Beware of Rogue Online Pharmacies Selling Counterfeit Cialis But Not Low-Cost Real Cialis

Counterfeit Cialis

FDA Seized Counterfeit Cialis at International Mail Facility

The FDA issued a warning about counterfeit Cialis, an erectile dysfunction (ED) medication,  being sold through the mail, which probably means it was purchased from a rogue online pharmacy. The fake Cialis is some whacky combination of Cialis’s active ingredient, tadalafil, and the active ingredient in Pfizer’s Viagra, called sildenafil. Apparently, the FDA seized the counterfeit product before it reached a consumer in the U.S. by mail.

Fortunately, over 99% of safe, personally imported prescription drugs are not seized at international mail facilities. Still, I’ve given the FDA considerable grief about seizing safe medications, which they usually deem “misbranded” or “unapproved” for intellectual property or labeling reasons – but in this case FDA protected someone from a bad drug and that’s cool.

According to Reuters, FDA “cautioned against purchasing prescription medicines online, noting that some websites may be selling unsafe products.” The FDA also said that there is no indication that the “legitimate supply chain” – meaning the U.S. domestic supply chain – is at risk and that licensed U.S. pharmacies are safe. That’s probably true but there’s no reason to believe that the legitimate supply chains in other countries aren’t safe either. In other words, foreign online pharmacies verified by PharmacyChecker.com continue to sell real Cialis, the one marketed by Eli Lilly, for a lot less than they do here.  The lowest cost Cialis (10mg) is $14.25 at a PharmacyChecker.com-approved international online pharmacy. That compares with a whopping $44.92 per pill at a one of the lower cost VIPPS-approved online pharmacies (VIPPS is the online pharmacy verification program of the National Association of Boards of Pharmacy).

The FDA recommends that consumers do not take Cialis supplied in bottles matching one or more of the following descriptions:

  • lists “AUSTR81137” on the front of the bottle;
  • does not include an NDC number on the front of the bottle, such as “NDC 0002-4462-30” for the 20 mg tablets;
  • does not include the tablet strength in a colored box;
  • has different patterns and colors; it has yellow and darker green designs on the front label;
  • has misspellings; it lists,  “CLALIS is a product of: Eli lilly Australia PTY Limited” on the side of the bottle;
  • lists the manufacturer location as “112 Wharf Road, WEST RYDE, NSW 2114” on the side of the bottle; and
  • lists “Lot: AC 066018, Exp: 01SEP17” on the side of the bottle.

I don’t agree with one of these – the bolded one - and here’s why:  safe and real Cialis, or other genuine medications, ordered from online pharmacies won’t necessarily  have an NDC number on it. In fact, if you were to travel to another country and purchase meds, real prescription drugs, in a brick-and-mortar pharmacy, they would not have an NDC number. That’s because NDC is unique to drugs packaged for sale in American pharmacies. Other countries use different labeling systems; for example, Canada’s version of NDC is called DIN (drug identification number).

One last important note: the truth is that many people want to get ED meds online, whether it’s Viagra, Cialis, or Levitra, without a prescription. PharmacyChecker.com strongly recommends that you don’t do that. The studies show that online pharmacies that don’t require a valid prescription are more likely to sell fake or otherwise bad medication, especially bogus ED meds!

Share
Tagged with:
 

Does Medicaid help its enrollees with Hepatitis C to obtain Sovaldi? (Part 3 of 3 on Sovaldi)

(Read Part 1 and Part 2)

Last year we discussed the cost of hepatitis C (“Hep C”) wonder drug Sovaldi for Americans paying in cash or using their health insurance. Notably absent, in both analyses, were how our most economically challenged citizens could afford the $84,000 treatment. According to Governing, “Many of the estimated 3.2 million people living with Hep C in the United States are poor, imprisoned or elderly, which means the cost of Sovaldi falls disproportionately on Medicaid and Medicare.”

