The decision by Nostrum Laboratories executives to more than quadruple the price of an antibiotic drug developed more than six decades ago reflects opportunistic greed in its most indefensible form. Nostrum is currently the sole manufacturer of the liquid formulation of nitrofurantoin, an antibiotic that also is available in pill form. As antimicrobial resistance poses a growing worldwide threat, incentivizing development of truly novel antibiotics is imperative. An exorbitant price hike that can impede access to older antibiotics that remain effective, without need or cause, is unethical.
The drug is one that infectious diseases physicians promote for the treatment of urinary tract infections, to avoid the suboptimal use of other medicines that can lead to drug resistance. The liquid form is important to patients who have difficulty taking pills. The manufacturer’s 400-percent price hike, from about $500 per bottle to more than $2300 per bottle can reduce access to an effective antibiotic, at a time when drug-resistance already has increasingly challenged treatment of those infections. In addition to contributing to rising numbers of hospitalizations, the price increase poses an irresponsible and unnecessary threat to patients and public health.
It is important to note that Nostrum Laboratories, which packages and markets the drug, had no role in its discovery, development, or production. The drug itself costs pennies to produce. Antibiotics offer tremendous value to society, but only if they are accessible in a way that allows their appropriate use. IDSA and HIVMA believe that antibiotics should be priced to reflect their value without compromising patient access. While nitrofurantoin is valuable to the patients who receive it, this price hike exploits, rather than reflects the value of the drug.
We believe that developers of new antibiotics should receive fair returns on their investments. We advocate strongly for incentives that promote innovation and strengthen the pipeline of these critical medicines. Financial models for antibiotic reimbursement, however, should reward true innovation, promote stewardship, and protect appropriate patient access to needed therapies. This price hike fails on all three points.
As with the price increase for the toxoplasmosis drug Daraprim (pyrimethamine) that earned Turing Pharmaceuticals company infamy just a few years ago, this price reflects cynical opportunism rather than investment and innovation.
As this price increase becomes news, it is worth noting that laws exist to discourage exorbitant price hikes of necessary supplies such as bottled water that exploit emergencies including hurricanes. This act of price gouging should not be viewed differently.