Generic Sumatriptan

The Minister of Health ruled that Imigran Sprint and Sumatriptan tablets to swallow were equivalent, ie. a prescription for Imigran Sprint could be used for Sumatriptan tablets (ie, copies of the earlier Imigran tablet), the way was opned for marketing copies of the original Imigran tablets.

As a consequence the cost of sumatriptan decreased over approximately ½ a year from about 50 DKK for 50 mg to around 5 DKK.

GSK (the manufacturer of Imigran / Sumatriptan) maintained for some time a somewhat higher price than the generics, but also continued to market tablets under the name of sumatriptan, along with the marketing of Imigran Sprint.

The cheap part of the market has competed hard on price, perhaps especially because the Danish subsidy system is designed so you only get full reimbursement for the cheapest medicines of the same type (here Sumatriptan + Imigran as they contain the same active ingredient).

The subsidy to the other triptans follows the active ingredient, ie. their price is not affected by price movements for Sumatriptan.

The price of Maxalt varies - probably because there are 5 different companies who market this triptan.

Reversed pricing

The pharmaceutical industry wants us to believe that the active ingredient is expensive to produce, so we are willing to pay a relatively high price for our medicine. After some time it has turned out, however, that tablets with 100 mg sumatriptan could be cheaper than the tablets from the same copy-producer with 50 mg sumatriptan. That is what we call reverse pricing. This phenomenon appeared at times in 2010 for 8 of the companies that marketed sumatriptan, including GSK.

Migrænikerforbundet can only conclude that sumatriptan is very cheap to produce, and that prices are based exclusively on market considerations.

Migrænikerforbundet does not regard reverse pricing is acceptable. It encourages the users of the medication to take tablets with a larger amount of the active substance than necessary.

Similarly there have been periods where the tablets in two packages with 6 tablets was cheaper than the same tablets in a pack of 12 or 18 tablets. A query to a couple of companies revealed that there could be problems getting delivered the larger packs, so the price went up. This corresponds to the above conclusion, it is not quantity or price of the active ingredient (sumatriptan), which determines the price we as customers pay for our medicine.

Why marketing very expensive copy-tablets?

We also do not understand that there may be reason to have medications on the market that is more than 10 times as expensive as the cheapest version. An example from April 2010 shows that the cheapest 100 mg tablets cost approximately 6 DKK in a 12 pack, and the most expensive around 60 DKK in a 6 pack. 5 companies practiced reverse pricing during this period - ie. 100 mg sold at a cheaper price than the equivalent 50 mg tablets in the same package size.

Approximately half of the Sumatriptan products were priced at more than twice the price of the cheapest tablet. It's hard to believe there are many migraineurs who knowingly chooses to buy the much more expensive sumatriptan, so we do not understand how it can be lucrative for companies to be on the market with the expensive tablets.

The pharmacy has a duty to inform you about the cheapest tablets according to § 38 of the prescription notice, but a guide from the Medicines Authority to pharmacists specify this to only apply if smaller packages (eg. 2 or 3 packs of 6 tablets) is cheaper than a larger package (eg. with 12 or 18 tablets).

Please remember, it is YOU who chooses which brand you want. The pharmacy should offer you the cheapest and if they do not have them in stock, you can ask them to get them. You can always choose a more expensive tablet, but you will then only get the subsidy which corresponds to the cheapest solution.

The cost of the triptans has been declining

The low cost of generic sumatriptan was reflected in the market in 2006. This could be seen in the statistics on the total cost of triptans. The average price for a dose of triptan in 2005 was approximately 65 DKK. During 2006, the average price for a 100 mg dose (or the equivalent) of triptans fell to approximaely 30 DKK. The average price included injections (approximately DKK 280 per injection) nasal spray (approximately 75 DKK per dose), dispergible tablets (approximately 55 DKK per tablet) the original tablets (about  50 DKK per tablet) and generic tablets (variable price, sometimesless than 5 DKK per  dose) for all triptans. A varying pricing resulted in an increase in the average price per dose in the second and third quarter of 2009. In 2010, the shift toward greater consumption of generic drugs brought the average price per triptan dosis down again.

The total savings amount to around 100 million DKK per year.

The consumption of triptans is increasing

The consumption of triptans increases by approximately 6% per year. The increase is mainly for the cheap generic drugs. The more expensive medicines held their share of the market for approximately 3 years but then their market share started to decline - coinciding with the financial crisis.

Migards market share is so small that it can not be seen in the graph. Data from ORDIPRAX.

Migrænikerforbundet is satisfied that the total cost of triptans has been declining, and hope that the low price of generic product Sumatriptan will continue to keep the total cost of migraine medication down to a reasonable level. Now we are curious to see if the same effect will appear when the patents on Maxalt, Naramig  and Zomig run out  in 2012, Almogran in 2013 and Relpax and Migard in 2015.

It is the responsibility of the migraineur not to get into medicine induced headache!

Migrænikerforbundet believes that it is the individual migraineurs responsible (preferably with a doctor's assistance) not to get into an overuse of triptans or other rescue medication and consequent drug-induced headaches. A mixed overuse is more difficult to get out of than an overuse of triptans without admixture of painkillers. Therefore we are pleased with developments in the price of triptans.

Although the price of the cheapest triptans may no longer be the limiting factor in our consumption, it is still better to prevent attacks than to treat them. There is still good reason to try to identify your triggers (eg. foods and hormone-supplements).

Generics and subsidies

Although the pharmacy will automatically offer the cheapest tablet, we always have the opportunity to ask for a brand with the same active ingredient we like better. The difference in price on copies and originals is now so small that the difference in the subsidy is insignificant and not a reason for getting an brand we do not trust.

Updated 23 January 2011