Uncontrolled and Arbitrary Drug Inflation

by Michael Nguyen, PharmD, CPh, Director of Clinical Services
Lisa Luong, PharmD

When Turing Pharmaceuticals acquired Daraprim® (pyrimethamine), a well-established treatment for toxoplasmosis, Turing’s CEO Martin Shkreli made a controversial business decision to astronomically inflate the price of this life-saving medication from $13.50 to $750 per tablet.

Daraprim’s overnight price increase of more than 5000% may be the most egregious recent example of drug inflation, but it is certainly not an isolated case. However, it did result in an immediate uproar by healthcare professionals and lawmakers who expressed outrage and criticism and brought public attention to the increasing trend of drug inflation.

What is the Impact of Drug Inflation on Workers’ Compensation Claims?

There are no general laws that govern drug pricing–or at least restrict increases to a gradual and reasonable rate. Left unchecked, pharmaceutical companies can essentially charge any price they want and change this price as often as they want without notice to unsuspecting consumers, healthcare providers, and insurance companies.

As drug companies raise the market price of medications, payers have to unexpectedly foot the bill for the sudden spikes in medication prices and many are unaware that there might be lower cost alternatives. A few examples of drugs with recent sudden spikes in pricing are Duexis®, Vimovo®, and Pennsaid®. At average wholesale price, a 30-day supply of these medications can cost payers several thousand dollars.

The myMatrixx Solution

myMatrixx One Drug Reviews identify specific areas of concern, including DAW 1 prescribing, compounds, and medications that have experienced recent or sudden price increases. myMatrixx pharmacists then alert claims adjusters of reasonable alternatives and contact the prescriber to request a medication therapy change.

Over the past two years, myMatrixx has achieved a success rate of 73.8%, meaning prescribers agreed to therapy changes nearly three-quarters of the time our pharmacists recommended them–saving our clients an average of $9,792 annually for each One Drug Review. For more information about One Drug Reviews and other clinical services offered by myMatrixx, please contact your myMatrixx Client Services Manager or Clinical Pharmacist, or call our 24-hour customer service line at (877) 804-4900.