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An ICU staple has exponentially spiked in price. Can compounding solve that problem? Now the courts will decide

The price of vasopressin, a staple of ICUs around the country, spiked in 2015. Now federal judges will decide if a cheaper, compounded alternative is worth the risk.

WASHINGTON — When a sepsis patient goes into vasodilatory shock — that is, blood stops flowing to the brain and other vital organs — the intensive care unit springs into action. Alarms blare and frenzied doctors and nurses rush to find a crash cart, scrambling through its contents for a decades-old drug: vasopressin.

Until recently, the drug was so vital and so cheap that hospital staffs kept it stashed in every corner of the ICU. In 2011, a box of 25 tiny vials cost less than $200. But after the Food and Drug Administration granted an Endo Pharmaceuticals subsidiary the exclusive right to make the drug in 2014, the price spiked: the same box, now bearing the brand name Vasostrict, cost over $4,000 in 2018.

It sounds like a time-worn tale in the vein of daraprim and EpiPen: another drug maker cornering the market and spiking the price of an old and vital drug.

There is, however, another version of vasopressin on the market — a compounded product, made by a Buffalo, N.Y.-based drug maker that combines the medicine’s bulk ingredients much the way as its FDA-approved counterpart. The alternative’s very existence has already sparked allegations of trade secrets theft, and inspired at least three lawsuits against its manufacturer and against the FDA itself. The latest was filed just last week.

Compounded drugs

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