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November 2018

Reducing Hospital Pharmacy Spend After Pharmaceutical Price Increases—Don’t Get Mad, Get Lean

Author Affiliations
  • 1Office of Clinical Quality Improvement, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 3Department of Pharmacy, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Pediatr. 2018;172(11):1005-1006. doi:10.1001/jamapediatrics.2018.2042

Isoproterenol is a β-adrenergic agonist used for the emergent treatment of pulmonary hypertensive crisis and other life-threatening cardiovascular conditions.1 In 2013, Marathon Pharmaceuticals acquired isoproterenol (Isuprel) from Hospira Pharmaceuticals and raised the wholesale acquisition cost of a 5-mL vial (0.2 mg/mL) from $45 to $208. Two years later, Marathon sold the drug to Valeant Pharmaceuticals, which raised the wholesale acquisition cost again to $1700 per vial. After this nearly 40-fold increase in price, isoproterenol accounted for $3.9 million (7%) of the total fiscal year 2016 pharmacy spend at our children’s hospital (Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania). Over the course of 2 years, an inexpensive generic medication that physicians ordered without thinking twice about price became one of the costliest medications in the pharmacy budgets of hospitals across the country.2