KV Pharmaceutical Company (KV) was an American drug company that brought generic and non-branded pharmaceutical products to the market. Headquartered in St. Louis, Missouri, it had research and manufacturing facilities, as well as marketing and sales operations, the latter activities conducted through its subsidiaries, Ther-Rx Corporation and Nesher Pharmaceuticals Inc. Background KV was founded by Bob Keith & Victor Hermelin in 1942 who ran the company until 1975, when he was replaced by his son Marc. Marc Hermelin was ousted in 2008 when an FDA inspection took place. The following year KV convicted of felony charges for the "making, marketing, and distribution of adulterated and unapproved drugs" was shut down by the Food and Drug Administration (FDA). After a proxy fight, M. Hermelin returned to the company's board. Between 2008 and 2010, KV lost three-quarters of its workforce, down to 350. KV was reapproved for manufacturing drugs in 2010, while its Ethex manufacturing subsidiary was sold. Rather than developing new molecular entities, KV researches different modes of drug delivery. It developed bioadhesive drug delivery where molecules adhere to wet sites such as a mucosa (example Clindesse), and is investigating quick-dissolving and controlled-release drug venues. Makena pricing controversy In February 2011, U.S. Food and Drug Administration (FDA) granted approval to KV for "Makena" (hydroxyprogesterone caproate or OHPC) for the prevention of premature birth in women with a single fetus of less than 37 weeks gestation who had at least one previous preterm birth. For many years, however, OHPC had been available and used by obstetricians "off label". Prior to the release of Makena, the drug was made available by pharmacies that compounded the agent for $15 or less per injection (typically 15 to 20 injections are given over a treatment course). With the FDA approval of Makena as an orphan drug, KV received the exclusive right to sell the drug for seven years. KV boosted its price by a factor of 100, to $1,500 per injection, or about $25,000 per treatment. The pricing policy of KV was heavily criticized as it substantially increased medication cost and removed less expensive alternatives. KV indicated that the cost of taking care of a premature birth is about $51,000 justifying the cost of the medication, further, a system would be in place to enable patients without means to obtain the medication. Thus, expenses would essentially fall on the public sector and insurance carriers. A number