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By Serge Kreutz (2010)
Dostinex is a brand name for the pharmaceutical chemical cabergoline. The pharmaceutical use of cabergoline is widely covered by patents held by Pharmacia & Upjohn, a worldwide company with strong Italian and US components. As they are the sole patent holder, Pharmacia & Upjohn can decide, rather arbitrarily in most countries of the world, at what prices cabergoline is sold. There are few exceptions. India is one. India does not recognize patents for pharmaceutical substances, so that, in theory, any Indian pharmaceutical company could start manufacturing cabergoline tablets, and sell them at least in India. Of course, supply would trickle through to other countries, as does the supply of sildenafil citrate (the active ingredient of Viagra).
Alas, I am not aware yet of any Indian cabergoline supplier, and Indian cabergoline supply is not the topic of this article.
The much cheaper cabergoline is supplied by Pharmacia & Upjohn themselves.
Pharmacia & Upjohn decides for specific marketing strategies based on a rather complex set of considerations. Obviously, they want to make as much money as possible. Nothing wrong with that, in principle. (Though I, for myself, prefer to buy for as low a price as possible.)
There are competing products for the same conditions (prolactinoma, Parkinson's disease, restless leg syndrome), such as bromocriptine, for which patents have expired, and which, for this reason, are produced by a number of pharmaceutical companies. That keeps prices down.
There are also government regulations to comply with, and they vary from country to country. In some countries, prices have to be officially approved if Pharmacia & Upjohn want cabergoline prescriptions covered by insurance.
Furthermore, a drug has to be approved for certain conditions separately in each country where it is marketed. In some countries, it's easy; in others, it's tedious.
All of this adds up to sometimes stark differences in the price of specific drugs.
Cabergoline is one of them.
First of all, cabergoline's label indications are rather limited in the US. By FDA approval, the drug is indicated in the treatment of prolactinomas (pituitary cancers that express themselves in increased prolactin levels).
However, in Europe where Pharmacia & Upjohn sell cabergoline under the brand names Cabaser (UK, Switzerland, and others) or Cabaseril (Germany), the approved use is not just in prolactinomas but also in the treatment of Parkinson's disease. That makes a huge marketing difference.
The cabergoline dosages needed for the treatment in prolactinomas are rather small: 0.5 to 2 mg per week. The dosages needed to treat Parkinson's disease are typically much higher, which is why cabergoline is always cheaper in countries where it is officially approved for the treatment of Parkinson's disease.
So, while in the US, Pharmacia & Upjohn sell cabergoline under the brand name Dostinex (sold for the treatment of prolactinomas) in tablets of just 0.5 mg, they market Cabaser and Cabaseril (for the treatment of prolactinomas and Parkinson's disease) in tablets of 0.5 mg, 1 mg, 2 mg, and 4 mg.
For cabergoline as Parkinson's disease medication, Pharmacia & Upjohn could not possibly charge 27.25 US dollars per 0.5 mg. Treatment at such tablet prices would cost a Parkinson's patient, or his insurance company, tens of thousands of dollars per year. That's unrealistic. So Pharmacia & Upjohn sell the drugs at much lower prices wherever it is approved for the treatment of Parkinson's disease. 16 times cheaper in most of Europe, and up to 34 times cheaper in some countries, such as Switzerland. If one buys the 4 mg tablets, not the 0.5 mg ones.
It is not uncommon that different-strength tablets of medications are sold at practically the same price. Pfizer's Viagra, for example, costs almost the same for the 25 mg, 50 mg, and 100 mg tablets. Which is why those who have to pay themselves for their Viagra (as opposed to those for whom insurance shoulders the bill) buy the 100 mg version and just split it with any ordinary scissors.
For cabergoline, too, this is the right approach.
As mentioned above, the lowest price for cabergoline is charged in Europe's richest country: Switzerland. In Switzerland, the government-approved price for 16 tablets of Cabaser at a strength of 4 mg is 151.80 Swiss Franks, which converts to about 100 US dollars.
That's 64 mg of cabergoline for about 100 US dollars, less than 80 US cents per 0.5 mg.
In the US it's 218 US per 8 tablets of 0.5 mg, which is 27.25 per 0.5 mg.
The US price is 34 times higher for exactly the same cabergoline, produced by exactly the same pharmaceutical company, Pharmacia & Upjohn.
I wonder whether pharmaceutical companies choose to sell the same medication under different names in different countries so that the price difference doesn't become too obvious to the average patient and consumer?
Obviously, Swiss pharmacies require prescriptions for prescription drugs. While in Germany and Australia, overseas prescriptions are not usually accepted, there is no such impediment in principle with Swiss online pharmacies.
And of course, a US physician is free to prescribe an approved drug for other conditions than those listed on the package brochure. This is called an "off-label prescription". A US physician prescribing cabergoline for Parkinson's disease would be a typical example.
