Breast Cancer Drugs 87% Cheaper Through International Mail Order
There is certainly more than enough physical and emotional stress surrounding a breast cancer diagnosis, but the United States healthcare system has decided financial strain should join the mix. A recent PharmacyChecker drug price analysis finds that the only three options in a targeted therapy to treat breast cancer are 3 times more expensive at pharmacies in the United States compared to online pharmacies that work with dispensing partners in Australia and New Zealand. Those same drugs -- manufactured by the same global pharmaceutical companies -- are as much as 17 times more expensive in the U.S. than those at vetted Indian online pharmacies. These international online pharmacies are accredited for safety and provide global shipping, making them viable cost-saving options for patients in the United States who are prescribed medications that are priced too high domestically.
When discussing access to medicine, affordability is a crucial component. The prices PharmacyChecker analyzed are for drugs called CDK4/6 Inhibitors, which are used as a targeted therapy to treat certain types of hormone receptor-positive, HER2-negative breast cancer. A PharmoEconomics study published in 2023 entitled “Cost Effectiveness of CDK4/6 Inhibitors in the First-Line Treatment of HR+/HER2− Metastatic Breast Cancer in Postmenopausal Women in the USA” concluded that “lowering the cost of these drugs [...] would improve the value” to breast cancer patients. And yet prices keep rising: One of the CDK4/6 inhibitors, Verzenio (abemaciclib), found itself among the top drugs sold in the United States that saw the largest price increases at the beginning of 2024, according to an analysis for The Wall Street Journal conducted by 46brooklyn Research, a nonprofit dedicated to the accessibility of U.S. drug pricing data. The analysis shows Verzenio’s list price increased 6% in January alone. The retail price of Verzenio 50mg is currently around $4,064.90 at U.S. pharmacies for a supply of 14 tablets. PharmacyChecker analysis shows that American consumers can save around 9% off the cash price if they use a local discount coupon; 63% if they order from an international online pharmacy that works with an Australian dispensing partner; and 82% if they opt for an online pharmacy that partners with an Indian dispensing pharmacy. All prices are derived from drug price comparisons published on PharmacyChecker.com, which compares U.S. discount coupon prices with mail-order prices provided only by online pharmacies that are vetted and monitored through the PharmacyChecker International Pharmacy Verification Program. Online pharmacies accredited by PharmacyChecker partner with dispensing pharmacies located in Canada, Australia, India, Mauritius, New Zealand, Turkey, the UK, and the United States.
Verzenio is approved in the United States to be taken on its own or in combination with endocrine therapy for the treatment of certain advanced or metastatic breast cancers. The other CDK4/6 inhibitors available, Ibrance and Kisqali, cannot be taken by themselves; they must be taken along with hormone therapy. All are approved as brand names in the United States, with no direct generic competition. Even with insurance, the cost of taking these drugs can be high. Depending on a patient’s income, they may qualify for financial assistance from the manufacturer. PharmacyChecker encourages patients to have an open conversation with their breast cancer treatment team about the cost of care, as they may have connections to grant programs that could bring out-of-pocket costs to zero. A treatment team can also evaluate the cost-benefit of importing medication from an accredited international online pharmacy. How these CDK4/6 inhibitors are taken differs as well, which can certainly contribute to the cost of therapy: Verzenio is taken daily, while Ibrance and Kisqali are taken for three weeks on, and one week off.
