pill cutting changes the market for hair-loss drugs
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Pill cutting changes the market for hair-loss drugs

Faced with the prospect of thinning hair and the reality of the high price of the hair-loss drug Propecia, some men are turning to a riskier alternative. Most insurance companies won’t cover Propecia, which contains 1mg of the testosterone blocker finasteride. They will however cover Proscar, an identical drug manufactured in 5mg pills to treat an enlarged prostate. While a one-month supply of Proscar costs only $5, a similar supply of Propecia can cost ten times as much. Some men suffering from hair loss are convincing their doctors to prescribe Proscar, planning to cut the pill in half to treat their condition. Some call this practice insurance fraud; others call it common sense.

Proscar was developed by Merck in the mid-1990s to fight enlarged prostate. In the course of their study, researchers realized that the pill had an added benefit; it stopped hair loss and even promoted hair growth. Merck introduced a 1mg dose of finasteride as Propecia in 1997 and sales have been strong ever since. In 2004, Propecia generated $270 million for Merck; sales of Proscar reached $733 million.

Merck calls the use of Proscar to treat hair loss an “off label” use, and has made public statements clarifying that the two pills are intended to treat very different problems. Most insurance companies do not cover off label prescriptions, but admit it is difficult to crack down on such usage.

While doctors who prescribe Proscar try to get their patients to cut Proscar into four pieces, most patients only cut the pills in half, resulting in a daily dose of 2.5mg (as opposed to Propecia’s 1mg per tablet). Merck is concerned because there is no way to ensure each section of the cut pill contains the same amount of active medication. They claim the pill cutting also poses a risk to others, as women who are pregnant or thinking of becoming pregnant are at high risk for a certain birth defect if they come into contact with finasteride. Risks aside, until the prices equalize, many men are likely to use Proscar in place of Propecia to treat hair loss.

Propecia and Proscar are the trade marks of Merck.

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