Our pharmacists often receive questions about specific medications such as how they are being used to properly treat an injured worker. Two drugs we hear questions about frequently are Nuedexta® and Levorphanol, which are high-cost, specialized medications in neuropathic conditions. Here are...
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" Levorphanol was previously manufactured by West-Ward Pharmaceuticals, a subsidiary of Hikma Pharmaceuticals, at a cost of $2.14 per tablet (AWP). West-Ward discontinued levorphanol in 2015. A small U.S. specialty pharmaceutical company, Sentynl Therapeutics, Inc. revived levorphanol shortly thereafter and raised the price to $46.90 per tablet in 2015 (a 2,092% increase). As of April 1, 2018, Sentynl is selling levorphanol for $53.40 per tablet (AWP) and is now only available in a 2 mg generic tablet. According to Sentynl, the higher cost of levorphanol is due to the high cost of manufacturing incurred by a smaller size company and historic low demand for the drug. Low volume drugs like levorphanol demand higher cost for sustainability. "
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Fast forward to mid-2015 when the recently formed Sentynl Therapeutics, Inc., a small US-Based specialty pharmaceutical company rereleased a “new” levorphanol to the market. It seemed like good news for pain sufferers that tolerated and responded to it well. But things turned sour for many when they learned that the average wholesale price (AWP) of 2mg tablets had changed from $214/100 tablets to $4650/100 tablets, a 2073% increase based on 2015 Red Book pricing.3 This practice has been a concern of Dr. Fudin and several of his colleagues since the new levorphanol resurfaced, and as
What the Market Will Bear pointed out in a previous paindr.com blog, numerous companies have heretofore come under fire for increasing the price of orphan drugs that have no generic or therapeutic alternative to treat the intended disease.
But at closer glance and unique to this situation is that unlike the
Daraprim (pyrimethamine) debacle and iniquitous behavior of Martin Shkreli outlined in the blog hyperlink above, Levorphanol is
not an orphan drug and
does have therapeutic alternatives. That paints Sentynl Therapeutics in a very different light compared to the scandalous behavior of Shkreli’s Turing Pharmaceuticals.
Unique to this situation, methadone and levorphanol share similar pharmacology, but levorphanol provides another option for those that cannot tolerate or are not candidates for methadone. And, levorphanol may be safer for a variety of reasons.4 But, when the comparing generic methadone pricing to generic levorphanol in terms of pricing, with this new AWP levied on levorphanol, methadone is $33.16 to $73.84/100 tablets depending on the strengths compared to $4650/100 tablets of levorphanol.3 In today’s healthcare marketplace, clinicians no longer have the luxury of considering just the risk/benefit ration when making therapeutic choices. The cost of therapy and the patient’s insurance coverage and large Pharmacy Benefits Managers are frequent determinants when comparing and selecting drug treatment options
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