When California鈥檚聽takes effect this June, could be faced with a hefty bill for the lethal medication. It retails for more than $3,000.
Valeant Pharmaceuticals, the company that makes the drug most commonly prescribed by physicians to aid patients who want to end their lives, doubled聽the drug鈥檚聽price last year, one month after California lawmakers聽.
鈥淚t鈥檚 just pharmaceutical company greed,鈥� said David Grube, a retired a family doctor in Oregon, where physician-assisted death has been legal for 20 years.
The drug is Seconal, or secobarbital, its generic name. Originally developed in the 1930s as a sleeping pill, it fell out of favor when people died from taking too much or from taking it in combination with alcohol. But when intended as a lethal medication to hasten the death of someone suffering from a terminal disease, Seconal is the drug of choice.
鈥淚t works very quickly and very gently,鈥� says Grube, who is also the national medical director for Compassion and Choices, an advocacy group. 鈥淧eople fall asleep with no complications. It鈥檚 a very gentle passing.鈥�
In 2009, Grube remembers the price of a lethal dose of Seconal 鈥� 100 capsules 鈥� was less than $200. During the next six years, it shot up to $1,500, according to drug price databases Medi-Span and First Databank. Then Valeant bought Seconal last February and immediately doubled the price to $3,000.
Most drug companies justify such hikes by pointing to high research costs. But Grube says that鈥檚 not the case with Seconal. It鈥檚 been around for 80 years.
鈥淚t鈥檚 not a complicated thing to make, there鈥檚 no research being done on it, there鈥檚 no development,鈥� he says. 鈥淭hat to me is unconscionable.鈥�
Valeant bought several other drugs聽at the same time it bought Seconal, raising some of those prices as much as 500 percent. That sparked a congressional investigation into its pricing practices. (The company鈥檚聽 Monday).
鈥淰aleant sets prices for drugs based on a number of factors,鈥� the company said in a statement, including the cost of developing or acquiring the drug, the availability of generics and the benefits of the drug compared with costly alternative treatments. 鈥淲hen possible, we offer patient assistance programs to mitigate the effects of price adjustments and keep out-of-pocket costs affordable for patients.鈥�
The most likely explanation for raising the price of Seconal is the lack聽of generics, says Mick Kolassa, founding partner of Medical Marketing Economics, a firm that advises drug companies on how to price and market their drugs.
Seconal went off patent in the early 1990s. There were some generics for a while, but then demand shrank and manufacturers abandoned them.
鈥淪o that meant when the current company bought it, they didn鈥檛 have any generic competition, simply because the market got so small that it left,鈥� Kolassa said. 鈥淪o in situations like that, a company can acquire it and raise the price.鈥�
鈥淗ere鈥檚 a company that said, 鈥榃ell, we can raise the price, keep it on the market and make some money with it. Or we can walk away and the product goes away,鈥欌�� he said.
Whatever the explanation, what cancer patients like Elizabeth Wallner see is a drug company taking advantage. She has one word to describe the pharmaceutical executive who decided to double the price of Seconal: 鈥淪cumbag.鈥�
Wallner was diagnosed with Stage 4 colon cancer five years ago. It spread to her liver and lungs. She always thought that if her suffering became too unbearable, she would consider ending her life. But she never thought about the price tag of the lethal drug.
鈥淵ou鈥檙e going to make money off my death,鈥� she said.
She鈥檚 most worried about her son.
鈥淵ou are literally, at that point, taking the money from children,鈥� she said. 鈥淓verything I have, if I鈥檓 going to die tomorrow, everything I have will be left to my son who will be 20 years old and almost 100 percent on his own.鈥�
Under the California aid-in-dying law, it is optional for health insurance companies to cover the costs of the practice. Most private insurers plan to do so, according to the California Association of Health Plans.
So does the state鈥檚聽.
But for patients who aren鈥檛 covered, there is a cheaper alternative: a three-part drug cocktail that can be mixed by a compounding pharmacy for about $400.
Grube says the cocktail works just as well, but doctors usually don鈥檛聽prescribe it聽because of the hassle some patients have to go through to get it. Seconal, on the other hand, is a ready-made pill, routinely available at most retail drugstores.
He says advocacy groups are working on campaigns to reduce drug costs and to聽聽and patients about the law.
鈥淢y dream is that any Californian who will choose aid in dying would have few burdens or barriers to jump through,鈥� Grube said.
Katie Orr contributed reporting from Sacramento.
This story is part of a partnership that includes , and Kaiser Health News.