My father was diagnosed with B Cell Prolymphocitic Leukemia in March 2017. He received 6 Cycles of Chemotherapy (Rituximab+Bendamestine). Last cycle was received in January 2018.
Now the disease has relapsed and doctor has advised Ibrutinib. In Pakistan Ibrutinib costs Pakistani Rupees 200,000/- per month course.
Does any one know about cheaper ibrutinib and its delivery process to Pakistan. I read somewhere that Indian ibrutinib is cheaper.
Please share yours information.
Thanks
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I wouldn’t trust a drug from Pakistan. I wouldn’t think the United States would accept a drug manufacturer in Pakistan to make it. Jansen is a Johnson and Johnson sister company. I would be shocked if Jansen didn’t manufacture it in the United States. I guess nothing would shock me anymore.
Its not made in Pakistan. Its smuggled to Pakistan through illegal ways, thats why Pakistan Drug Regulatory Authority has not registered/regularised the drug and thats why its expensive here.
Imbruvica is made in china It is manufactured there by a TEVA company that is the worlds largest generic company. It is distributed by Jansen. I;m a retired retail pharmacist. Most prescription drugs taken here are made overseas-many in countries with cheap labor. The facilities that are used are actually inspected by the FDA.
Sorry, I do not know where to get cheaper ibrutinib. but from the information you provided, 200,000 Pakistani Rupees is $1,360 per month. About one-tenth of the cost here in the US. My insurance usually pays 80% of the medical cost and I need to pay 20%. This is about half price even after insurance coverage.
Hi B-LL Pakistan,
I’m sorry we cannot advise on here how to source any medication through unregulated means that is outside of clinical supervision and monitoring.
I’m sorry to hear of your father’s situation but we cannot permit requests like this because there’s no way of knowing if you’d be at the mercy of unscrupulous suppliers with inadequate medication.
I’m afraid I must switch off replies to this post.
Newdawn.
It's important for us to understand how critical to the medicine supply-chain is the contribution from our fellow World citizens who live in what we in the West call the Third-World. Just because they are severely under-resourced economically they're vital because many of the medicines we use in the west are first tested for safety and efficacy overseas, and later in those same locations the factories pump-out the pills that are shipped to suppliers in the USA, UK, Oz, etc. We mustn't assume that because a drug is sourced overseas that it should be suspect because of contamination. All the Western pharm companies have extensive, even intrusive, inspections to satisfy Western regulators of the integrity of the manufacturing processes.
Now, it <is> true that there are counterfeiters of many popular Western medicines in poor countries. If there's a market then there'll be a vendor! I've seen knockoff drugs of all kinds in every SE Asian location I've visited ~~ but never for orphan-drugs like Ibrutinib.
Specific to CLL-medicines, I have something to add ...
I teach once or twice a year in India at a medical school. I also teach in Pakistan at several universities (but not to medical/pharmacy faculties) and from all this I have a little knowledge about this issue, and might have something useful to add to the questioner and perhaps other interested CLL-ers. Here goes ...
Because I have an interest in CLL-tx, I've specifically checked out novel-agent availability in India (but not yet in Pakistan). There is no retail availability in streetside-pharmacies or in general hospital pharmacies for any of the novel agents. There are no "smuggled" or "fake" ibrutinib sources. You can't just go in and purchase the legitimate product there either. There is simply too little call for novel-agents in retail pharmacies for the counterfeit versions yet to have emerged. If a typical person has CLL, say in India, they likely wouldn't know it because it's not on the radar for physicians to diagnose and if whitecoats did recognize it there's no tx except limited-access chemo-therapeutic options.
For the 'average Indian', CLL just hastens death in what is already a shorter lifespan than is typical in my Western home-town.
There <is> a small amount of the 'legitimate' Ibrutinib drug available in some teaching hospitals that is sourced directly from the manufacturer expressly for specific named patients, on an as-needed basis. This availability is because of an international program available direct from all Western pharmaceutical companies that makes MANY drugs available to third-world countries at a reduced, cost-covering fee. The price is calibrated to match the cost-of-living in each 3rd-World country based on its financial means, and so varies. Even at this highly subsidized price (compared to US/UK-costs) it's still unaffordable for all who seek treatment in a 'government' hospital. So, realistically, to get any novel agent for CLL in India, for example, the CLL-er would need to be a fee-paying patient in the 'private-wing' of a teaching hospital, in a major city, and would have to have a consultant who is knowledgeable about CLL and also willing to go through the mountains of paperwork that such a request requires. As you'll guess ... not many will be so lucky. Accessing chemotherapeutic tx is almost as difficult. Sad, I know, but that's the reality.
To avoid the problem of resale-for-profit, this limited-access program from drug manufacturers is only available via major teaching hospitals where there is a means to track medicines (and keep them appropriately refrigerated, if needed) and also to have a specific, named medical professional attest to the need for its use, and (if asked) to 'prove' its use on a specific patient.
These safeguards are so as to avoid setting up a black-market. Every pharm company has a program like this for its medicines. It's good PR for them, and also helps them when they want to set up safety & efficacy trials in distant settings where, generally, the regulatory restrictions are fewer. These programs are mentioned upfront as part of the package presented to Western regulators when its time for a roll-out of the product. Incidentally, such trials are only done at major teaching hospitals so that's a way that pharm companies can identify appropriate personnel to manage the program 'on the ground' and it also serves as a payback and education mechanism for those centers of medical excellence in 3rd-World countries.
I could go on ... but I just wanted to add a little to some of the musings of other respondents to you, our poster from Pakistan.
Caven
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