The huge increase in the price of a lifesaving lead poisoning treatment has prompted a Michigan lawmaker to call for a congressional investigation into Valeant Pharmaceuticals.
Two years ago, the drug maker boosted the list price for Calcium EDTA by roughly 2,700 percent. After Valeant bought the drug in 2013 as part of a deal in which it took over another company, the list price for a package of vials started rising quickly. After being stable at $950, Valeant raised the price several times before closing out 2014 at more than $26,900.
“It’s a pretty grotesque example of corporate greed to see this kind of price increase,” US Representative Dan Kildee, (D-Mich.), who hopes to convince a Congressional committee to hold a hearing, told us. “We’ve seen such increases elsewhere, but that doesn’t justify it for a drug that, in most cases, is very likely to be used for a child who lives in poverty and exposed to high levels of lead ingestion. That makes it pretty egregious.”
The price hikes have angered toxicologists, who note the drug is decades old and that other companies sell the same medicine for much lower prices in other countries. Ever since the price hikes began two years ago, poison-control specialists and physicians have been complaining, but until now, their efforts — which included reaching out to Washington lawmakers — did not gain traction.
As we noted previously, doctors acknowledge there are relatively few cases of severe lead poisoning each year, which means that only a small number of packages are stocked. There were about 50 serious cases reported in 2015, according to the American Association of Poison Control Centers, which also contacted Congress earlier this year about the increased pricing.
But even this small outlay can take a toll on hospital finances, and by extension public health, according to emergency room experts. In part, this is because the shelf life for the treatment is limited, but also because the funds could be used for other purposes, which can be an issue especially for some inner city hospitals that have limited resources and are more likely to see cases of lead poisoning.
The pricing further frustrates toxicologists because there are few viable alternatives. Most hospitals are not equipped to compound their own versions of the intravenous medicine. A pill called DMSA can be used, but since people suffering from severe lead poisoning are unconscious or can have seizures, it must be administered through a nasal tube into the stomach, which creates a risk of lung-related complications.
Valeant has explained the current pricing is justified in order to maintain consistent supplies, and that there are high carrying costs, since about 200 to 300 units are sold each year. Each unit contains a pack of five vials. The company also must purchase sufficient supplies of needed ingredients in advance and this can amount to three to five times more than recent annual sales, which were between $3 million and $5 million last year. The list price also does not reflect any rebates or discounts that Valeant pays.
Kildee, by the way, represents a part of Michigan that includes Flint, where lead in the water has become a huge public health problem. However, he noted that, while exposures were very high, residents were exposed over a period of time, which would have precluded emergency treatment with the drug. “So the opportunities to be treated (with the Valeant drug) were made more difficult as a result,” he explained.
“But this isn’t just about Flint kids,” he continued. “This is about any child or person exposed to high levels of lead and about a kind of corporate greed that, if left unchecked, can just continue.”
[UPDATE: Valeant later issued a statement noting that it “does not sell a product that can treat chronic asymptomatic exposure to lead.” Also, Dr. Michael Kosnett, an associate clinical professor in the division of clinical pharmacology and toxicology at the University of Colorado’s School of Medicine and a consultant to the California Poison Control System, whose complaints about pricing were previously reported, has noted the drug would not be used for situations such as the Flint water crisis because concentrations of lead would not likely have been high enough.]