The Price Increase

In September 2015, Turing Pharmaceuticals raised the price of Daraprim (pyrimethamine) from $13.50 to $750 per tablet, a 5,455% increase. Turing had acquired the drug weeks earlier. A standard course of about 100 pills went from $1,350 to $75,000. Annual maintenance therapy for one patient could cost $336,000 to $634,000.

By late September, pharmacy prices had reached $888 to $906 per pill with dispensing fees included.

The Acquisition

On August 10, 2015, Impax Laboratories announced the sale of US marketing rights to Daraprim to Turing Pharmaceuticals for about $55 million. Impax CEO Fred Wilkinson called the deal "mutually beneficial." Turing also announced $90 million in first-round financing from Martin Shkreli and other investors. Daraprim was Turing's first commercial asset.

An internal email from Shkreli to his board, later disclosed through the FTC investigation, read: "Very good. Nice work as usual. $1bn here we come."

The FTC later established that from Turing's creation in fall 2014, the company had been searching for "a sole-source drug with a small patient population that it could place into restricted distribution."

Shkreli's Justifications

On Bloomberg TV on September 21, 2015, Shkreli said: "These days, in modern pharmaceuticals, cancer drugs can cost $100,000 or more, rare disease drugs can cost half a million dollars. Daraprim is still underpriced, relative to its peers."

He told CBS News the drug "was unprofitable at the former price, so any company selling it would be losing money. And at this price, it's a reasonable profit. Not excessive at all."

He told other outlets: "I'm like Robin Hood... I'm taking Walmart's money and doing research for diseases no one cares about."

Turing publicly claimed that the drug was underpriced relative to comparable medications, profits would fund R&D for improved toxoplasmosis treatments, patient assistance programmes would protect access, and 60% of net income would be reinvested in research.

In a later interview, Shkreli said he regretted the decision only because he had not raised the price further.

Internal Testimony

Former General Counsel Howard Dorfman, who served at Turing from December 2014 to August 2015, testified under subpoena at the Senate Aging Committee hearing on March 17, 2016. He said the price increase was "not justified by any such actual expenditure" in R&D, clinical trials, or educational programmes.

Dorfman testified that Turing had no formal study protocol for next-generation toxoplasmosis drugs, had not funded clinical trials, and had not produced the educational materials the company publicly cited as justification. He and other management committee members had "repeatedly raised business objections" to the pricing plan.

Dorfman also testified that Nancy Retzlaff, Turing's Chief Commercial Officer, had privately raised concerns about the price increase in management committee meetings while publicly defending it.

Hospital and Clinic Responses

Massachusetts General Hospital switched patients to alternative regimens in October 2015, calling Daraprim "prohibitively expensive." The hospital sent Turing a complaint about "inaccurate/misleading information" on patient access.

Grady Memorial Hospital in Atlanta lost access to the drug entirely for extended periods. Dr. Wendy Armstrong reported that each prescription required approval from a hospital review committee because of the cost.

At academic centres, infectious disease specialists went from prescribing Daraprim about five times a month to once a month or less.

One large public hospital documented the cost change: total drug costs for toxoplasmosis admissions rose from $50,310 across 66 admissions before the price hike to $1,026,006 across 61 admissions after it, a 20-fold increase.

Sales Collapse

Pills sold fell from 25,500 in August 2015 to 600 in December 2015, a 98% decline in four months. Senator Claire McCaskill disclosed the figures at the Senate Aging Committee hearing.

Turing's Partial Retreat

On November 24, 2015, Turing announced a hospital pricing programme:

  • Up to 50% discount for hospitals ($375 per pill)
  • New smaller 30-tablet bottles
  • 340B programme participation at "as low as $1 per 100-pill bottle"
  • Expanded patient assistance for uninsured patients below 500% of the federal poverty level

The list price of $750 per pill did not change.

The Patient Assistance Reality

Turing's patient assistance programme required enrolment through Walgreens Specialty Pharmacy, the sole authorised distributor. Patients and providers had to submit extensive financial and health information. Benefits were capped at $5,000 per month and $15,000 per year. Moving through the programme could take hours or days.

Some patients faced copays of $16,830 despite the programme. Turing claimed universal access, but patients and hospitals reported otherwise. That gap became a central focus of the 2016 congressional hearings.

Prior History at Retrophin

Shkreli had used the same approach at Retrophin, the company he founded in 2011 and was fired from in September 2014:

  • Thiola (tiopronin), used to treat cystinuria: price raised from $1.50 to $30 per pill, a 2,000% increase. Patients required 10 to 15 pills per day.
  • Chenodal: price raised approximately fivefold.

Both increases drew little public attention because the patient populations were smaller. Daraprim followed the same model: a sole-source drug, a captive patient population, and no therapeutic alternative.

The price of Daraprim did not return to $13.50. Generic pyrimethamine became available in February 2020, five years after the increase. The FTC settlement in December 2021 required the company, then called Vyera Pharmaceuticals, to provide the drug at no more than $1 a tablet to certain buyers. Vyera filed for bankruptcy in May 2023.