Patients have been aware in recent years of steep increases in the cost of prescription drugs which they require. Public attention to this issue escalated last year after the cost of Daraprim, a drug used to treat toxoplasmosis, a parasitic disease posing a threat to patients with HIV/AIDS and other immune disorders, was raised from $13.75 to $750 per capsule.

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Clif Cleaveland

Despite a public outcry, that is the price quoted today at

Turing Pharmaceuticals, a small, privately held company, bought the rights to Daraprim early last year from Imax Laboratories for $55 million. The market for the drug was small with sales of 9 million per year. Daraprim, however, was critical to the survival of hundreds of Americans.

Congress responded to the price hike of Daraprim with hearings in which which Turing's CEO, Martin Shkreli, repeatedly invoked his Fifth Amendment rights in his testimony. He subsequently resigned because of unrelated charges of securities fraud. Turing countered adverse publicity by promising that the company would assure access to Daraprim by anyone who needed it, regardless of ability to pay.

Other steep price hikes have garnered less publicity despite affecting many thousands of patients.

The August 2016 issue of Consumer Reports questions the pricing of Treximet, a medication for migraines. Treximet is a combination of generic sumatripan and over-the-counter naproxen. The co-payment for patient purchasing 27 tablets in 2013 was $92. The following year, the co-payment increased to $827. Consumer Reports determined that a 90-day supply of various doses of sumatripan could be purchased for less than $45 from a discount pharmacy, while 300 tablets of naproxen, 220 mg, sold for less than $12 at Walmart. Purchasing the components of Treximet separately saved $790 for a 90-day supply.

The July 31, 2016 edition of The New York Times focused attention upon the pricing policies of Valeant Pharmaceuticals. In summer 2015, the company raised the price of 30 tablets of Glumetza, an oral medication for treating diabetes, from $572 to $3,432 and, finally, to $5,148. Glumetza is an extended-released form of metformin. Sixty tablets of metformin cost less than $4 at multiple pharmacies.

Valeant Pharmaceuticals also raised the price in 2015 for 30 capsules of Zegerid, a medication for acid-reflux, from $421 to $3,034. Zegerid is a compound of omeprazole and sodium bicarbonate. Thirty capsules of omeprazole may be purchased for less than $10 at Walmart.

Pricing of EpiPen, an injectable form of epinephrine that is vital to the treatment of sudden, acute allergies, has returned the spotlight to runaway drug prices. New York Times reports in August detailed the steep increase from 2007, when a two-dose set of the drug cost less than $100 wholesale, to July 2013, when the wholesale price rose to $264.50, to May 2016, when the price rose to $608.61. Persons subject to severe allergic responses to insect stings and such food allergies as nuts and shellfish depend upon prompt injection of epinephrine to save their lives. Persons subject to such allergies keep EpiPen on hand for emergencies, as do school nurses.

While insurance plans may bear the majority of EpiPen costs, patients will pay hundreds of dollars in co-payments. Uninsured persons and those with high-deductible insurance plans could be stuck with the full price. Mylan bought the rights to Epi-Pen, which had a relatively stable price for decades, in 2007. The company has responded to adverse publicity by promising to make the drug available at no-charge to those who cannot afford it.

Facing huge public and political outcry, on Aug. 29, Mylan announced the release in several weeks of a generic EpiPen which will cost half as much, but it's still three times costlier than the 2007 price.

Adrenaclick is an alternative to Epipen. Cost for two injectable doses ranges from $145 to $350 among Chattanooga pharmacies.

Congress has responded to EpiPen price hikes with its usual statements of outrage and a call for hearings. But this begs a broader issue. Widespread, steep increases in prescription drugs are hurting countless patients. Hearings drag on for months until the public forgets about an issue.

We must have congressional hearings now about unconscionable price gouging involving numerous vital drugs. The issue of price controls must be addressed. If Congress fails to act, it tells us that it has become a subsidiary of a drug industry that annually pours millions of dollars into lobbying.

Contact Clif Cleaveland at