Activists hold signs containing the image of Turing Pharmaceuticals CEO Martin Shkreli in front the building that houses Turing's offices on Oct. 1, 2015 in New York. Craig Ruttle/AP

Many cardiac arrest patients can no longer count on getting a life-saving generic heart drug because it has become too costly for some hospitals to stock, a witness will tell a congressional committee Wednesday.

The drug, isoproterenol hydrochloride, sells for $2,700 a vial, up from $50 just two years ago, Erin Fox, director of the Drug Information Service at the University of Utah Health Care, will tell members of the Senate Special Committee on Aging. The increase would have driven the academic health care network's costs for the one drug to $1.6 million, an amount that the university couldn't recoup from the managed care plans that cover most of its patients.

"We had to remove the medicine from our emergency crash cart, because we couldn't continue to stock it," Fox says. Fox, whose service tracks shortages of prescription and generic drugs, is one of four experts scheduled to address a Senate committee investigating drug prices that, in some cases, have risen by 1,000 percent or more. Many of the drugs are generics acquired through a merger or acquisition by a drug company that promptly increased the price.

The shortage of isoproterenol complicates care for some critically ill heart patients, especially those who've had heart transplants, Fox says. Fortunately, doctors have managed to care for most patients effectively without it. In life-and-death situations, however, they use the drug. "So far we haven't had any problems that I'm aware of," she says. "Our physicians are frustrated that we have to make these choices just because of cost."

"We need to find out whether there's a failure in this marketplace—and given the incredible price spikes we've seen that's certainly a possibility," says Sen. Claire McCaskill, D-Mo., ranking member of the Senate Aging committee. "My goal is to ensure that some companies aren't using a lack of competition… as an excuse to cash in at the expense of taxpayers and people that need these medications."

Among the companies provoking concern are Valeant Pharmaceuticals, Inc., which now owns Isuprel, and Turing Pharmaceuticals, AG, maker of the antibiotic Daraprim. The Aging committee last month announced a bipartisan investigation into "dramatic drug price increases–often on older, off-patent drugs."

The probe is only the latest of several congressional inquiries. Last year, the Senate Subcommittee on Primary Health and Aging held a separate hearing; House Democrats have formed a task force to investigate the issue.

The committee is looking into companies that snap up, and profit from, drugs that are already on the market. These drugs typically don't require any additional research or development. In the case of isoproterenol, nothing has changed since Valeant purchased it – other than the price. "Hospira is still manufacturing the drug," Fox says. "The only thing that's changed is the label."

In November, the committee sent letters to several firms requesting information about their pricing practices. The Turing letter questions why the company raised the price of Daraprim from $13.50 a tablet to $750. The committee asked Valeant to explain why it raised the price of isoproterenol from $4,489 for 25 ampules to $36,811 and nitroprusside from $257 to $805.61 per vial. Two other companies, Rodelis Therapeutics and Retrophin Inc., have also been asked to provide pricing information.

Edward Painter, Turing's head of communications and investor relations, said the company would not comment on the hearing. Valeant did not return a call requesting an interview.

Committee members plan to examine causes of the price increases, how they affect patients' access to the drugs and "related regulatory and public policy concerns." One issue, experts say, is the wave of mergers that is restricting the number of competitors, opening the door to monopoly pricing.

"The Turing drug is an example," says Gerard Anderson, a Johns Hopkins University professor of health policy and management, who will address the committee. "It's an orphan drug with only one manufacturer."

Generic drugs, which account for 80 percent of all drugs sold in the U.S., were once considered a bargain in the high-priced world of health care. No longer. "Quite a number of them now are going up at a fairly rapid rate," Anderson says, helping to drive up health care costs across the board.

Last year, he says, drug spending increased by 11 percent, five times faster than inflation. The U.S. News Health Care Index shows that prescription drug spending by consumers grew 55 percent from 2000 to 2013, and an April report by IMS Institute for Healthcare Informatics, a global information and technology services company, found spending on medications reached a record high of $373.9 billion in 2014.

Anderson says he'll encourage the committee to recommend expedited Food and Drug Administration review for generic drugs when there's no competitor on the market to generate competition. It can take from six to 18 months to get FDA approval for a generic drug, he says. "If I get it faster, I can get quicker price competition."





In the meantime, Fox says, her hospital deals with high-priced generics just as it deals with drugs in short supply: Doctors and pharmacists figure out how to do more with less. That's particularly worrisome for drugs of last resort, like isoproterenol, and antibiotics. Antibiotics are a concern because substitute drugs are often stronger, which can promote antibiotic resistance.

Unpredictable pricing makes it challenging to plan the pharmacy's budget, she says. "We try to plan for newer medications that we know are going to cost more money. It's almost impossible to predict when older products are going to act like brand-name drugs, through price increases."

Rising prices aren't just a problem for patients, doctors and hospitals, says Kevin Schweers, senior vice president of the National Community Pharmacists Association. "The payment rates paid to pharmacies aren't updated enough to keep pace with these costs," he says. "These used to be isolated incidents, but now it happens on an almost daily basis, and community pharmacies are forced to dispense medication at a loss."

