September 24th, 2015

Decision to Lower Price of Pyrimethamine a Good One, Especially Given the Weak Defense of the Price Hike

The big ID story the past couple of weeks is that the price of pyrimethamine — a drug that’s been available generically for decades — went from $13.50 to $750 for one pill after the exclusive rights to the drug were purchased by Turing Pharmaceuticals.

Now, after a barrage of criticism — all the way from this little blog to the Infectious Diseases Society of America to the New York Times to the leading Democratic candidate for President — the company has wisely decided to lower the price.

Exactly what the price will be remains to be seen, because there’s a lot of space between $13.50 and $750, but we’ll find out soon enough.

How about defense of the initial decision to raise the price?

Roll ’em:


There are a bunch of claims here that don’t quite ring quite true.


  1. We don’t “desperately” need new treatments for toxoplasmosis [0’54”, those are minutes and seconds in the video]. Most people who have toxoplasmosis have asymptomatic latent infection and need no treatment. 90% of those that do develop active disease generally respond to the treatments we have. Clinically relevant resistance is, fortunately, a rare event. Alternative therapies (notably trimethoprim/sulfamethoxazole) are also pretty good, and have become standard-of-care in some settings.
  2. Treatment of toxoplasmosis does not cure it [5’22”] — if a patient’s immune system again becomes weakened, they can suffer a relapse even after they have been treated. This is why chronic suppressive therapy must be continued indefinitely if a patient remains immunocompromised.
  3. Patients with AIDS who need treatment don’t get a “very short treatment administration” [5’30”]. The HIV Opportunistic Infection Guidelines recommend 6 weeks of initial therapy, followed by chronic maintenance therapy until there is “an increase in CD4 counts to >200 cells/µL after ART that is sustained for more than 6 months.” In other words, patients treated for toxoplasmosis can easily be on treatment for a year, sometimes even longer.

The part around 2’30”, however, is undeniably true:

Profits are a great thing to maintain your corporate existence.

Look, there is nothing wrong with companies making profits for discovering, developing, and creating good products — this is a capitalist country, after all, and innovation should be rewarded. I write that sentence keenly aware that the new iPhones are about to appear in stores this weekend, and yes, my iPhone 4 is looking a little tired.

But with the pyrimethamine price increase, some sort of threshold of reasonableness was passed.

The negative response has been essentially universal, and quite appropriate.

3 Responses to “Decision to Lower Price of Pyrimethamine a Good One, Especially Given the Weak Defense of the Price Hike”

  1. Louie Katz MD says:

    Paul is much more restrained and reasonable in his characterization than I have been.

  2. S.K. says:

    Found this piece interesting as it relates to your post:

    “After the uproar over 5,000% price hike on toxoplasmosis treatment pyrimethamine (Daraprim), Trends-in-Medicine pointed to the recent “gigantic” price increases on generic cardiac drugs: 525% for isoproterenol (Isuprel) and 212% for nitroprusside (Nitropress) after Valeant Pharmaceuticals’ purchased them from Marathon Pharmaceuticals.

  3. John R Nienow says:

    Paul, given you’re love of Doxycycline, I would have thought you’d be apoplectic over that price increase..a much more essential and widely usable drug. Same degree of price increase.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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