Another Installment of Prices of America's Most Expensive Drugs in Mexico
Many people find my site when they are looking for the cost of a drug in Mexico. Periodically, I check the queries on Google console for drugs queried not already on my list. I recently added the price in Mexico for the following drugs.
Recently researched drugs:
Mesalazina (colitis) 60 tablets U.S. $345 Mexico: (called Salofalk): $30 dollar
Lupron 1 month U.S. $1,642 Mexico: (Lucrin): $672
Ampyra (multiple sclerosis) 56 tablets U.S. $2,731 Mexico (Fampyra): $922
Flomax tecfidera (multiple sclerosis) 1 month U.S. $5,320 Mexico: $2,527
Simponi (arthritis) 1 injection U.S $4,873 Mexico: $1,362
Cosentyx (arthritis/skin) U.S. $4,928 Mexico: $1,404
Repatha (cholesterol) monthly U.S. $777 Mexico: $328
Zytiga (cancer) 120 (3 mo) U.S. $9,817 Mexico: $3,494
Xeljanz (arthritis) (60 capsules) U.S. $4,686, Mexico $1,016
Entresto (heart) 1 month U.S. $360 Mexico: $115
The challenge is not finding the Mexican price but rather the U.S. price to cite. Rebates and discounts from the list price causes quotes to swing wildly. Health insurance companies, clinics, and hospitals don’t pay the highest list prices because they negotiate bulk rates and discounts (These savings are not passed on to the consumer but rather pocketed by clinic or hospital or doctor’s office receiving the rebate).
The amount of discounts and rebates are kept secret, making it hard to calculate what the drug’s average cost might be. The U.S. price I settle upon is usually the GoodRX price, which seems to run the lowest of prices given online. The price could be considerably more.
My first experience with these crazy price differences was when I had a prescription cream that cost $30 out-of-pocket with one insurer and $340 when my insurance changed. That is how much volume and deal-making by pharmacy benefit managers, rather than the underlying value of the drug, determines what is covered and to what degree. The fact that one drug can have this kind of variance is by itself proof enough of a broken system.
Since the beginning of this blog in 2014, I have kept up with the issue of skyrocketing drug prices in the U.S. Many people who retire to Mexico do so in great part out of fear that one day they too might get enmeshed in the rapacious American healthcare cartel, and be stuck in a country where even people with insurance go bankrupt and die because they can no longer afford the out-of-pocket cost of drugs.
People have suggested to me that Mexican drugs might be of inferior quality. That is simply not the case, as explained by Monica Rix Paxson in her book The English Speakers Guide to Medical Care in Mexico.
“The Mexican Health Ministry, a powerful government agency, oversees the manufacturing and sales of Mexican produced drugs. Mexican manufactured pharmaceuticals are exported to other countries including the US where they are often packaged and sold as brand-name drugs. All Mexican manufactured drugs— both brand name and generic— are made to the same high standard and from the same high-quality materials. The book features interviews with staff of these manufacturing companies.
But not all drugs sold in Mexico are manufactured there, and those made in China or other Asian countries do not fall under the same government supervision as Mexican ones do. Checking the packaging and calling around to verify the product was made in Mexico are important precautions. Another obvious precaution is buying them only from nationally-recognized, reputable chain pharmacies.
It’s logical that Mexican pharmacies do not accept foreign prescriptions. They’d have no way of knowing if the prescription is even from a real doctor. You cannot expect a Mexican pharmacist to deal with language issues and determine if a prescription is fraudulent.
It is not that hard to find a Mexican doctor (Mexico does not have the A.M.A. controlling the number of candidates who enter medical school every year.). Expats will tell you that specialists are relatively easy to get appointments with, and office visits cost a fraction of the cost in the U.S. Many have been trained in the U.S.
The U.S. State Department recommends that you carry a letter from your attending physician, describing your medical condition and any prescription medications, including the generic names of prescribed drugs.
Likely, getting a prescription is not a problem for purchasing drugs in Mexico. Travelers are limited to taking no more than 50-day doses back over the border. It is our own government protecting pharmaceutical industry, just like they do when they prohibit the sale of certain cheaper, yet just as effective drugs when there is a more expensive one the industry is pushing.
