By Keoni Everington
Taiwan News, March 18, 2019
The popular antidepressant Prozac is to be permanently removed from pharmacy shelves this April in Taiwan, announced the drug’s Taiwanese manufacturer Zuellig Pharma (裕利藥廠) last week, reported CNA.
Claiming to be unable to cope with frequent price cuts by Taiwan’s National Health Insurance (NHI), the local Taiwanese maker of the Prozac 20 mg, Zuellig Pharma, announced last week that it will stop selling the antidepressant in Taiwan on April 1. The company said that it will completely withdraw the drug from the Taiwan market, but all orders received before March 29 will still be fully supplied.
On March 13, the company sent a letter to all hospitals announcing that due to the annual reduction of drug prices by the National Health Insurance Administration, along with an increase in raw material and transportation costs in recent years, it will be ceasing the supply of Prozac. The company also mentioned the rising costs of following the Pharmaceutical Inspection Co-operation Scheme (PICS) and Good Manufacturing Processes (GMP) to ensure the quality of the medication.
Zuellig Pharma said that after taking the above-mentioned factors into an actuarial analysis, it was notified by Eli Lily Taiwan, the owner of Prozac, to cease production on April 1 and withdraw the product from the Taiwan market. In order to ensure the rights of hospitals and patients, the company said that orders received before March 29 will be fully supplied.
In an interview with CNA, Chang Wen-ching 張文靜, spokesman for the Taiwan Pharmacist Association, said Prozac is a commonly used drug in treating depression. Chang said that it is a widely used first-line drug because of its long history of use and relatively fewer side effects.
For these reasons, its usage rate is very high, and in recent years, the cost of this drug under NHI coverage per tablet has dropped from NT$2.08 (US$0.067) to NT$1.96 (US$0.063).
Substitutes for Prozac:
Chang said there are substitute generic drugs available and there are also some other famous brand names with the same chemical composition in Taiwan. Chang recommends that patients return to their hospital and have their prescriptions adjusted with the help of professional physicians.
The active ingredient in Prozac is Fluoxetine, which is also sold under other brand names, such as Sarafem and Selfemra.
Drugs.com, Accessed March 19, 2019
U.S. price of 20mg Prozac:
from $US503.98 for 30 capsules = $US16.80 per capsule
U.S. price of 20 mg fluoxetine (generic Prozac):
from $US15.52 for 30 capsules = $US0.52 per capsule
By Don McCanne, M.D.
Virtually everyone is in agreement that something must be done about the outrageous drug prices in the United States, though there is disagreement on how we do that. Some suggest that we should allow the free market to work to drive prices down (as if we were not already attempting to do that, unsuccessfully), while others suggest that the government should play a major role in establishing fair prices for pharmaceuticals. Since there is considerable interest in establishing fair prices through enactment of a single payer Medicare for All program, it can be instructive to look at how Taiwan establishes fair prices through their single payer health care financing system.
Because of our complex, dysfunctional health care financing system, it is difficult to determine drug prices here. Is it a brand name or a generic drug? Has the patent expired? Is it under a drug insurance plan? Is it under Medicare Part D? Is a discount coupon involved? Is it under a patient assistance program? And, perhaps most confusing of all, does it travel through the catacombs of a pharmacy benefit manager? Just for a rough idea of prices in the U.S., we’ll use those for Prozac and its generic version, fluoxetine, that are listed on the Drugs.com website.
In the United States, a 20mg capsule of Prozac sells for about $16.80. The generic version sells for about $0.52 per capsule. The discussion continues as to how much of a markup brand name drugs should have compared to the generic versions, but we likely won’t seriously address that until we are ready to switch to a publicly-administered and publicly-financed program (single payer).
Compare the price in Taiwan. The brand version of 20mg Prozac is only about six cents a capsule, and competing brand and generic versions are available. How tightly prices are controlled there is demonstrated by the fact that the government reduced the price by only four-tenths of a cent, but that proved too much for Eli Lily Taiwan, so they are pulling the product from the market. Two other brand versions and other generics are still available.
Having that kind of control over drug prices is only in our fantasies, but it doesn’t have to be. The public stewards of our single payer system, were we to establish a bona fide Medicare for All program, could work with the pharmaceutical firms (negotiating, bidding, or setting administered prices if necessary, etc.) to be sure that their legitimate costs are covered along with a fair profit margin. Is there risk of driving pharmaceutical firms out of the market? Although we don’t know the full background story in Taiwan, it is not likely that we would shut them out over four-tenths of one cent.
It is unlikely that HHS Secretary Alex Azar – former president of the U.S. division of Eli Lilly – is going to help us get there. But if the people understand that we can fix this problem, it wouldn’t matter much what he thinks since elections can have favorable consequences. But we do have to step up our education efforts directed to the public. After all, it is for their benefit. Besides, under Single Payer Medicare for All, Prozac would be freely available for Alex Azar and his colleagues in case they and their health care professionals think they need it.
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