To treat every one of the 750,000 Americans with Hep C who receive state-funded treatment through Medicaid or the prison system with Sovaldi would cost $55 billion, according to Express Scripts, and budget realities mean that that simply won’t happen. Public health officials will use prior authorization guidelines in determining who will be covered, similar to the way benefits administrators with private health plans determine eligibility.

Unlike private insurers, drug manufacturers must give Medicaid a 23% discount. The lower price is helpful but does not necessarily make Sovaldi affordable. Current models of drug pricing under Medicaid are not tailored to handle Sovaldi and other specialty medications. According to a letter sent from National Association of Medicaid Directors, “Simply put, the federal Medicaid statute is not designed to allow states to respond to this new pricing approach for pharmaceuticals. Sovaldi is just the first of many such exceptionally high-cost ‘curative’ specialty drugs.”

That letter recommends several federal policies to address Sovaldi and other high priced medications, including the creation of a special federal fund for specialty meds, similar to Ryan White federal funds for AIDS; additional rebates for specialty medications that reach a certain threshold in the percent of the population affected; and, my favorite because of the ludicrousness of international price disparities where U.S. prices are twice the average of other rich countries, “Modify the ‘best price’ policies for breakthrough drugs to include the selling price in other countries.”

There are more suggestions by the NAMD, and they are good future possibilities, but we’ve got to get down to the bottom line here: if you have Medicaid, then under what circumstances will you get Sovaldi? The states are all over the place in terms of coverage policies, but usually a person has to be very sick to get Sovaldi!

The Sovaldi Squeeze, written for Medicaid Health Plans of America (MHPA) by Viohl and Associates, takes a good stab at identifying Medicaid coverage policies. Thirty-five states require prior authorization. Most, if not all, of those states require enrollees to take a liver biopsy; the results of which determine whether or not Sovaldi will be covered. Some states will only cover someone who has not used illicit drugs and alcohol for three years. Other states, including Illinois, Florida, and Louisiana will limit coverage terms to make sure the patient is complying properly with the regiment. For example, Louisiana will only cover Sovaldi for 28 days at a time.

The most extraordinary criterion I saw is referred to as the “once in a lifetime” rule in the MHPA report. As you imagined, if a patient doesn’t adhere to their covered Sovaldi treatment then it won’t be covered again.

Like we discovered with private health insurance and certainly for people who must pay the full price in cash, there are serious obstacles to obtaining Sovaldi even if you’re covered on Medicaid. The costs are just too prohibitive. Yes, Gilead is right that unlike maintenance medications Sovaldi (and other new Hep C meds we’ll discuss below) can cure the patient, which means lower healthcare costs overall. Nonetheless, the market is not established to handle such insane upfront costs.

You might expect that more treatments with the curative-type power of Sovaldi would add competition to bring down prices. Indeed, there are three new Hep C specialty meds on the market. Olysio, marketed by Jansen is cheaper than Sovaldi, but still sells for $840 per pill. Harvoni is actually more expensive than Sovaldi, carrying a price tag of$94,500 for three months, about ten grand more than Sovaldi. Unfortunately, like Sovaldi it is made by Gilead so the competition factor is diluted! Harvoni does have the advantage of being a stand-alone treatment, however, whereas Sovaldi is taken in conjunction with ribavirin.

Viekira Pak, marketed by Abbvie, was approved just last month. Express Scripts wisely decided to make a deal with Abbvie that it would exclude Sovaldi in exchange for lower prices on Viekira Pak! Sure enough, Gilead fought back against Abbvie by making a deal with CVS Health that Harvoni and Sovaldi would be the preferred Hep C medications for CVS’ PBM business.

And which drug is the best? We’re not going to touch on that but the online magazine, Hep Mag, has an excellent summary on all the new Hep C medications discussed above, which could prove helpful.

The market dynamics for Sovaldi and other breakthrough medications like it are highly complex but largely stacked in favor of pharmaceutical company profits against taxpayers and consumers. Neither Medicaid nor private health insurers can afford to treat the millions of people who are infected with Hep C.

