According to the Taiwan Pharmaceutical Manufacturer’s Association (TPMA), Tienam, which is an antibiotic and Prozac (also known as fluoxetine), a widely used antidepressant, have been withdrawn from the Taiwan market permanently as of April 1, 2019. Orders for the drug that had been received prior to March 29, however, were fully supplied.
The decision was made to do so after manufacturers of pharmaceuticals had been feeling the crunch of reimbursement cuts for drugs covered by the country’s National Health Insurance system, in addition to the rising costs of raw materials. Specifically, Zuellig Pharma, a local pharmaceutical company, stopped selling Prozac in Taiwan starting April 1 because of rising raw materials and transport costs, along with price cuts by the National Health Insurance Administration (NHIA). This was stated in a letter received by all hospitals in Taiwan from Zuellig Pharma on March 13 of 2019.
In just the past year, prices of several raw materials for many different pharmaceuticals skyrocketed by more than 40%, creating a financial burden on pharmaceutical companies. This trend doesn’t show signs of slowing down in 2019, either. Zuellig Pharma also cited the rising costs of following Good Manufacturing Processes (GMP) and the Pharmaceutical Inspection Cooperation Scheme (PICS) as reasons for the removal of Prozac from Taiwan.
Not as Bad as It Seems?
Su Tung-mao, TPMA Chairman, explains that the withdrawal of Prozac (fluoxetine) from the Taiwanese market is not as serious as it sounds; he pointed out that six other pharmaceutical firms throughout the country also sell other antidepressants that contain the same ingredients as Prozac at the same dosage. Prozac is widely used as a first-line treatment for depression because of relatively few side effects and its long history of success.
While there are alternatives to Prozac out on the market, those manufacturers received only 40% of reimbursements from the NHIA in 2018, despite accounting for over 70% of the domestic market. The other 60% of reimbursements, according to Su, went to the original manufacturer of Prozac.
Merck Sharp & Dohme Corp., a U.S. pharmaceutical company, has pulled its Tienam for injection from Taiwan for the same reasons: rising manufacturing costs. In response, the NHIA states that reimbursement amounts are based on market surveys; they leave a three-to-five percent profit margin for suppliers of pharmaceuticals to ensure that they do not sustain any profit losses. The NHIA cut the price of Prozac from about $0.067 per tablet to $0.063, creating what pharmaceutical companies dubbed a financial burden.
The active ingredient in Prozac, fluoxetine, is sold under other brand names including Selfemra and Sarafem.