Presentation video link in BMS Ireland site ( Pfizer Ireland Pharmaceuticals Little Connell Newbridge Co. ) Broshure advertising their services to the pharma industry. Can hear why "packaging" is not so simple, for example blister pack of pills that can only last 3 years sealed with Nitrogen + CO air mix.
@howardc64 -- Couldn't get the presentation video link to work for me. Can you double-check if I have this right:
https: //players.brightcove.net/1852113022001/iJst0J4zh_default/index.html?videoId=6201723413001
@howardc64 -- Couldn't get the presentation video link to work for me. Can you double-check if I have this right:
https: //players.brightcove.net/1852113022001/iJst0J4zh_default/index.html?videoId=6201723413001
Legitimate channels (US gov, large US brick mortar pharmacies, US accredited assoc) can not vouch for foreign grey market channels of course. Naturally, they caution the US consumer.
Grey market channels (Canadian online pharmacies) could be sourcing the same high quality Eliquis. However there are a few countries and middleman in between which offers opportunities for counterfeit / substitute / lower grade. Canadian online pharmacies are all shell drop ship websites. Addresses are likely PO Box or small suites. Call support if any are likely overseas (Called LifeRxPharmacy and sounds like I reached Philippines) Legitimacy websites such as CIPA (not much info in About) or Pharmacy Checker (founder is US MD with other websites to legitimize supplements) seems mostly just web click through website. These are all barebones operations.
So in summary
Secured High Quality drugs in US = $$$ through legit channels
Grey market drugs is much much cheaper (< 1/4 of Medicare D) Could be same high quality stuff but more opportunities for fakes/lower grades going through 4-5 countries and middleman custody.
My mother can afford the ~$2k/annual Medicare D Eliquis cost from US so we might choose this more cautious route than grey market channels to save $1500/year.
Alternatives to Pfizer/BMS's Eliquis from other countries are Apixaban generics. Availability probably depends on courts favorability to Apixaban generics vs Pfizer/BMS patents in various countries.
remove space between : and // to form proper url below
Suggest availability in UK and Canada. Google shows recent favorable ruling for generic Apixaban in UK courts.
There seems to be quite a few generic Apixaban manufacturers worldwide. Teva ($16B Isreal genenic phrama) supplies a product for UK. Taro-Pharma ($1B Isreal company acquired by $6B Indian company Sun Pharma Industry Ltd) supplies Apixaban generics in Canada.
FDA's 2019 first approval for Apixaban generic in US was for Mylan (ex generic division of Pfizer) and Micro Labs Ltd (Indian Pharma founded in 1973) Not sure if the UK and CA sourced Apixaban brands have gone through FDA as US courts ruled against generic Apixaban by upholding the Pfizer/BMS patents in US. Here is FDA's approval on one of these generics in 2019. They do a bioequivalence evaluation. (Remove space between . and // for proper url)
I guess these Apixaban generics from outside US is another kind of grey market. In this case, may not have gone through FDA approval but the approval of Pharma regulatory body in countries where they are available.
Generic Apixaban is also not much cheaper than Medicare D in donut hole pricing unless sourced from India marketed products.
@blinken I appreciate this information! But I am confused; the article @colleenyoung recommended 12/4/23 about safe pharmacies said that it is illegal to ship prescription medication’s over the border. How have you gotten around this regulation, please? 🙏🏻
It’s the pharmacy that does the shipping not you. My physician will fax prescriptions to Canadian Pharmacy services. The prescription stays valid for a couple years.
I’ve been very happy with them. They will tell you what country the drug is coming from and I think you can request that the drug comes from Canada not sure about that. But you have to consider, if you are reluctant to buy from outside US because of quality that indeed others from these countries survive and live without FDA review.
If they would spend 1/10th of their time and investment being transparent and pricing the drug "fairly" * and less time on what appears to be deceitful practices, we'd all be a lot better off. These pricing practices lead inevitably to a Thermidorean reaction on the part of regulators/legislators which is truly not in the interest of patients (their customers) and their shareholders. I wish you had posted the names and addresses of the CEOs so that people could write to them and to the Chair of their boards of directors.
If they would spend 1/10th of their time and investment being transparent and pricing the drug "fairly" * and less time on what appears to be deceitful practices, we'd all be a lot better off. These pricing practices lead inevitably to a Thermidorean reaction on the part of regulators/legislators which is truly not in the interest of patients (their customers) and their shareholders. I wish you had posted the names and addresses of the CEOs so that people could write to them and to the Chair of their boards of directors.
Yes, its a challenging problem. US is the only first world nation that pays for advanced drug development. Rest of the world just use fast copying generics providers (US also benefits from rest of the world investing in its stock market to fuel the domestic capitalism forces)
How to provide financial incentives for lengthly developments (safety testing) and practice more socialized healthcare is a huge challenge that hasn't been solved in US. What exist is stratified layers of healthcare and affordability. It would certainly be desirable to have the lower economic strata to have more affordability. But how to achieve this...