To conclude, I’ll leave you with the words of Caroline, who commented on our Part 1 post about paying for Sovaldi in cash, as she sums it all up perfectly:

“Well I’m insured but this medication is not on the formulary for either health care companies offered at my job. They are two well-known companies and according to my GI doctor, none of the insurance companies are approving this drug unless you are at least at stage 3 liver disease. So I’ll have to get a little sicker before I can get it. Thanks Gilead!”

Share
Tagged with:
 

Low Cost Counterfeit Drugs Save Lives in China…What?!

I wish I was joking about the racy headline above. The United States is not the only great power in which citizens go without medication because of cost. The cancer drug Gleevec (imatinib), made by Novartis, costs 23,500 yuan, or about U.S. $3,783, per month, in China. Gleevec is not covered by health insurance in China so people there must pay for it out of pocket. Ten years ago, Lu Yong was diagnosed with chronic myelocytic leukemia and was prescribed Gleevec. After facing bankruptcy due to his drug costs, Lu discovered a generic version of Gleevec, called Veenat, and began purchasing it by mail-order from India where it is an approved drug, at a cost of only 3,000 yuan, or about $482, per month — 87% less than the brand name drug.

Lu’s condition improved quickly using  the generic version. He began to help people with leukemia who he met online obtain Veenat. Now, according to the English edition of Caixin, an independent Beijing-based media outlet, he is facing criminal charges for credit card fraud and selling counterfeit medication. The same story was covered by official Chinese media under the headline “Leukemia patient prosecuted for buying pills overseas.” Lu has helped 1,000 people with leukemia obtain treatment. Three hundred of them are petitioning the authorities to have his name cleared.

The medications involved are real and clearly life-saving! So why is Lu being prosecuted for counterfeit drugs? Under Chinese law, any drug not specifically licensed for sale in China, even a genuine medication lawfully manufactured by an authorized drug company, is considered counterfeit.

The charge of credit card fraud was based on Lu’s using a foreign credit card to make the purchases. Lu said he did so because using domestic Chinese bank-issued credit cards for international purchases is nearly impossible.

Lu was not charged for procuring his own cancer medication. The charges were for directly facilitating the purchase of the drug for 1000 people, who consequently regard Lu as a hero.

When people can’t afford to obtain life-saving medication locally, the U.S, and all countries, should consider themselves morally obligated to expressly permit their citizens to obtain it internationally.

Share
Tagged with:
 

The fight for access to safe and affordable medication will continue in 2015. As 2014 ends we find the price of medication continuing to escalate. AARP’s recent drug price report showed that brand name drug prices had increased by 13% in 2013, eight times the rate of inflation. The costs of generic drugs are going through the roof, some by astronomical amounts – to the tune of thousands of percent. Then of course 2014 brought us Sovaldi at $1000/pill, which is just the tip of the iceberg, as many more outrageously priced “specialty medications” are coming down the pipeline in 2015. New drugs that save lives and help people get better are great…but only if they are affordable.

In the holiday spirit, Senator Amy Klobuchar from Minnesota published a Christmas-themed op-ed last week called “How the Drug Companies Play Scrooge,” as in Ebenezer Scrooge, the greedy miser in Charles Dickens’ famous story A Christmas Carol. Klobuchar’s ghosts of Christmas past, present and future are, respectively, rampant drug price increases; the highest drug prices in the world by far; and the continuing assault on the pocketbooks of Americans by pharmaceutical companies unless Congress acts. Interestingly, Sen. Klobuchar’s metaphor compares Scrooge to Congress (not the pharmaceutical industry). She writes: “if Ebenezer Scrooge can be transformed from a crotchety, thoughtless, “bah humbug” miser to a generous steward of good will to all after only one night of ghostly visits, certainly there is hope for Congress.”

What can Congress do to end its Scrooge-like protection of big pharma?  Sen. Klobuchar recommends three legislative solutions. Congress should pass legislation that would allow Medicare to negotiate drug prices with pharmaceutical companies under the same protocols permitted to the Department of Veterans Affairs. Currently, federal law actually bans such negotiations. Under one estimate, due to the VA’s ability to negotiate prices, drug prices are 40% lower when obtained through the VA than through Medicare.

