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Illustration: Aïda Amer/Axios

In 2008, a box of 30 anti-inflammatory rectal suppositories that treats arthritis, called Indocin, had a price tag of $198. As of Oct. 1, the price of that same box was 52 times higher, totaling $10,350.

Why it matters: As federal lawmakers continue to waver on drug price reforms, Indocin is another example of how nothing prevents drug companies from hiking prices at will and selling them within a broken supply chain.

Driving the news: Indocin has changed ownership multiple times over the years, and the companies involved have controversial histories.

  • Iroko Pharmaceuticals, the original owner of Indocin suppositories, consistently raised the drug's price.
  • Indocin's list price (what uninsured patients would pay) was $198 for 30 suppositories in 2008. Iroko raised it to $2,550 by January 2018 after more than a dozen separate increases, according to Elsevier's Gold Standard Drug Database.
  • Later in 2018, Iroko was going bankrupt and sold itself to another small company called Egalet.
  • After Egalet acquired Iroko's drugs, Egalet significantly increased prices. We reported on one of those large price hikes in 2019.
  • Egalet doubled the price of Indocin, to $5,100, months after the company acquired it, according to Elsevier's pricing database.
  • Egalet then changed its name to Zyla Life Sciences in 2019, right after its price hikes were aired.
  • Zyla raised the price on Indocin again, to $5,604.90 in January 2020, and then sold itself to a separate drug company called Assertio in May 2020.
  • Assertio previously was named Depomed, a company that sold a controversial opioid.
  • Since acquiring Indocin, Assertio has marked up the price twice: first to $6,159.79 at the start of this year, and then again this month to $10,350.
  • Indocin sales hit $27.7 million in the first half of this year, representing more than half of Assertio's revenue. That total was five times higher than $5.4 million collected during the same period of 2020.

Tim Walbert, CEO of Horizon Therapeutics, served as the board chair of Egalet and Zyla since 2015. He resigned from the board of Assertio last December.

  • Walbert and Horizon have been criticized for their pricing practices and drug formulations.

What they're saying: A spokesperson for Horizon Therapeutics told Axios that "Walbert has not been involved with Assertio for approximately a year and as a result does not wish to comment."

  • Assertio did not respond to interview requests.

The bottom line: Indocin is a small drug within the pharmaceutical industry, but it shows how the Martin-Shkreli-type price increases never disappeared and occur for numerous drugs that fly under the radar.

Go deeper

Medicare drug negotiations may not be as limited as we thought

Illustration: Rae Cook/Axios

Here's one wonky but meaningful clarification, at least for us: Democrats' drug pricing bill would allow Medicare to negotiate the prices of up to 20 new drugs a year, but the prices negotiated in previous years would remain in effect until a competitor enters the market.

Why it matters: Which drugs can be negotiated is still much more limited than Democrats' original plan. But this means that, eventually, Medicare will likely be able to negotiate the prices of a lot more than just 20 drugs.

Updated 43 mins ago - Health

New Zealand aims to create smoke-free generation with tobacco ban

New Zealand Prime Minister Jacinda Ardern at a December news conference in Auckland, New Zealand. Photo: Phil Walter/Getty Images

New Zealand officials announced Thursday legislative plans to outlaw smoking by making it illegal to sell or supply tobacco products to the next generation as part of a lifetime ban.

Why it matters: "People aged 14 when the law comes into effect will never be able to legally purchase tobacco," Associate Health Minister Ayesha Verrall said in a statement announcing the proposed law, part of the Smokefree 2025 Action Plan.

California father and son accused of "reckless arson" in Calder Fire

Firefighters at the Caldor Fire along Highway 89 west of Lake Tahoe, California, in September. Photo: Wally Skalij/Los Angeles Times via Getty Images

California officials said they arrested a father and son Wednesday on suspicion of starting the Caldor Fire, which threatened the Lake Tahoe area as it burned for over two months earlier this year. They deny any wrongdoing.

Why it matters: The wildfire was the 15th-biggest ever recorded in California, razing more than 1,000 structures, forcing thousands to evacuate and injuring five people as it burned across nearly 222,000 acres of land in El Dorado, Amador and Alpine counties.