Eliquis from Canada

Posted by pickleball1946 @pickleball1946, Dec 4, 2023

Starting my research today on buying Eliquis from Canada….. anyone any recommendations?

Interested in more discussions like this? Go to the Heart Rhythm Conditions Support Group.

Looking for safe lower cost option for my mother with AFib. Read through all the comments.

=== Current Drug and Cost

Mother is on Medicare Advantage with Kaiser Perm in WA state with Part D.
Drug lable = Generic Apaxaban MFG BMS (Bristol Meyer Squibb) Primarycare. No country of manufacturing
Cost $250 before donut hole and $500+ after first 1/3 of the year and entering donut hole

=== CA online Pharmacy Choice

A few posters have been using liferxpharmacy and their website for Eliquis is quite clear so I'll probably choose this pharmacy. However, I can't find them on Alberta College Pharmacy website that suppose to list reputable pharmacies.

So far, I've not been able to find any CA online pharmacies listed in the Province Pharmacy College's reputable pharmacy websites.

=== Drug Choice

BMS Eliquis is offered made in Australia Canada and Turkey. Turkey is the cheapest by far.

=== Question

My question is : Assuming the pharmacy is reputable. Is there any difference between Made in Turkey BMS Eliquis and current drug? Its cheaper and much cheaper in donut hole. I suppose no easy way to know 🙁

I have experience with other advanced products (SKF bearings) and price difference is huge given COO (Country Of Origin, basically where its manufactured) Presumably the price difference is governed by a country's trade and domestic manufacturing laws etc. This naturally promotes grey market distributors to source from cheaper COO and deliver to more expensive COO. Quite often Canada is a grey market pathway between global COO products and US. Its close to US and I guess import laws are less strict than US.

REPLY
@howardc64

Looking for safe lower cost option for my mother with AFib. Read through all the comments.

=== Current Drug and Cost

Mother is on Medicare Advantage with Kaiser Perm in WA state with Part D.
Drug lable = Generic Apaxaban MFG BMS (Bristol Meyer Squibb) Primarycare. No country of manufacturing
Cost $250 before donut hole and $500+ after first 1/3 of the year and entering donut hole

=== CA online Pharmacy Choice

A few posters have been using liferxpharmacy and their website for Eliquis is quite clear so I'll probably choose this pharmacy. However, I can't find them on Alberta College Pharmacy website that suppose to list reputable pharmacies.

So far, I've not been able to find any CA online pharmacies listed in the Province Pharmacy College's reputable pharmacy websites.

=== Drug Choice

BMS Eliquis is offered made in Australia Canada and Turkey. Turkey is the cheapest by far.

=== Question

My question is : Assuming the pharmacy is reputable. Is there any difference between Made in Turkey BMS Eliquis and current drug? Its cheaper and much cheaper in donut hole. I suppose no easy way to know 🙁

I have experience with other advanced products (SKF bearings) and price difference is huge given COO (Country Of Origin, basically where its manufactured) Presumably the price difference is governed by a country's trade and domestic manufacturing laws etc. This naturally promotes grey market distributors to source from cheaper COO and deliver to more expensive COO. Quite often Canada is a grey market pathway between global COO products and US. Its close to US and I guess import laws are less strict than US.

Jump to this post

Did some more research. People might find this interesting

Many older Americans are on cholesterol medication atorvastatin and very cheap. Mine comes from Kaiser Perm pharmacy and MFG = NOVADOZ. NOVADOZ is a NJ marketing company thats a wing of MSN (google msnlabs). MSN is an Indian company. So many people are already drinking cheap meds likely from India.

Bristol Myer Squibb's (BMS) world wide locations shows manufacturing in China as well as western leading nations like US and various EU countries. These western manufacturing locations are often biologics meaning drugs grown by biology. These are more advanced and likely trickier to produce. So it is quite natural formulated drugs shift towards lower cost countries (India seems to be leader) google CPHI events (pharma conference) 10x in next year are 2x China, 1x Thailand, 1x India, 1x Saudi Arabia 2x EU, 1x Korea, 1x Japan, 1x US.

For drugs like Eliquis and Entresto (my mother use this as well for AFib and is pricy) It is likely US drug companies always aim at 15-20 of high profits from newer drug discoveries with improvements. Lock in the patents and keep strict distribution in wealthy countries to lock in higher profit. Eliquis generics was successfully blocked by BMS+Pfizer (coinventers) in 2021 in US courts. Eliquis is the #1 drug expense on Medicare and represent $12B out of $45B 2023 revenue for BMS.

So the goal for US drug companies is to pitch medical community to prescribe latest patent enforced drug (and newer drugs are usually better just maybe not as much as they pitch. There are other blood thinner alternatives to Eliquis which just gradually falls out of favor amongst the US medical establishment) Lobby hard in congress and hire lawyers to defend the patents. And generally scare the living day lights out of consumers to buying overseas where the drug was likely made anyways.