Problem is Medicaid is the only economic strata assist for the poorest (support by taxation rather than lower drug price/profit). Medicare is age based qualification and a huge number of older Americans. So Medicare is a huge market for healthcare companies and they are surely unwilling to give up so much of the profit source. Tricky issue on setting multiple price point strata is the lawyers has the potential to sue to drug companies to lock to the lowest price. So drug companies aren't going to self offer such solution. On some super expensive drugs (much pricier than Eliquis), drug company do offer support (free for qualified customer) but is likely based on US gov's poverty line definition so consumers above this strata is stuck with the higher cost.
Probably all that can be done is gov renegotiate Medicare price with healthcare companies when the drug/procedure reach high volume and huge profit level. Eliquis is probably getting close to this.
Yes, its a challenging problem. US is the only first world nation that pays for advanced drug development. Rest of the world just use fast copying generics providers (US also benefits from rest of the world investing in its stock market to fuel the domestic capitalism forces)
How to provide financial incentives for lengthly developments (safety testing) and practice more socialized healthcare is a huge challenge that hasn't been solved in US. What exist is stratified layers of healthcare and affordability. It would certainly be desirable to have the lower economic strata to have more affordability. But how to achieve this...
Problem is Medicaid is the only economic strata assist for the poorest (support by taxation rather than lower drug price/profit). Medicare is age based qualification and a huge number of older Americans. So Medicare is a huge market for healthcare companies and they are surely unwilling to give up so much of the profit source. Tricky issue on setting multiple price point strata is the lawyers has the potential to sue to drug companies to lock to the lowest price. So drug companies aren't going to self offer such solution. On some super expensive drugs (much pricier than Eliquis), drug company do offer support (free for qualified customer) but is likely based on US gov's poverty line definition so consumers above this strata is stuck with the higher cost.
Probably all that can be done is gov renegotiate Medicare price with healthcare companies when the drug/procedure reach high volume and huge profit level. Eliquis is probably getting close to this.
US gov has a fairly poor negotiation position. What leverage does US gov have over BMS/Pfizer with?
- Invalidate the patent or allow generics (violating its own IP laws which will never survive the court system)
- Won't buy other drugs from BMS/Pfizer? BMS/Pfizer has already speciaiized into IP based high value drug company and shed generics business (other than as an investor of the generics business it shed)
With such poor negotiation position. Why would BMS/Pfizer negotiate? Other than to put out "we are not greedy bad company press"
It’s the pharmacy that does the shipping not you. My physician will fax prescriptions to Canadian Pharmacy services. The prescription stays valid for a couple years.
I’ve been very happy with them. They will tell you what country the drug is coming from and I think you can request that the drug comes from Canada not sure about that. But you have to consider, if you are reluctant to buy from outside US because of quality that indeed others from these countries survive and live without FDA review.
Connect
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Presentation video link in BMS Ireland site ( Pfizer Ireland Pharmaceuticals Little Connell Newbridge Co. ) Broshure advertising their services to the pharma industry. Can hear why "packaging" is not so simple, for example blister pack of pills that can only last 3 years sealed with Nitrogen + CO air mix.
https colon //players dot brightcove dot net/1852113022001/iJst0J4zh_default/index.html?videoId=6201723413001
@howardc64 -- Couldn't get the presentation video link to work for me. Can you double-check if I have this right:
https: //players.brightcove.net/1852113022001/iJst0J4zh_default/index.html?videoId=6201723413001
Thank you!
/LarryG
You have an extra space between : and // Will work after removing that
Here are a couple of urls, remove space between : and // to make it work
Turkish Medical Authority website Eliquis search
https: //titck.gov.tr/storage/Archive/2021/kubKtAttachments/5kt_4363538b-4b56-42ed-9c6d-2d235580d3a7.pdf
Use google translate (document) and see last 2 pages for license holder and manufacturing site
NABP (US medical accreditation, looks legit) paper on Canadian online pharamacies. page 8-10
https: //nabp.pharmacy/wp-content/uploads/2016/08/Internet-Drug-Outlet-Report-August-2017.pdf
Summary after the research so far
Legitimate channels (US gov, large US brick mortar pharmacies, US accredited assoc) can not vouch for foreign grey market channels of course. Naturally, they caution the US consumer.
Grey market channels (Canadian online pharmacies) could be sourcing the same high quality Eliquis. However there are a few countries and middleman in between which offers opportunities for counterfeit / substitute / lower grade. Canadian online pharmacies are all shell drop ship websites. Addresses are likely PO Box or small suites. Call support if any are likely overseas (Called LifeRxPharmacy and sounds like I reached Philippines) Legitimacy websites such as CIPA (not much info in About) or Pharmacy Checker (founder is US MD with other websites to legitimize supplements) seems mostly just web click through website. These are all barebones operations.
