Saturday, March 04, 2017

Notes from The Cornered Druggist: Xerese, another useless FDA-approved drug

(While listening to public radio this morning, I was struck by its discourse on language and its various paths of evolution.   The combination of the letters “GM,” for example, can mean "genetically modified," "General Motors," or my first name when spoken in Alabama. But I digress...)

Yesterday, I received an order from a dentist's office for a product called Xerese, something we have never stocked, and a product that was listed as available from my wholesaler for the princely sum of $1085. This certainly warranted further exploration.

It turned out that this five (5) gram tube of an ointment contains a combination of 5% acyclovir and 1% hydrocortisone.

Acyclovir, a long-generic antiviral treatment for herpes, comes in capsules of 200mg for about 10 cents each, and hydrocortisone has also been available as an ever-the-counter product and can be found at a dollar store for, well, a dollar.

Five grams of Xerese contains a total of 250mg of acyclovir (a 5% concentration means 5 grams in 100 grams, so using the cross-multiplication process in algebra -- oh heavens, this note contains math! -- 250mg is in 5 grams, after the proper conversion of grams into milligrams -- oh my head, more math).

This means Valeant, the makers of Xerese, is taking raw materials that cost at most $1.10 and is charging $1085 for the product, wholesale.

So you may wonder why I just don't make this product by scratching together the ingredients,
investing about five minutes of mix and label time, and pass it on to the patient at a huge savings.

The answer is this - I am forbidden to do so by federal law. The FDA has given the license for this combination to Valeant of Canada, and for me to create the combination is to violate the directives of the FDA, and in so doing, would be dispensing a non-FDA approved product.

You may recognize the name Valeant, by the way, one of the recent collection of gouging pharmaceutical companies.

However, I can get a prescription for 8 acyclovir capsules from that dentist, see that the patient charge is no more than $5, then instruct the patient to get a one dollar tube of hydrocortisone ointment from my shelf, and then, by demonstration, show the patient how to mix the two products, how to put the combination into a one-ounce ointment jar, and then possess not just five grams, but thirty grams of homemade "Xeresel” with a wholesale value of over six thousand dollars.

To put it in context: Xerese costs $217/gram.   Gold (as of 3 March 2017) costs $39.70/gram.

Sadly, the WMU prescription benefit actually covers this product with a $40 copay to the patient. I will be aggressively petitioning them to correct this oversight.