So its all grey market for the cheaper sources from overseas. And gov+industry+medical community are all making $$$ from mostly elderly US consumers paying for leading drug development and providing no info on cheap oversea solution naturally generates consumer distrusts.

Not suggesting we all drink meds from India Turkey and buy from online Canadian Pharmacies. But likely most of the cheap drugs no longer protected by patents are already coming from there. I read Canadian online pharmacies are usually just an online presence and just have distribution agreements with oversea pharmacies to drop ship drugs directly from say India and Maruitius (little island nation in the middle of Indian Ocean) Cheaper Eliquis are typically Product of Turkey made in Puerto Rico labled as Pfizer (contract manufactured by BMS) and shipped via Maruitius. Maruitius must offer laws that allow grey market side step entry into US.

So I wonder if Eliquis my mother is using is basically same as made in Puerto Rico by BMS shipped from Maruitius. Seems likely but gov+pharma+medical industry in US is never going to confirm or provide any kind of clarity. Rather, their aim is to create distrust to lock-in their profits. Even pharmacies gets a cut and of course elected gov officials through lobbying.

REPLY

I've had to start taking Eliquis 5mg, 2x, and pay $425 for a 90-day supply. So, I began to dig around for generic versions and found the FDA had approved several back in 2019. However, the mfg (Bristol Myers Squibb) was able to obtain a court injunction to stop distribution at least until April 2028. The second link provides one to the ruling.
https://www.drugs.com/availability/generic-eliquis.html
https://www.singlecare.com/blog/news/eliquis-generic-apixaban/

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My husband's been getting his off-patent Eliquis (apixaban) from Canada for over a year now--huge savings. We used a company in India for awhile but they became very unpredictable in their mail delivery. The Canadian company's service has been very good.

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Eliquis is very expensive here. I looked into Canada and have been buying Apixaban, generic Eliquis, from there. I buy the Canadian manufacturer as I wasn't sure about delivery times from other companies around the world. So far so good.

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Just an update.

I think no Canadian online pharmacy will be listed in various provinces pharmacy school listing of pharmacies. Those listings seems to only contain brick and mortar pharmacies.

Canadian online pharmacies also seem like a business largely targeting US consumer's high cost and are mostly drop ship operations. So they setup contract with foreign pharmacies and ship directly from there. It seems quite natural Providential pharmacy schools would not list these operations.

Another interesting note is Eliquis from US pharmacy will not have original pill bottle and package. Just generic pharmacy pill bottles and their sticker. Country which product originates and manufacturing site information is lost.

google "eliquis made in america cheaper abroad"

This article shows the actual packaging info of Eliquis purchased in US vs Product of Turkey. US one is Product of Ireland, made by BMS without manufacturing site. Product of Turkey is Pfizer labeled. Manufactured in Puerto Rico (US territory) and manufactured by BMS. It is quite likely all of these are identical and made by BMS. Eliquis drug chemical structure seems simple. Surely BMS/Pfizer's basic strategy is maximize profit in all consumer territories leveraging domestic pharma and trade laws. On lower per capita GDP countries, they can still make $ so they do. Just not as much as say US.

Anyhow, we are going to go with CA online pharmacy rxlifepharmacy and choose Product of Turkey shipped from Maruitius and manufactured by BMS.

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One more update.

It seems

Country of Product is probably just where it was legally marketed and sold
Country of Manufacturing could be just where its packaged
Probably no chance to find out where the drug or ingredients are actually made.

Saw a 2016 FDA approval document (google NDA 202155/ S-13) to BMS to approve Puerto Rico Humacao factory (closure news in 2023 so BMS is shifting this else where) to package Apixaban. It seems packing drugs isn't just the matter of handling plastic bottles and paper box. For syringed products, probably require capability and secure handling.

In the Pharma industry, there is CRO (Contract Research Org) CMO (Contract Manufacturing Org) and CDMO (Contract Development Manufacturing Org) CMS/Pfizer are just western brand names and large corporations at the top. We have have no ability to find out where the drug itself is actually made.

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Found more info that might be interesting to those searching for legit Eliquis. I think the reality is there is no way to know. Given the astronomical cost in US, every layer of middle man in US AND offshore operations are trying to appear legitimate and take a cut.

First, what is the source of US Eliquis?

Visited Kaiser Perm Pharmacy in WA and asked to see the bottle. Indeed it says BMS Product of Ireland as noted by online articles. But this could just mean it was sold there. Maybe not even packaged there and ingredient's sources are certainly unknown.

