Senators Collins, McCaskill lead panel investigating sudden spikes in prices of meds
The Director of Drug Information at University of Utah Health Care, Erin R. Fox, Pharm D, went before a U.S. Senate panel on December 9th, 2015 “to provide perspective on how sudden price increases of off-patent drugs have impacted our health system.”
University of Utah Health Care is the only academic medical center in Utah and in a region that spans over 10% of the continental United States, including Idaho, Wyoming, Montana, much of Nevada, and western Colorado. The Drug Information Service is nationally recognized for providing all drug shortage content for the public website of the American Society of Health-System Pharmacists (www.ashp.org/shortage).
As part of her role in the organization, Dr. Fox works to help manage drug shortages, assists with developing drug budgets, and leads and guides medication use policy.
Under oath, she stated: “Our organization has been adversely impacted by recent price increases of medications we have used for years.
“Two key examples are nitroprusside and isoproterenol. These are critical medications used to treat very sick patients. Nitroprusside is particularly important for patients with severe high blood pressure or heart failure. Isoproterenol can be potentially life-saving for patients with very slow heart rates in emergency situations.
“In 2013, University of Utah Health Care paid approximately $50 a vial for nitroprusside and isoproterenol, which were sold by Hospira. Marathon purchased these products from Hospira in 2014, and raised the price of nitroprusside to about $215 and isoproterenol to about $440.
“In 2015, Valeant purchased these drugs from Marathon, and prices increased again—nitroprusside went from $215 to about $650, and isoproterenol went from $440 to about $2700.
“We calculated the potential impact to our inpatient pharmacy budget and discovered that if we continued to purchase the same amount of each drug, it would cost our organization just over $1.6 million more for isoproterenol and approximately $290,000 more for nitroprusside compared to what we paid the previous year.
Recognizing that this type of arbitrary and unpredictable inflation is not sustainable in our hospitals, especially when we receive capitated payments for most of our patients, we began exploring how we could minimize costs without impacting patient care.”
According to Dr. Fox’s testimony, one of the changes they made in their management of isoproterenol was to keep a small amount in the pharmacy area, where emergency responders can access it and bring it to wherever the emergency, or “code,” is occurring. This contrasts with the previous protocol of keeping each “crash cart,” located in hallways throughout the facility, stocked with the medication.
So, it’s clear that a certain level of readiness has already been sacrificed in order to deal with the monumental price hikes. When a patient dies because they didn’t get their isoproterenol quickly enough—and it’s only a matter of time before that happens—who could possibly fault the medical center?
The Utah Health Care doctor also told Committee Chairman Susan M. Collins (R-ME) and Ranking Member Claire McCaskill (D-MO) that, unlike isoproterenol, “we have not found a way to drastically reduce use of nitroprusside, a drug that is critically important for some patients.”
Dr. Fox, along with three other pharmaceutical industry experts, gave testimony before the Special Committee on Aging investigating “Sudden Price Spikes in Off-Patent Drugs: Perspectives from the Front Lines.” The hearing took place in the Dirksen Senate Office Building in Washington, D.C.