September 23, 2015

TO: NASTAD Members and ADAP Directors

FR: Murray Penner and Sean Dickson

RE: NASTAD Response to Daraprim Pricing and Access

Recently, there has been substantial media attention to a price increase for Daraprim (), a drug used to treat in patients with HIV. As we previously reported to you, Turing Pharmaceuticals (Daraprim’s manufacturer) recently increased the price of Daraprim from $13.50 per pill to $750 per pill. ADAPs, as 340B entities, may purchase Daraprim at the 340B price of $0.01 per pill, though some ADAPs have reported being unable to access this price. NASTAD has worked with several states directly on these access issues.

Yesterday, NASTAD sent the attached letter to the Health Resources and Services Administration Office of Pharmacy Affairs (HRSA OPA), detailing a possible violation of the 340B Drug Discount Program’s non-discrimination provisions. NASTAD had previously worked with Turing to address these issues, and we hope they will be resolved shortly. However, the previous violation of the non-discrimination provision warrants attention from OPA. NASTAD also included Senator (VT) and Representative (MD) on the correspondence to HRSA as they have launched an investigation into this issue.

Turing announced yesterday that they would soon lower the price of Daraprim from $750 per pill back to $13.50 per pill, the price under the prior manufacturer. This price change is not expected to take effect immediately. Turing has not released any details of when the pricing change will occur or if Turing will expand distribution of Daraprim to ensure that ADAPs are able to purchase at the 340B price through their normal purchasing channels. If you have any challenges accessing Daraprim, please contact Sean Dickson for assistance.

Below, please find several links to news coverage of the price increase, Turing’s backing down from the price increase, interviews with Turing’s CEO, and coverage of the CEO’s problematic history with drug pricing. Also, please find an article describing how the manufacturer of cycloserine, a drug used to treat TB, recently reduced the price following activist pressure.

 Drug Goes From $13.50 a Tablet to $750, Overnight; http://www.nytimes.com/2015/09/21/business/a-huge-overnight- increase-in-a-drugs-price-raises-protests.html?ref=topics  Jump in Price for an Old Drug Will Be Rolled Back, C.E.O. Shkreli Says; http://www.nytimes.com/2015/09/23/business/big-price-increase-for- an-old-drug-will-be-rolled-back-turing-chief- says.html?ref=topics&_r=0  Big Price Increase for Tuberculosis Drug Is Rescinded; http://www.nytimes.com/2015/09/22/business/big-price-increase-for- tb-drug-is-rescinded.html  Turing CEO: Drug priced where we could make 'comfortable profit'; http://video.cnbc.com/gallery/?video=3000423226&play=1  Drug Goes From $13.50 to $750 Overnight; http://www.bloomberg.com/news/videos/2015-09-21/why-turing- increased-price-of-daraprim-over-500-  CEO who raised price of old pill more than $700 calls journalist a ‘moron’ for asking why; https://www.washingtonpost.com/news/to- your-health/wp/2015/09/21/ceo-of-company-that-raised-the-price-of- old-pill-hundreds-of-dollars-overnight-calls-journalist-a-moron-for- asking-why/  Is Big Pharma’s Biggest A**hole; http://www.thedailybeast.com/articles/2015/09/21/martin-shkreli-is- big-pharma-s-biggest-asshole.html  U.S. drug industry distances itself from company with 5,000 pct price hike; http://www.cnbc.com/2015/09/22/reuters-america-us-drug- industry-distances-itself-from-company-with-5000-pct-price-hike.html

Please contact Sean Dickson if you have any questions.

Murray C. Penner, Executive Director National Alliance of State & Territorial AIDS Directors (NASTAD) 444 North Capitol Street NW, Suite 339 Washington, DC 20001 Phone: (202) 434.8099 Fax: (202) 434.8092 [email protected] www.NASTAD.org