So in summary
Secured High Quality drugs in US = $$$ through legit channels
Grey market drugs is much much cheaper (< 1/4 of Medicare D) Could be same high quality stuff but more opportunities for fakes/lower grades going through 4-5 countries and middleman custody.
My mother can afford the ~$2k/annual Medicare D Eliquis cost from US so we might choose this more cautious route than grey market channels to save $1500/year.
-
Like -
Helpful -
Hug
2 ReactionsAlternatives to Pfizer/BMS's Eliquis from other countries are Apixaban generics. Availability probably depends on courts favorability to Apixaban generics vs Pfizer/BMS patents in various countries.
remove space between : and // to form proper url below
https: //www.liferxpharmacy.com/products/eliquis.html
Suggest availability in UK and Canada. Google shows recent favorable ruling for generic Apixaban in UK courts.
There seems to be quite a few generic Apixaban manufacturers worldwide. Teva ($16B Isreal genenic phrama) supplies a product for UK. Taro-Pharma ($1B Isreal company acquired by $6B Indian company Sun Pharma Industry Ltd) supplies Apixaban generics in Canada.
FDA's 2019 first approval for Apixaban generic in US was for Mylan (ex generic division of Pfizer) and Micro Labs Ltd (Indian Pharma founded in 1973) Not sure if the UK and CA sourced Apixaban brands have gone through FDA as US courts ruled against generic Apixaban by upholding the Pfizer/BMS patents in US. Here is FDA's approval on one of these generics in 2019. They do a bioequivalence evaluation. (Remove space between . and // for proper url)
https: //www.accessdata.fda.gov/drugsatfda_docs/appletter/2019/210128Orig1s000TAltr.pdf
https: //www.accessdata.fda.gov/drugsatfda_docs/psg/PSG_202155.pdf
I guess these Apixaban generics from outside US is another kind of grey market. In this case, may not have gone through FDA approval but the approval of Pharma regulatory body in countries where they are available.
Generic Apixaban is also not much cheaper than Medicare D in donut hole pricing unless sourced from India marketed products.
-
Like -
Helpful -
Hug
1 ReactionIt’s the pharmacy that does the shipping not you. My physician will fax prescriptions to Canadian Pharmacy services. The prescription stays valid for a couple years.
I’ve been very happy with them. They will tell you what country the drug is coming from and I think you can request that the drug comes from Canada not sure about that. But you have to consider, if you are reluctant to buy from outside US because of quality that indeed others from these countries survive and live without FDA review.
-
Like -
Helpful -
Hug
3 ReactionsIf they would spend 1/10th of their time and investment being transparent and pricing the drug "fairly" * and less time on what appears to be deceitful practices, we'd all be a lot better off. These pricing practices lead inevitably to a Thermidorean reaction on the part of regulators/legislators which is truly not in the interest of patients (their customers) and their shareholders. I wish you had posted the names and addresses of the CEOs so that people could write to them and to the Chair of their boards of directors.
*Whatever that means
-
Like -
Helpful -
Hug
1 Reaction@howardc64 -- Got it now, H. Thanks!
/LarryG
Yes, its a challenging problem. US is the only first world nation that pays for advanced drug development. Rest of the world just use fast copying generics providers (US also benefits from rest of the world investing in its stock market to fuel the domestic capitalism forces)
How to provide financial incentives for lengthly developments (safety testing) and practice more socialized healthcare is a huge challenge that hasn't been solved in US. What exist is stratified layers of healthcare and affordability. It would certainly be desirable to have the lower economic strata to have more affordability. But how to achieve this...
Problem is Medicaid is the only economic strata assist for the poorest (support by taxation rather than lower drug price/profit). Medicare is age based qualification and a huge number of older Americans. So Medicare is a huge market for healthcare companies and they are surely unwilling to give up so much of the profit source. Tricky issue on setting multiple price point strata is the lawyers has the potential to sue to drug companies to lock to the lowest price. So drug companies aren't going to self offer such solution. On some super expensive drugs (much pricier than Eliquis), drug company do offer support (free for qualified customer) but is likely based on US gov's poverty line definition so consumers above this strata is stuck with the higher cost.
Probably all that can be done is gov renegotiate Medicare price with healthcare companies when the drug/procedure reach high volume and huge profit level. Eliquis is probably getting close to this.
-
Like -
Helpful -
Hug
1 ReactionUS gov has a fairly poor negotiation position. What leverage does US gov have over BMS/Pfizer with?
- Invalidate the patent or allow generics (violating its own IP laws which will never survive the court system)
- Won't buy other drugs from BMS/Pfizer? BMS/Pfizer has already speciaiized into IP based high value drug company and shed generics business (other than as an investor of the generics business it shed)
With such poor negotiation position. Why would BMS/Pfizer negotiate? Other than to put out "we are not greedy bad company press"
-
Like -
Helpful -
Hug
1 ReactionThank you so much for all this information! I appreciate it