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Low-price cabergoline

By Serge Kreutz

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.

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 Blue, 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 sildenafil citrate (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 URL is:

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.”

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.

EU residents who want to receive their Cabaser through the postal services, and 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. This primarily concerns data like credit card numbers, and the amount of money to be remitted.

Their address details are:

Farmacia Meritxell Dr. Nequi n’ 7 Andorra la Vella Principat d’Andorra

Phone: + 376 826060 Fax: + 376 862086

mail@farmaciameritxell.com

Their website:

http://www.farmaciameritxell.com/

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.

Finally, cabergoline is also sold as veterinary medicine. The brand is Galastop, by Boehringer Ingelheim. I haven’t seen a price tag.