“This Is A Stick Up — Your Money or Your Life”

When I read a recent Hepatology editorial (Hepatology 2015; 61: 1106-8), I could not help think of the aforementioned title of this blog.

Here’s the scoop:

The two most commonly used medications for Wilson’s disease are trientine (Syprine) and D-penicillamine (Cupramine). For about 20 years, the original manufacturer of these medications kept the consumer cost at ~$1 per 250 mg tablet.  Currently the cost of Syprine is ~$200 per 250 mg tablet and Cuprimine costs ~$55 per 250 mg tablet.  This 200-fold increase translates into a yearly cost of ~$300,000.

How did this happen?

  • Little competition
  • Profit motive
  • Patients are reluctant to protest (they need this medication to be manufactured)

Why is this outrageous?

This increase in cost was not driven by any new discovery or research innovation.

Are there options?

Zinc is inexpensive and may be an option after initial period of chelation/normalization of liver biochemistries.  Zinc needs to be taken two to three times per day and “well away from meals for best absorption.”

Bottomline: These medication prices are outrageous.

Briefly noted:

  • “Molecular pathophysiology of portal hypertension”  Hepatology 2015; 61: 1406-15. Terrific review with excellent figures.
  • “Ezetimibe for the treatment of Nonacloholic Steatohepatitis” (MOZART trial) Hepatology 2015; 61: 1239-50. This randomized double-blind, placebo-controlled trial with 50 patients (biopsy-proven NASH) showed that Ezetimbe was not significantly different from placebo in histologic response rates, serum aminotransferases, or in magnetic resonance elastography findings.
  • Van Biervliet et al. “Clinical Zinc Deficiency as Early Presentation of Wilson Disease” JPGN 2015; 60: 457-9. Case report.

Screen Shot 2015-04-19 at 8.55.40 PM

6 thoughts on ““This Is A Stick Up — Your Money or Your Life”

  1. I have always admired your blog, the reviews and the insight. Yet, never ever did I feel this compelled to comment on anything as I do now when I read ur post on penicillamine pricing. The Indian pharmaceutical environment has a hell lot to complain on and we often are awed by your strict regulations but this is outrageous by all standards. I feel that it is the doctors who should be protesting much before the patients do. Probably any company that enters a particular drug market and is the last to remain in that market, should not be allowed to exit it unless there is no market for it (less likely unless the disease is eradicated) or till there is at least one other company which is ready to enter the market and replace it. There should be a cap on their profit margins too. They are not selling iPhones. These r drugs and the rules should be different. I might be naive on market economics but better minds should sit together to create better standards for pharmaceutical pricing. My sympathies go out to your patients.

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