Ending what Sen. Klobuchar calls “illegal pay-to-delay” deals between brand name and generic pharmaceutical companies, which postpone market availability of lower cost generic drugs, is another solution that can be addressed legislatively. Legislation introduced by Klobuchar and Sen. Charles Grassley would give the Federal Trade Commission more authority to stop those deals. Sen. Klobuchar asserts that the savings from ending pay-to-delay could be $4.7 billion for the U.S. budget and $3.5 billion for consumers.

Last but not least, Sen. Klobuchar recommends helping American consumers to personally import lower cost medication by passing The Safe and Affordable Drugs from Canada Act. This legislation, co-sponsored by Sen. John McCain from Arizona, would essentially codify the current practice of Americans buying lower cost medication from Canadian pharmacies.  We support this bill but believe it needs to be expanded to include pharmacies in many other countries from which lower cost and safe medication can be and currently are obtained.

Congressional opponents of Klobuchar’s personal drug importation bill, the most vociferous among them surely raking in huge donations from big pharmaceutical companies, will argue that the Act will open the door to counterfeit drugs and rogue online pharmacies.  The fact that counterfeit drugs and rogue online pharmacies exist, however, is not an argument against facilitating safe personal drug importation from verified international online pharmacies. Five million Americans already import medication for their own use.  Consumers who purchase from safe international online pharmacies, such as those in the PharmacyChecker.com Verification Program, are able to save thousands of dollars a year.  For many, personal importation of lower cost medication is the only option for obtaining needed prescription drugs.

While the FDA doesn’t prosecute Americans who import medications for their own use, federal law still holds that, under most circumstances, it is a crime!! It’s understandable that prescription drug importation meant for re-sale in U.S. pharmacies is regulated to that extent that those who violate the laws are subject to penalties.  In contrast, people who need to import medication for their own use because they can’t afford the prices at U.S. pharmacies should not be subject to criminal enforcement of any kind, ever. So I hope that Senator Klobuchar and her colleagues, in addition to her recommendations identified above, introduce and pass a bill to amend federal law to decriminalize personal drug importation.  By doing so Congress would bring prescription justice to Americans who are haunted by the scary ghosts, past, present and future, of the pharmaceutical industry.

Happy Holidays and New Year from PharmacyChecker.com!!

Share
Tagged with:
 

Internet Society and Online Access to Affordable Medication: The Problem with dot Pharmacy

We’ve talked a lot about the efforts of the National Association of Boards of Pharmacy (NABP), funded by big pharmaceutical companies, to curtail online access to safe and affordable medication by conflating rogue online pharmacies with safe international online pharmacies: most distressingly through its application to the Internet Corporation for Assigned Names and Numbers. I had the opportunity to present our position about the importance of maximizing online access to safe and affordable prescription drugs by participating on a panel organized by the Internet Society New York Chapter. The focus of the panel overall was on public interest commitments as they pertain to new generic top level domains (gTLD) (i.e., new domain endings such as .book, .amazon, .religion, .nyc, and .pharmacy). Such gTLD’s area acquired through the opening up of this space by ICANN.

The mission of the Internet Society is directly applicable to the issue of online access to affordable medicine:  “By connecting the world, working with others, and advocating for equal access to the Internet, the Internet Society strives to make the world a better place.”

The NY Chapter recently held a meeting in my home borough of Brooklyn! Members of the New York Chapter are currently concerned with potential abuses of the .nyc domain space. For example, the organizer of the panel and board member, Thomas Lowenhaput, is concerned that a corporation like Domino’s or Pizza Hut will own the domain pizza.nyc, not only obtaining a commercial advantage but denigrating New York pizza’s culinary cultural soul. The heart and soul of New York pizza has nothing to do with national retail pizza chains so there should be safeguards preventing commercial abuses of those premium domain names. You get the idea!

