Years after Martin Shkreli kicked off a drug pricing controversy around the HIV drug Daraprim, the price of the drug has not fallen to pre-Shkreli figures despite several generic competitors.
There are now four generic versions of Daraprim, which was first approved in 1953 and is used to treat parasitic diseases associated with HIV.
Those generics still cost more than Daraprim did before Shkreli bought the rights to the drug in 2015 and sharply hiked the price from $17.50 a pill to $750 a pill.
Mark Cuban Cost Plus Drug Company sells a 25 mg version of the drug, known generically as pyrimethamine, for $115 per pill — still six times more than the pre-Shkreli price.
List prices for Daraprim and its generics range widely. In 2023, Teva’s generic version was about $235 per pill while Vyera Pharmaceuticals’ brand-name version was $690 a pill, according to the nonprofit drug pricing research firm 3 Axis Advisors.
Vyera is the new name of Turing Pharmaceuticals, which was the company founded by Shkreli. In December, Tilde Sciences purchased Daraprim from Vyera for about $650,000, which was a fraction of the $55 million that Turing paid Impax Labs for Daraprim in 2015.
So why hasn’t the price of pyrimethamine dropped, as is typically the case with generics?
Antonio Ciaccia, CEO of 3 Axis Advisors, told Endpoints News that “there is not a meaningful volume play for generic manufacturers, and they will attempt to generate revenue through keeping the price up rather than there being a mad dash to capture market share through aggressive price deflation. If one decided to drop the price to a few dollars a tablet, the market share gain would not outweigh the value of keeping the price up.”
None of the generic competitors — Alvogen, Aurobindo, Cerovene or Teva — nor Tilde responded to a request for comment about the list price for pyrimethamine.
Other drugs have withstood price declines even with generic competition.
Stacie Dusetzina, professor at the Vanderbilt University School of Medicine, said she’s seen “high prices linger for specialty drugs before,” citing lenalidomide, also called Revlimid.
“This case reminds me of another generic,” she said, “that has used similar tactics to hold off generic competition.”
In 2020, a Congressional investigation found that the average net price unit of Revlimid rose from $293 in 2009 to $598 in 2018. In 2022, when Teva launched its Revlimid generic with a list price of $720 per capsule, Optum noted that the brand-name version of the cancer drug was about $833.