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
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.