What Goes Around Usually Does Come Around.

If you look up "arrogant jerk" in the dictionary, I suspect you'll find a photograph of Martin Shkreli, CEO of Turing Pharmaceuticals.

If you haven't been following this story -- and I sort of wish I hadn't been, because it's so depressing -- Shkreli, a former hedge fund manager, runs Turing, a start-up pharmaceutical company. How do you start up a pharma? By buying existing drugs.

In August, Turing acquired Daraprim, a 60-plus year old drug that is used primarily to treat a serious and often life-threatening parasitic ailment, toxoplasmosis, and is also used to treat malaria. Overnight, the price of the drug went from $13.50 a tablet to $750 a tablet. That's right, $750. Take the original price and increase it more than 50 times. (For expanded discussion of the original price increase and of the problems Shkreli has seen and/or caused in previous careers, see the Sept. 20 New York Times article by Andrew Pollack, here.) 

Despite a storm of protests, late last month Turing refused to lower the price (Times article, also by Andrew Pollack, here). It did say, however, that "it would offer discounts of up to 50 percent to hospitals and would take other measures to help patients afford the medicine."

Protests have been ineffective, obviously, but now Turing faces a new foe: Express Scripts, the nation's largest prescription drug manager.

According to Andrew Pollack of the New York Times, Express Scripts "will promote use of a compounded medicine that contains the same active ingredient as the Turing drug." (Full story, here)

Nathan Bomey of USA Today (article, here) reported that Express Scripts will "speed access to a $1 treatment offered by San Diego-based Imprimis Pharmaceuticals" and noted that while the Food and Drug Administration has not approved Imprimis' compounded drug formulations as a recommended treatment for toxoplasmosis," doctors can immediately prescribe the treatment.

Not surprisingly, Turing reacted negatively. Bomey reported that a Turing statement termed the move "potentially unsafe and ineffective", and added that the compounded version is "unnecessary" because "patient assistance programs" can reduce the cost to an insured patient to a $10 copay (last time I checked, $10 was still a lot more than $1), and free of charge to qualified uninsured patients.