“Bob Field was set to kick off his second course of BCG — a potent immunotherapy that treats his fast-growing bladder cancer. Instead, the New York City banking executive got a call from his urologist’s office, canceling that week’s appointment: They were running low on vials of BCG and rationing their dwindling supplies. Field was no longer eligible.”
Thus begins an interesting and important article by Meghana Keshavan on the shrinking supply of BCG in the U.S. The only remaining producer in the U.S. is Merck, and it shows no eagerness to increase production because apparently it doesn’t make enough money at it, even at the U.S. price of $186.00 a vial.
As I wrote to Meghana, I am stuck in Mexico, where I am having great difficulty in getting BCG preparatory to an exam of my bladder as a follow-up to cancer treatment.
If you try to buy BCG in Mexico, it can run as high as 9000 pesos a vial (about $450). This was the price that my first urologist in Mexico sold it to me for. That’s because Mexico doesn’t produce the drug, and Merck (MSD here in Mexico) doesn’t produce it here. This year, my second urologist was able to find some for 5000 pesos ($250) which is closer to the U.S. price.
So I went online and found that you can buy the stuff in India for $11 (!!) It’s not made by Merck, but it is made by Serum Institute of India, which is run by Cyrus Poonawalla. Serum Institute is the largest vaccine producer in the world. Poonawalla is supposedly the fourth richest doctor in the world. BCG is no longer under patent, so basically anyone can make it if they have the talent.
So I found a cheap, good source of BCG. But how do you get it into Mexico? I can’t find an India seller who sells into Mexico, even if Mexico is a better market by price than the U.S.
I have a feeling that Merck is blocking the India producers from selling in the U.S. and maybe even Mexico. That seems ridiculous, but in a world of capitalism, why isn’t someone finding a way of moving a cheap (and plentiful) Indian product to Mexico and the U.S., which are good markets and really need it?
I have been working with my urologist here, but he doesn’t have much experience, I think, in solving this problem. I have written to Farmacia Similares, a leading discount pharmacy here, hoping that they might want to pick up this product. They wrote back and sounded possibly interested, but they don’t have the drug currently and didn’t say what they were planning on doing.
I know that this product is readily available in India, because I wrote to IndiaMart to put my interest out in public. I got six responses from various sellers of drugs. I finally got a bid of $63 from a large online seller (that was for three vials plus shipping), compared to $1,052 from my urologist, who put me in touch with his supplier. The latter was reluctant to discuss where he was getting the drugs, so I suspect that he is getting it illegally across the border from the U.S.
This entire matter has gobbled up many hours of time, as you can imagine. I was initially careful about contacting the Indian suppliers, but I now understand that they are eager to sell and have lots of supplies. I think that the only problem is getting the drugs legally through customs in Mexico.
I don’t know the market for the product in Mexico, but I assume 29,000 people annually would need it. The population of Mexico is 40% of the U.S, and 74,000 get bladder cancer annually in the U.S. There is a shortage of BCG in both countries. I’m not sure why the Indian producers can’t sell in both countries and make a lot more money than they can in their own locales.
After all this, my second urologist was able to locate a version of BCG made by Teva, an Israeli company that works internationally. I am now able to buy four vials of BCG by Teva for U.S. $315 through Farmacias Especializadas. It is also available through Farmacia San Pablo. Now, compare the prices. In India, it would be $44. In the U.S., if you could find it, the price would be $744. The question is: why is Merck the only source available in the U.S., if you can get basically the same stuff from India for $44? Why do urologists in Mexico ignore the fact that they can buy locally for a lot less that shipping Merck across the border? Or was my first urologist cheating me?
What bothers me most is Merck. It charges the most, and yet it appears reluctant to produce the drug. And the pharmacies in the U.S. don’t appear to sell Teva or the Indian BCG. Why is that? American consumers are just being hung out to dry.