They cite the reason for the limit at the border is the danger that people selling the drugs for a profit. We can’t possibly let sick people buy life-saving medicines when there might be some mule out there making money that should be going into the $36 million dollar paycheck of Brenton Saunders (CEO of Allergan.)
All the major publications, the NYT, the WaPo, CNBC, Scientific American, NPR, VOX, and many others have written articles already this year, in 2019, on the scandal that is the American healthcare system, particularly when it comes to its cost of drugs.
This gouging situation is largely unheard of by my Spanish language practice partners in Spain, the country considered to have the best-run healthcare system in Europe (Spain too has its problems, specifically with what some say is over-generosity regarding treatment of certain conditions). Our situation, where people are more scared of our healthcare system than the disease, confounds Europeans (but we’re the best!)
Certain facts are no longer disputed by anyone other than lobbyists and those vested directly or indirectly in the obscene profits pharmaceutical companies make. They all, even conservative outlets, agree that
1. High costs are not due to the cost of R&D, a claim that the industry has long hidden behind. R&D costs average 17% of the company budget, less than the money spent on marketing drugs to doctors and running ads (I remember one days hearing probably 15 ads in one day on YouTube for the same drug). Another part of those marketing budgets target doctors, influencing them to prescribe more costly drugs, even when far cheaper drugs would do as good a job.
People really should read source documents researching our healthcare system from university studies not funded by Big Pharma. This amazing study by two researchers at Stanford University and Princeton, Donald Light and Rebecca Warburton, on of how R&D costs are calculated reads more like an exposé than the dry, unemotional language you’d expect from scholars.
“Industry executives, well supplied with facts and figures by the industry’s global press network, awe audiences with staggering figures for the cost of a single trial, like tribal chieftains and their scribes who recount the mythic costs of a great victory in a remote pass where no outside witnesses saw the battle.
“Companies tightly control access to verifiable facts about their risks and costs, allowing access only to supported economists at consulting firms and universities, who develop methods for showing how large costs and risks are; and then the public, politicians and journalists often take them at face value, accepting them as fact.”
The report concludes that the bigger problems lie elsewhere, “Most R&D dollars are not being directed at discovering clinically superior medicines, even for affluent customers, because companies are so generously rewarded for developing hundreds of new products little better than the ones they replace.”
Pretty strong words for an academic! Maybe they are tired of drug companies braying about their “cutting edge” research when much of the basic research comes not from pharmaceutical labs but from universities, providing drug companies free research, like the study I just quoted.
2. High drug costs are due to pharmaceutical companies charging as much as they want simply because they can. Some reporters are more circumspect in the language, saying the price are due to “a lack of competition and the regulatory environment in the U.S. that allows for price increases much higher than in other countries."
Why be so polite about it? CEOs themselves don’t try to hide their greed anymore. CEO of Nostrum Laboratories, Nirmal Mulye explained the mindset quite candidly in an interview about why he raised the price of an antibiotic by more than 400%, from under $500 to over $2,000. He said “I think it’s a moral requirement to make money when you can … to sell the product for the highest price,”
Exactly whose morals is he referring to?...Jack Abramoff?… Solomon? ( 700 wives and 300 concubines). I guess criminal morality is still morality. He went on to compare his pricing strategy to that of an art dealer who sells a painting for half a billion dollars.”
The list prices of hundreds of medications increased an average of 6.3 percent on Jan. 1, according to a recent analysis from the health software company Rx Savings Solution (Inflation was 2%). Many of the drugs that have had huge jumps in prices have been around for years, such as Lantus insulin a drug out of patent which increased from $30 to $300 a vial.
According to one survey, 45% of patients with diabetes have skipped doses of insulin because they can’t afford it. In a post comment, one doctor wrote that the outsourcing of essential drugs to maximize profits has caused “false shortages” of everything from saline I V bags for drug administration to local anesthetic agents which are now outrageously expensive.