Swiss pharmacies are usually diligent in answering email (I haven't had a single email that remained unanswered), and English is not a problem in principle. However, many of these pharmacies are not accustomed to sending medications abroad, and they may decline orders because they are not familiar with international credit card transactions, or just shay away from the bureaucratic effort. Most Swiss pharmacies will answer that they accept abroad prescriptions, but that the Cabaser will have to be purchased personally at their pharmacy.
On the other hand, at least one Swiss pharmacy, the Victoria Apotheke in Zurich, has been shipping medications worldwide for many years. Their URLs are:
http://www.access.ch/victoria_pharmacy/ and http://www.pharmaworld.com/
Their website states:
"Costs: The medicine will be charged at the official retail price. Prices may vary slightly according to currency fluctuations. Additional costs for shipping and handling will be calculated according to the weight of the consignment."
I have not seen their official price list, and the Victoria Apotheke has been slow in answering my mail. Please note that I have no affiliation whatsoever with the Victoria Apotheke, or, for that matter, with any other source I list. Therefore, I cannot be held responsible for the prices charged by the Victoria Apotheke or any other source. Please have prices confirmed before ordering.
The government-approved Swiss retail price is 151.80 Franks. And this is the price I have paid for my Swiss Cabaser, bought on a German prescription, and I have been quoted exactly the same, 151.80 Franks, by all the Swiss pharmacies I contacted. Please note: the German / Swiss word for pharmacy is: Apotheke
The Victoria Apotheke requires that the original prescription is sent by mail.
Americans and people who live in other non-EU countries can buy cheap cabergoline (Cabaser) from the following source:
Click on their C list for Cabaser. 16 tablets at 4 mg are 130 US dollars, which is only slightly more expensive than the Swiss price of approximately 100 US dollars. Their shipping charge is 15.50 dollars.
It seems that their website is sometimes down for maintenance. It's usually back online within two or three days. In case you should have problems accessing their website, here are their address details:
5 Sandridge Close
Harrow Middlesex HA1 1TW
Direct Line from USA
Tel: 01144 20 8424 9400
Fax: 01144 20 8427 1994
From outside the USA
Fax: +44 (0) 20 8427 1994
They mention that they ship a lot to the US, and do not request a formal prescription. Instead they ask those who order to agree to the following statement: "I declare that these items have been provided for my personal use only and that they are not for commercial resale. No beneficial or therapeutic claims have been made for these items, and the amount does not exceed a three month supply. These items are used with the consent of my Physician. I hereby hold MASTERS MARKETING COMPANY harmless from legal action which may be brought against any of these products."
The above source is not available to residents of EU countries. EU residents, of course, can buy at any local pharmacy in their respective countries at prices that, typically, are only about double the Swiss price, or less than double the Masters Marketing price, but still much less than 10 percent of the US price.
EU residents who want to receive their Cabaser through the postal services, and should have communication problems with the Vioctoria Apotheke, can order at roughly double the Swiss price (which is still much, much lower than the US price) at the Farmacia Meritxell online pharmacy, based in Andorra. They are effectively organized, and on working days, they answer mail quickly. Their replies are in Spanish, but those parts you have to comprehend in order to order are easily understood even for people who do not speak Spanish (like me). This primarily concerns data like credit card numbers, and the amount of money to be remitted.
Their address details are:
Dr. Nequi n' 7 Andorra la Vella
Phone: + 376 826060 Fax: + 376 862086
16 tablets Cabaser 4 mg cost 219.37 Euro, which is roughly the same price as one pays for 8 tablets Dostinex 0.5 mg in the US. Therefore, ordering from Andorra is 16 times cheaper, and it's still the same cabergoline, produced by Pharmacia & Upjohn.
Farmacia Meritxell will answer your inquiry with an order form and a proper bill. You will have to fill in your doctor's name and code, as well as your credit card information. I haven't seen a clear note of the requirement for a prescription, but I assume that one will be needed.
While Europe seems to have the lowest prices on cabergoline, US buyers can already cut their cost into about half when having Dostinex-brand cabergoline sent from Canada. At www.CrossBorderPharmacy.com, 8 tablets of Dostinex 0.5 mg cost just 114 US dollar, as opposed to the US price of about 218 US dollars.
There are a considerable number of Canadian pharmacies with Internet order facilities, and filling US prescriptions is a standard procedure for them.
Convenience has its price. They save you the trip to the clinic, but their Dostinex is the most expensive one I have seen: Two tablets of 0.5 mg cost 75.95 US dollars, and a strip of 8 is 268.95 US dollars.
Finally, cabergoline is also sold as veterinary medicine. The brand is Galastop, by Boehringer Ingelheim. I haven't seen a price tag.
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Copyright Serge Kreutz