Breast Cancer CDK4/6 Inhibitors - International Price Comparison |
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| Brand Names | Average US Retail Price | Average PharmacyChecker US Coupon Price | Lowest PharmacyChecker Accredited Online Pharmacy Price | Lowest PharmacyChecker Tier 1 Accredited Online Pharmacy Price * | Tier 1 International Online Pharmacy Savings | International Online Pharmacy Savings |
| Verzenio | $290.35 | $264.60 | $52.43 | $106.77 | 63.23% | 81.94% |
| Ibrance | $801.86 | $732.05 | $20.31 | $207.40 | 74.14% | 97.47% |
| Kisqali | $328.89 | $324.31 | $61.01 | $118.56 | 63.95% | 81.45% |
| Average Savings: | 67.10% | 86.95% | ||||
| Prices collected February 2024. All prices listed are per tablet. The Average Retail Price at U.S. Pharmacies was sourced from Drugs.com. All other pricing is derived from prices and quantities compared on PharmacyChecker.com. International online pharmacy prices include shipping costs. *All PharmacyChecker-accredited online pharmacies (tier 1 and non-tier 1) are verified for compliance with the PharmacyChecker Verification Program Accreditation Standards. To ensure continued compliance, PharmacyChecker verifies online pharmacy credentials and practices on a regular basis. PharmacyChecker knows that some patients and their clinicians would prefer to order medication from a pharmacy located in a country known to have the most advanced systems of pharmaceutical and pharmacy regulations. To meet this need, online pharmacies that only process orders dispensed from such countries are marked with the Tier 1 icon. Under section 802 of the Food, Drug & Cosmetic Act, the U.S. Food and Drug Administration (FDA) has identified the following countries eligible for export of unapproved drugs: Australia, Canada, Israel, Japan, New Zealand, Switzerland, South Africa, and member countries of the European Union or the European Economic Area (EEA). These countries are known to have high regulatory standards equivalent to those in the United States and are sometimes referred to as Tier 1. Currently, PharmacyChecker-accredited online pharmacies with the Tier 1 icon only fill prescription orders through their own pharmacy or dispensing pharmacy partners located in Australia, Canada, Israel, New Zealand, the United Kingdom, or the United States. | ||||||
Certainly germane to the cost-benefit conversation is efficacy: In December 2023, albeit narrowly, Verzenio failed to show that it significantly extends patients’ lives. Previously, Ibrance (palbociclib) also failed the same trial, leaving Kisqali (ribociclib) as the only CDK4/6 inhibitor that has shown significant survival.
Verzenio, Kisqali, and Ibrance International Marketing
When looking to order medication from a foreign country, it’s important to be mindful of the fact that drug names and strengths of medications can vary globally due to marketing strategies. Although often considered clinically equivalent, any variations need to be approved by a patient’s prescriber.
Across the world, we see that Eli Lilly markets abemaciclib under various trade names including Verzenio, Verzenios, Ramiven, and Yulareb. Lilly markets the drug under the name Verzenio in the United States and Canada. Abemaciclib is marketed by Lilly under the name Ramiven in India. Yulareb, manufactured by Lilly, appears to be the trade name for abemaciclib sold in Turkey, Pakistan, and Thailand, among others.
Pfizer appears to maintain the trade name “Ibrance” for palbociclib across many countries, including India, Australia, Canada, Turkey, New Zealand, and the United States. Although still under patent protection in much of the world, generic versions have been approved and available in India since 2023.
Novartis markets ribociclib under the name Kisqali globally, including in the United States, India, Turkey, Canada, and Australia.
As PharmacyChecker has found to be the case with many branded products in the United States, none of the three drugs we highlight here – Verzenio, Kisqali, Ibrance sold in the United States – are made in the United States. Verzenio and Ibrance are manufactured in Ireland. Kisqali’s active ingredient, ribociclib, is manufactured in China and the drug is finished in Slovenia.
Verzenio - manufacturer: Eli Lilly - country of origin: Ireland
According to its label, the active ingredient of Verzenio (abemaciclib) sold in the United States originates in Ireland.
Image source: National Library of Medicine
Ibrance - manufacturer: Pfizer - country of origin: Ireland
According to its label, Ibrance (palbociclib) sold in the United States is made in Ireland.
Image source: National Library of Medicine
Kisqali - manufacturer: Novartis - country of origin: China; Slovenia
According to its label, the active ingredient of Kisqali (ribociclib) sold in the United States originates in China, with the finished drug product made in Slovenia.
Image source: National Library of Medicine