Some of these expensive drugs have equally safe and effective alternatives that are sold at a fraction of the price in other countries. These alternative drugs (biosimilars) are prohibited from being marketed or sold in the U.S.
3. Our costs are higher than other wealthy countries largely because we are the only one that prohibits the government, particularly Medicare, from negotiating bulk rates. This protects the profits of an industry that outspends any other on lobbying and campaign contributions, which topped $2.5 billion last year.
Now that even Americans without European friends realize that other countries pay a fraction of what U.S. citizens pay, no one can any longer pretend it’s beyond our government's control. A look at campaign contributions tells the rest of the story.
4. We are not, for all this money, seeing new and innovative drugs. According to the London School of Economics and Political Science, for years about 85 percent of new drugs have little to no better outcomes than existing ones. To keep patents, companies often tweak old drugs rather than invent new ones (this applies to medical devices such as artificial joints as well). Seventy-eight percent of the drugs with new patents last year were not new drugs coming out but existing ones.
5. The U.S. does not use more healthcare than any other developed country. The claim that the U.S. spends more on healthcare because Americans use more healthcare, or that they use fewer generic drugs has also been refuted by studies. We use generics more (84%) and healthcare a little less (we take prescription drugs 12 fewer days) than those in other wealthy countries.
All this you probably know. What you may not know
1 Fat profits from sales is not enough for these companies. They also take the donations people make to healthcare non-profits to fund their research. One of my favorite dirty little secrets from working in the non-profit field for years, and a source of great discomfort for health charities like the American Cancer Society, is that they aggressively collect donations to fund drug research. Then pharmaceutical companies turn around and charge outrageous prices for drugs that charitable donations helped bring to market.
2. The U.S., unlike countries like England and Japan, has no system to compare the effectiveness of a drug being tested against cheaper drugs before bringing them to market. Nor do they take into any consideration the price that might be charged. The FDA determines if the drug is effective and safe, and lets the pharmaceutical companies’ marketing departments take it from there.
3. Negotiations between pharmaceutical companies and hospitals, insurance companies, and clinics for rebates and discounts often include exclusivity agreements whereby they cannot offer other, perhaps cheaper, drugs. The more of the medicine they sell, the bigger the rebate and the bigger the incentive for the pharmaceutical company to negotiate that the recipient of the discount only sell their drug. You never really know if you are getting the best drug for your condition at the best price. That’s all their little secret.
Some journalists go as far as saying that the real intent of the industry is to make medicines so costly that Medicare will collapse in spite of the program’s high marks from the general public.
I love a good conspiracy theory as much as the next person, but drug companies already have an open tab with Medicare, who has to pay for the drug prescribed by the doctor. However, Medicare going bankrupt isn’t hard to imagine.
Several years ago a 70-year old friend of mine on Medicare ran up a bill of over a million dollars for treatment of colon cancer. I loved my friend dearly (I was in the room when he died two years later). Obviously, our healthcare system cannot support this kind of bill forever in an aging society.
Other advanced countries refuse to buy extremely expensive new drugs unless the drug can demonstrate substantial improvement in effectiveness and increased life expectancy to warrant the sticker price.
Memorial Sloan Ketterling Cancer Center recently decided they would no longer give obscenely expensive drugs to their patients. Making hard decisions like refusing to cover a new drug that the maker markets as better (without being able to prove it) will be hard to accept when bright and shiny new drugs with millions of dollars in marketing dollars behind them are waved in front of sick faces.
Soon we will have to make choices, or leave a major swath of our population without any.
My complete list of drug prices - Ventanas Mexico.
Sick in Mexico? That’s okay because pharmacies deliver - Ventanas Mexico
Most recent: What to do and what to skip in that Mexican party-dise of Cancún.
About the author:
Kerry Baker is a partner with Ventanas Mexico and author of two books, the Interactive Guide to Learning Spanish Free Online, a curation of the best Spanish language tools on the web, organized by level along with links to them. The second book, If Only I Had a Place, is your guide for finding the best long-term rental in Mexico, where renting is played differently. Avoid the pitfalls and find opportunities with this book.