On the panel, I talked about NABP’s plan to operate the domain space called .PHARMACY because we believe it furthers pharmaceutical corporate interests at the expense of consumers, although in this case the issue is health not pizza! I informed the meeting’s participants that the NABP’s application to ICANN to operate .PHARMACY was funded by pharmaceutical companies and that its domain registration policies will help serve their commercial interests. Not surprisingly, pharmaceutical companies prefer it when consumers pay much more at U.S. pharmacies for the same medicationssold in Canadian and other foreign pharmacies at a much lower cost.

NABP’s policies will prohibit a .PHARMACY registration to any non-U.S. pharmacy that sells medication to consumers in the U.S. The basis for its policy mirrors and relies on the discriminatory U.S. and state regulations prohibiting safe personal drug importation. In so doing, NABP is using the levers of Internet governance to support domestic policies that impede consumers from obtaining medications they need. Essentially, in the parlance of the Internet Society, I told the group that NABP’s vision of .PHARMACY undermines the Internet’s promise as a tool to “make the world a better place.”

Share
Tagged with:
 
A Bittersweet Prescription

A Bittersweet Prescription

OPEN enrollment for Medicare Part D drug plans ended this past Sunday, but my thoughts about them linger. Our website www.MedicareDrugpPlans.com received about 150 ratings of part D plans in 2014 – most of them highly critical, and some of them downright scathing! Whether it’s a plan’s horrible customer service, lack of coverage of many brand name drugs, or dropped coverage, we’re hearing from many irate seniors. At the same time, some studies have shown most seniors are happy with their plans. Why all the contradictions about Part D? To understand, please join me on a trip down Part D memory lane.

When PharmacyChecker.com was founded in 2002, American seniors did not have pharmacy benefit plans through Medicare. While most seniors had some drug coverage through private health insurance or Medicaid, 25% were without any drug coverage and, thus, vulnerable to a pharmacy’s highest retail price. Just eight months after our website launched in April 2003, Congress passed and the president signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), which created a pharmacy benefit opportunity for all Medicare enrollees known as Part D.

It’s amazing and sad to report that, today, the problem of high drug prices for Americans overall is worse than the problems existing before the MMA was born. In 2001, the Commonwealth Fund reported that 28 million Americans did not fill a prescription due to cost. That number shot up to 50 million Americans in 2012!

(more…)

Share
Tagged with:
 

Some consumers who order medication from safe international pharmacies are finding themselves unable to use their VISA credit cards. We hope that doesn’t interfere with their ability to access safe and affordable medication. What’s going on?

Essentially, in taking actions to stop rogue online pharmacies from selling medication, VISA’s online pharmacy policy ends up discriminating against consumers seeking affordable medication from safe international online pharmacies. It appears that VISA has adopted the online pharmacy worldview of LegitScript, a verification service that categorizes safe international online pharmacies as “unapproved” (but not “rogue”) and teams up with big pharmaceutical companies and U.S. chain pharmacies!  VISA’s policy may set a precedent for more credit card payment processors; discontinued service to rogue pharmacy websites is good, but if service is discontinued to safe international online pharmacies, including ones approved by PharmacyChecker.com, that’s bad. (more…)

Share
Tagged with:
 
People should not have to go without one or the other

People should not have to go without one or the other

As we settle in to our Thanksgiving dinners tomorrow, let’s not forget the many millions of Americans who cut back on groceries each year to pay for medication or simply go without. How prevalent is this travesty? According to Consumer Reports, 21% of American adults with a prescription benefit and 39% without a prescription benefit are cutting back on groceries each year.

According to Hunger in America 2014, 14% of Americans receive charitable food assistance each year – about 46.5 million people. Of those people, 66% had to choose between “paying for food and paying for medicine or medical care in the past year, with 31 percent reporting facing this tradeoff every month.” That’s about 31 million Americans choosing between food and medical care/medicine each year.

The Consumer Reports survey shows that millions of middle class Americans are suffering under the burden of high drug prices. The Hunger in America 2014 survey shows how dramatically the poor are affected.

