocate strongly for incentives that promote innovation and strengthen the pipeline of these critical medicines. Financial models for antibiotic reimbursement, however, should reward true innovation, promote stewardship, and protect appropriate patient access to needed therapies. This price hike fails on all three points.”

“As this price increase becomes news,” they concluded, “it is worth noting that laws exist to discourage exorbitant price hikes of necessary supplies such as bottled water that exploit emergencies including hurricanes. This act of price gouging should not be viewed differently.” – by Marley Ghizzone

The Infectious Diseases Society of America and HIV Medicine Association strongly criticized Nostrum Laboratories Inc. today for quadrupling the price of the antibiotic nitrofurantoin from approximately $500 to more than $2,300 per bottle, saying it was unethical, irresponsible and unnecessary.

Nostrum is the only manufacturer of the liquid formulation of nitrofurantoin and “costs pennies to produce,” the groups said in a statement. They compared the price hike to raising the price of bottled water during a hurricane.

“To more than quadruple the price of an antibiotic drug developed more than 6 decades ago reflects opportunistic greed in its most indefensible form,” they said. “It is important to note that Nostrum Laboratories, which packages and markets the drug, had no role in its discovery, development, or production.”

Nitrofurantoin, which is available in pill and liquid form, is commonly used by ID physicians to treat urinary tract infections, and the liquid form is critical for patients who struggle taking pills, the groups noted. They said the price hike will limit access to an effective antibiotic, which could result in increased drug resistance, making treatment of infections even more challenging.

The IDSA and HIVMA compared the situation to the Daraprim price hike in 2015 and said it “reflects cynical opportunism rather than investment and innovation.”

“We believe that developers of new antibiotics should receive fair returns on their investments,” they said. “We advocate strongly for incentives that promote innovation and strengthen the pipeline of these critical medicines. Financial models for antibiotic reimbursement, however, should reward true innovation, promote stewardship, and protect appropriate patient access to needed therapies. This price hike fails on all three points.”

“As this price increase becomes news,” they concluded, “it is worth noting that laws exist to discourage exorbitant price hikes of necessary supplies such as bottled water that exploit emergencies including hurricanes. This act of price gouging should not be viewed differently.” – by Marley Ghizzone

    Perspective
    Carlos del Rio

    Carlos del Rio

    As with Daraprim and other drugs, price gouging is becoming more common — someone who is not a pharmaceutical company buys the exclusivity rights to distribute the drug and bumps the price to whatever they feel like. Unfortunately, there are no guardrails to prevent them from doing that. It’s almost like if I was the only person allowed to sell televisions in this country and I said now televisions are going to cost $10,000 apiece. Why? Because I’m going to get paid, and if you want a TV that’s what you pay. I think that because there are no protections, no guardrails, there is no way to prevent this from happening. People without scruples will continue doing it, and I think that’s something that we need to be aware of. This practice will continue until someone says, “No.”

    The biggest payer for medications in this country is Medicare. Why is the government allowing this to happen? Why doesn’t it have ways of saying that this makes no sense? Some drugs have higher prices than others, but nitrofurantoin was approved in 1953. It is not a new drug. It’s one of the drugs on WHO’s list of essential medicines. Throughout the world, you can get nitrofurantoin for, at most, $10 for an entire course of treatment. So why do I need to pay $2,000 for a dose? You may say, you don’t have to pay for it, but your insurance, Medicare or taxes pay for it. So, at the end, we’re all paying for it. That’s why health care costs are so high.

    There are three interventions that I see. No. 1, there could be regulations, there could be price controls. There are ways that prices get set. I think there must be a way that prices for drugs can get approved. It doesn’t need to be incredible control, just a panel that agrees and approves the pricing of drugs. That can be done through Medicare or CMS. No. 2, let’s open the market. We’re a country that believes in competition. Let’s open the markets, open the borders. Let’s get nitrofurantoin from Mexico or Canada, available for $10, and bring it over here. Let’s remove the monopoly that many of those people have on the distribution of the product. They are raising the price because they have a monopoly. So break the monopolies. No. 3, let’s not use their drug. The moment that a drug is that expensive, the market needs to respond by not prescribing the drug. The vast majority of doctors are unaware of the costs of anything they prescribe. This is a challenge we all have. The way the system was set up, none of us know how much something costs. But if I knew a drug like this cost that amount of money, I would prescribe something else. I would give the patient something that is cheap. There are very few clinical cases where this would be the only treatment. Let’s use not an equivalent drug because there is a monopoly, but a drug that can compete against this one for a much cheaper price. By doing that, we will break the monopolies.

    In the Daraprim disaster, the pharmaceutical executive was not indicted for those drug prices. The problems the executive had with the law were not related to the price of the drugs. It had to do with illegal trading, security fraud and other things in the market that were illegal. Let’s not confuse that. Martin Shkreli did not go to jail, and he did not get fined because of high drug prices. Raising the price of the drug is not going to send you to jail in this country and therefore people are going to continue to do it. I don’t think it’s illegal; I just think it’s immoral.

    As physicians, we all need to be more conscious and aware of this practice. It’s not just the price hikes of Daraprim and nitrofurantoin that are a problem. It’s becoming routine. We as physicians, we as providers need to be keenly aware about the price of medications and we need to say, “No.” We need to oppose this. We need to actively advocate. This is not an acceptable practice, and we need to protect our patients, and we need to protect the payers. Like I said, at the end of the day, we’re all paying. This is predatory pricing, and it should not be allowed. We have a job to stop this kind of behavior.

    • Carlos del Rio, MD
    • Professor of medicine, Emory School of Medicine

    Disclosures: del Rio reports no relevant financial disclosures