Canadian Online Pharmacies

All of these are drop ship operations. Cheaper Pfizer/BMS Eliquis will ship from Mauritius and are Product of Turkey. Once I get one, will post box label on where manufactured (likely Puerto Rico which could just mean was "packaged" there although "packaging" likely is more than just plastic bottles and paper boxes. Could mean adding the time release coating (don't know, need a drug manufacturing expert to share knowledge) BMS might have shifted location per 2023 news BMS has closed a Puerto Rico plant)

Canadian Online Pharmacy Checkers and Associations

As far as I can tell, all of these are middle mans that gets a cut from the online pharmacies to make them appear more legitimate. Look closely at these Pharmacy Checkers and Associations, they are all private. None are gov agencies like FDA etc.

Mauritius

Wiki provides an interesting background on this small Island nation. Diego Garcia leased to US for B-52 base might be what most people have even heard of this place.

Maruitius is one of the wealthier nations in east Africa (Technically far off the coast even beyond Madagascar) Majority of the population is actually fron India with ex British and French colony history. $10k annual per capita GDP (For reference China $10k, India $2.5k, Puerto Rico $35k, Portugal $25k, Spain $29k - home of Zara clothing)

Google mauritius pharmacy and look on google maps will actually show some pictures of these pharmacies. Not some third world nation.

Ideally, Eliquis package received from Mariuitius might reveal which pharmacy was the contracted drop ship pharmacy from one of these Canadian online drop ship ordering sites. It would trace closer back to drug's origin. Next would be finding the Turkish distributor... then finally Pfizer/BMS's Turkish business entities.

I suppose at the end of the day, Consumer that can afford the US medicare D prices can pay for a peace of mind. Those who can not have to use the grey market to lower cost. It might be exactly the same stuff but no local government or company will tell you that.

REPLY

Since Mauritius shipped Eliquis is Product of Turkey and labeled Pfizer. Searched Pfizer 10-K annual report for info and found the following

JV with BMS

Jointly developed with Bristol Myers Squibb. Pays BMS a % in countries where only Pfizer sells. Turkey might be such a location.

Revenue

Pfizer global revenue went from $100B in 2022 to $58B in 2023. $42B reduction from Covid19 vaccine and drug sale reduction. Eliquis is $7B out of total $58B. BMS was $12B/45B in 2023.

Turkish HQ

Located inside big shiny glass tower (LEVENT 199) in Istanbul. Pfizer 10-K annual report list Turkish subsidiary as

Pfizer PFE İlaçları Anonim Şirketi

Address is

Esentepe Mah. Buyukdere Caddesi Levent 199 No:199 Interior Door No: 106 Floor:26, 34394 Levent, Sisli, Istanbul

google maps have a nice street view.

License

Pfizer Turkish website has a Turkish translated document for Eliquis (can't include links. Just search inside Pfizer Turkish website with Eliquis. Document 19195)

Google translated it to English shows Turkish license info

7. LICENSE HOLDER

Pfizer PFE Pharmaceuticals Inc.
Esentepe Mah. Büyükdere Cad.
Levent 199 Blok No: 199 ÿç Kapÿ No: 106 ÿiÿli / ÿstanbul

8. LICENSE NUMBER

2015/845

9. FIRST LICENSE DATE / LICENSE RENEWAL DATE

First license date: 05/11/2015
License renewal date: 25/10/2018

10. RENEWAL DATE OF KÜB

25.05.2022

=====

So Pfizer was definitely marketing Eliquis in Turkey at least. All that remains is to find the Turkish distributor and Mauritius Pharmacy that is drop shipping Eliquis to US consumers for Canadian online pharmacies.

REPLY

Found more info in Turkey

Turkish Medicines and Medical Devices Agency (“TMMDA”) handles the license of medical products. Website is titck dot com

google titck dot (subsititute with actual . ) com Eliquis

This finds a Turkish document. Google translate shows the following at the bottom

License owner:

Pfizer PFE Pharmaceuticals Inc.
Muallim Naci Cad. No:55, 34347 Ortaköy/ÿSTANBUL

google map this address (walk a little to see the main entrance) shows a large 2 story building with VIATRIS Pfizer sign.

VIATRIS is a $15B US public company formed in 2020 merger between Mylan (acquired EpiPen from Merck in 2007 + other products) and Upjohn ( previously an off-patent division of Pfizer)

Production place:

Bristol-Myers Squibb Manufacturing Company, Humacao, Porto Riko
Pfizer Ireland Pharmaceuticals Little Connell Newbridge Co. Kildare ÿrlanda

Prior research shows

BMS Humacao plant handles packaging and was closed in 2023. So future Eliquis from Turkey maybe will show another manufacturing site? But BMS has another site in Manati PR.

google "Pfizer Ireland Pharmaceuticals Little Connell Newbridge" shows Pfizer website indicating this is a manufacturing plant in Ireland for "oral solids" and is a Pfizer CDMO (Contract Development Manufacturing Organization) My mother's current Eliquis dispensed by Kaiser Permanente Pharmacy comes from a bottle labeled "Product of Ireland"

Maybe these pills are all from the same Ireland factory haha. But we don't really know for sure. Need to ask Pfizer insider!

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