There is poverty in other advanced economies as well but with much lower rates of people struggling to afford food and medicine. We can do better in America. We hope that PharmacyChecker.com helps alleviate the burden of prescription drug costs and prevents sickness and lives lost when people find medication they can afford by using our information.

A healthy and happy Thanksgiving,

PharmacyChecker Team

Share
Tagged with:
 
From Pembroke Consulting, published on DrugChannels.net

From Pembroke Consulting, published on DrugChannels.net

Yesterday, Senator Bernie Sanders (I-VT) held a hearing in front of the Senate Health, Education, Labor and Pensions Subcommittee on Primary Aging and Health entitled “Why Are Some Generic Drugs Skyrocketing in Price?” Bizarre drug price increases of 1,000% and up are becoming more common. This problem is not new: in the beginning of this year the People’s Pharmacy reported a 6,000% increase in the price Doxycycline!

Senator Sanders noted that the price of Digoxin, which treats congestive heart failure, has increased 883% from 12 cents to $1.06 per pill from 2013 to 2014. Migraine drug Divalproex Sodium ER spiked 881% from 27 cents to $2.38 per pill.

We are always ecstatic when Congress scrutinizes the obscene drug prices in America, and we applaud Sen. Sanders, but our focus is on what can be done now so that people today don’t go without needed medications. In his introductory remarks, Sen. Sanders said: “Drug prices in the country are by far the highest in the world.” Let’s elaborate on that. (more…)

Share

Nexium OTC or Prescription Nexium: Singing the Generic Blues as Esomeprazole Magnesium Stays Purple

Last June we wrote about how Americans taking Nexium – AstraZeneca’s multibillion dollar proton pump inhibitor that treats gastro esophageal reflux disease (GERD) – were losing out on savings due to the FDA’s postponement of a generic version in the U.S. market. Well, it looks like they’re going to wait even longer to find generic copies of the Purple Pill at local pharmacies (and the generic versions probably won’t be purple!). Initially, Indian pharmaceutical company Ranbaxy held exclusive marketing approval to sell generic Nexium in the U.S., but they were banned from actually selling it due to poor manufacturing practices. Well, last week the FDA revoked both Ranbaxy’s approval and its marketing exclusivity for generic Nexium. That might be good for the Purple Pill’s profits (say it fast) – but it leaves consumers singing the blues.

Cash paying Americans are left with the following domestic options: Prescription-strength (40 mg), Nexium or Nexium OTC (20 mg). Prescription-strength Nexium will run you about $600 for 60 pills. That’s a ridiculous price. It’s only $70 to get 126 capsules of Nexium OTC! So, can you just buy Nexium OTC instead of prescription-strength Nexium and just take two pills?

You might be able to, but you need to ask your doctor, pharmacist, or other healthcare provider. I asked my local pharmacist if I could just take OTC Nexium instead, and without hesitation she said I could, but that it may not be as effective and that it comes as a tablet rather than a capsule. The OTC version also has different inactive ingredients, I was told, so if you are allergic to any of those, you should stick with the 40 mg version. She suggested OTC Nexium if I couldn’t make a trip to my doctor or if my insurance didn’t cover prescription Nexium. Even if Nexium is covered, it might be a tier 2 or 3 drug, which could result in your co-pay being higher than the OTC cost.

We’d feel remiss in not reminding you that there are a plethora of proton pump inhibitors on the U.S. market, many that come at a much lower price tag.

But if you need to stick with prescription-strength 40 mg Nexium, it is available from international online pharmacies: 60 pills would be about $50, so it’s actually a better deal than Nexium OTC in the U.S. It’s worth noting that just like the OTC 20 mg pill, the 40 mg purple pill is sold as a tablet, not a capsule, in many foreign markets. You can view our comparisons of Nexium prices.

Hopefully we see these delays sorted out, and a generic version of 40 mg Nexium finally come to market in America. Until then, Nexium OTC at your local drugstore or ordering from an international online pharmacy may be your best options to avoid the drug price blues.

 

Share
Tagged with:
 
Get Adobe Flash playerPlugin by wpburn.com wordpress themes