[Ip-health] FT: US charges 200 times UK price for common worm pill

Charles Clift charlesclift at tiscali.co.uk
Wed Dec 21 07:46:34 PST 2016

I don't know Danny but could it be that the price paid by the licensees to GSK/TEVA reflected the fact that this would be their future strategy? So the big firms can capture some of the anticipated revenue but avoid the flak. It would be odd to be giving away large volumes of product free to developing countries while price gouging in the US! And how would the Index mark that? 

-----Original Message-----
From: Ip-health [mailto:ip-health-bounces at lists.keionline.org] On Behalf Of Danny Edwards
Sent: 21 December 2016 13:00
To: Thiru Balasubramaniam <thiru at keionline.org>; Ip-health at lists.keionline.org
Subject: Re: [Ip-health] FT: US charges 200 times UK price for common worm pill

Does anyone have any reflection/insight into a rationale for why Teva might have exited the US market for mebendazole?  (and, related question) why GSK exited the US market for albendazole) - am trying to piece together the puzzle which has led to the current situation on these medicines in the US.


Danny Edwards
Research Programme Manager
Access to Medicine Foundation

On 19 Dec 2016, at 08:20, Thiru Balasubramaniam <thiru at keionline.org> wrote:


Drug prices

US charges 200 times UK price for common worm pill

Impax sells childhood infection treatment course for $880, against £3.50 in Britain

by: David Crow in London

A US drugmaker has put a price tag of more than $800 on a pinworm treatment — 200 times more expensive than the equivalent medicine on British pharmacy shelves, in the latest example of “price gouging” in the world’s largest healthcare market.

Impax Laboratories started selling mebendazole this year at an average wholesale price of $442 per pill, according to figures seen by the Financial Times, which were checked with several US pharmacy chains including Walgreens and CVS.

Most cases of pinworm, a parasitic infection also known as threadworm, require two pills, meaning a course of treatment costs about $884. The drug is available prescription-only in the US but can be bought over the counter in the UK, where Boots, a British chemist chain, charges £6.99 for a pack of four pills, or £1.75 each.

The pinworm parasite, which is common in children, affects 200m people a year worldwide and up to 40m in the US. It is recommended that family members are treated for the highly contagious infection at the same time, meaning a household of five’s treatment costs more than $4,400.

Mebendazole was first used to treat pinworm and other parasitic infections in the 1970s and is on the World Health Organisation’s list of essential medicines. In the developing world it can be bought for less than 1 cent per pill.

The drug was available as a cheaper generic version priced at around $1.60 per pill until 2011, when it was removed from the market by Teva, the manufacturer, without explanation.

Impax reintroduced a branded version of the pill, Emverm, in April, and is the only provider of mebendazole tablets in the US. It is also the only purveyor of albendazole pills, which treat other parasitic infections, and which doctors sometimes prescribe for pinworm.

“In my opinion, this is the latest example of a pharma bad actor cornering the US market and taking advantage of payers and consumers,” said Michael Rea, chief executive of Rx Savings, which makes software to help reduce the cost of medicines.

Impax declined to comment.

Impax is not a household name, but the group briefly gained notoriety in
2015 after it sold Daraprim, a life-saving drug for Aids and cancer sufferers, to a company controlled by Martin Shkreli, the disgraced pharma entrepreneur.

Mr Shkreli swiftly raised the price of Daraprim from $13.50 to $750 a pill, prompting an international outcry. Like mebendazole, Daraprim was first discovered decades ago, appears on the WHO’s essential medicines list, and is available in developing countries for just a few cents.

Critics say the reintroduction of mebendazole at such a high price more than 40 years after it was first used by doctors — and decades after its patents expired — shows how drugmakers are able to charge huge sums for old medicines that cost them little to develop.

“We’ve been seeing isolated examples of generic price gouging — individual products that become essentially single source, which are able to take enormous price increases,” said Steve Miller, chief medical officer of Express Scripts, a US pharmacy benefits manager that negotiates drug prices on behalf of employers and insurers.

Impax has not released sales figures for the medicine since it went on sale eight months ago, but David Amsellem, analyst at Piper Jaffray, estimates the market could be worth nearly $300m per year.

In its third-quarter earnings, Impax said it would be “building awareness that mebendazole is back” and told investors that Emverm was the “only prescription therapy for pinworm” approved by the US Food and Drug Administration.

For families with good healthcare coverage, their insurer would pick up most of the cost. But a growing number of Americans on cheaper insurance plans contribute up to 50 per cent of the price.

Families unable to afford the medicine must use a powder formulation, pyrantel pamoate, which has not been approved by the FDA. The formula is less effective than mebendazole and can cause side effects such as toxicity in the central nervous system, according to Stanford University.
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