Generic Farxiga Hits the Scene: Comparing Dapagliflozin Costs Across Countries

This past year, generic version approvals of Farxiga, Forxiga, and Forziga (all are dapagliflozin propanediol; shortened chemical name: dapagliflozin) have made a swift rollout across many countries. The European Medicines Agency granted marketing authorization for the generic Dapagliflozin Viatris as therapeutically equivalent to Forxiga in March 2023. Also in 2023, Health Canada approved generic alternatives made by Accel Pharma, Angita Pharma, Apotex, JAMP Pharma, and Auro Pharma. 

And the United States FDA rang in 2024 with its own Farxiga generic approvals.

You may recall that Farxiga finds itself on the short list of medications up for U.S. Medicare price negotiations that will go into effect in 2026. As a refresher: the Inflation Reduction Act of 2022 authorizes the Secretary of the Department of Health and Human Services to negotiate Medicare prices directly with participating manufacturers for selected drugs that have high total spending and are high expenditure, single-source drugs without generic or biosimilar competition. Medicare has spent about $3.3 billion a year to provide Farxiga to about 800,000 patients. At the time of Farxiga’s selection, it didn’t face generic competition – and, although perusing Orange Book patents only seems to confirm its continued exclusivity, FDA data does indeed show there are FDA-approved generic labelers, including Bryant Ranch Prepack, A-S Medication Solutions, and PRASCO, LLC. Authorized start dates for them to market are listed between January and February 2024 – and PharmacyChecker has confirmed that Farxiga generics are on U.S. retail pharmacy shelves. It’s likely that recent generic approval won’t disqualify Farxiga from negotiations – they will only serve to weaken the Secretary’s choice of its inclusion of the short list of drugs up for negotiation. Surely, if the price is right, a generic option will show up on Medicare plan formularies. As you’ll see on the sample price comparison chart below, the U.S. generic retail price is around 25% cheaper than the Farxiga brand name. 

Farxiga, Forxiga, or Forziga?

Whatever the branded name, dapagliflozin is used in much of the world to treat type 2 diabetes, as well as heart failure and chronic kidney disease. It was developed by innovator drug company Bristol-Myers Squibb in partnership with AstraZeneca, earning its first health authority approval in 2012 in the European Union; and the United States in 2014. Differences in brand names are common across countries, even when the drug is marketed by the same manufacturer. This is one such case, where drug company AstraZeneca markets dapagliflozin under at least three different trade names: Global consumers can find dapagliflozin branded under the name Farxiga in the United States; Forxiga in countries such as Japan and the United Kingdom; and Forziga in Turkey. 

The convoluted nature of the global pharmaceutical industry goes beyond just these slight branding differences: Likely, the medication on your local pharmacy’s shelves is not made domestically. For example, the majority of medicine sold in the United States is not made in the United States. In the case of U.S. brand Farxiga, the origin of its active ingredient dapagliflozin is Sweden and the final Farxiga product is finished in Switzerland. The U.S. generic labeler PRASCO appears to produce U.S.-sold dapagliflozin in Ireland. 

Comparing Dapagliflozin Costs Across Countries

Dapagliflozin’s price has left many patients, especially those in the U.S., wondering how to afford this vital maintenance medication. American consumers who compare brand costs on PharmacyChecker.com can save as much as 96% off the U.S. discount coupon price of Farxiga by ordering internationally from an accredited online pharmacy. What’s remarkable about this price discrepancy is that it is essentially the same medication, marketed by the same manufacturer. A look below at the price comparison chart shows that brand Forxiga at an online pharmacy that works with an Indian pharmacy dispensing partner is sold for $0.70 per tablet – shipping included. Brand Farxiga is sold at U.S. retail pharmacies for around $18 per tablet if purchased in conjunction with a discount coupon. 

Forxiga and Farxiga are both dapagliflozin. 

Forxiga and Farxiga are both manufactured by AstraZeneca. 

It’s highly probable that, like Farxiga sold in the United States, Forxiga sold in India is manufactured in Switzerland. 

Prices collected February 2024. All pricing is derived from prices and quantities compared on PharmacyChecker.com. International online pharmacy prices include shipping costs.

Generic Dapagliflozin Global Manufacturers

Generic manufacturers are a different story. You can see above in the chart that, in the case of dapagliflozin, there isn’t consistency in generic manufacturers across borders. In our sample comparison, you can see that Prasco is listed as a manufacturer that sells the generic in the United States. (Reminder that the company makes the dapagliflozin they sell in the U.S. in Ireland). The Canadian-sold generic manufacturers include JAMP Pharma and Apotex. And then there are a few manufacturers used by Indian pharmacies: Natco, MSN, and Indoco. 

The quality of drugs manufactured in India, whether sold in the U.S. or elsewhere, is the subject of much intense, oft-warranted scrutiny. As such, the PharmacyChecker International Pharmacy Verification Program has special requirements for Indian pharmacy participants that dispense medication internationally. All PharmacyChecker-accredited pharmacies (those located in India and elsewhere) must ensure that the drug products in their inventories are ethically promoted pharmaceutical products manufactured by first-tier Indian manufacturers and global pharmaceutical companies. According to the PharmacyChecker Accreditation Standards and Guide, Standard 6.0, pharmacies “must only market, sell, process and/or dispense medications that have been approved for sale in at least one of the following countries/regions: Australia, Canada, European Union, India (subject to additional requirements/restrictions, as per PharmacyChecker Policy 16-05 Marketing / Dispensing Indian Pharmaceutical Products Internationally), Israel, New Zealand, Singapore, South Africa, Turkey, United Kingdom, or the United States.” Natco, MSN Lab, and Indoco are considered global pharmaceutical companies. Natco markets and distributes products in over 50 countries, including the United States, India, and member nations of the European Union. MSN Lab is approved to market in the United States. Indoco has drug approvals on file with the US FDA, the UK Medicines and Healthcare products Regulatory Agency, among other health regulatory authorities.

To ensure continued compliance, PharmacyChecker regularly conducts thorough audits of pharmacy credentials and practices. 

We’re well aware 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 given a Tier 1 designation in our program – and are clearly marked with the Tier 1 icon on our website. Under section 802 of the Food, Drug & Cosmetic Act, the U.S. Food and Drug Administration 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). 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.