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Posted 2011-02-01 14:23:43
Do all pharmacies charge the same price for the same med? Or is it worth shopping around?
Does anyone know of a "better priced" pharmacy in Chiang Mai?
I'm pleased that my BP med here costs much, much less than it does in America, even cheaper than I can buy and import to the US, but I was very surprised that naproxen (Naprosyn) which is similar to another NSAID Ibuprofin is quite expensive here.
I can buy a bottle of Ibuprofin or Naprosyn in the States for 1/4 what I would pay here though the over the counter dosages do not seem available only the prescription dosages. For instance Ibuprofin OTC in America costs about $12 for 200, here Ibuprofin 600mg cost as compared to the three 200mg OTC tablets I'd normally have, costs double or triple.
Posted 2011-02-01 20:14:28
My MD recently changed one of my BP medicines to Madiplot, still in patent and manufactured in Japan. In other words, no generic available.
I went to three pharmacies in Huay Kaew Central Shopping Center in the basement. One opposite Tops quoted 24 baht for each pill, Tops pharmacy quoted 27 baht and Pharma Choice quoted 19 Baht each pill.
Stopped at a "local" pharmacy, pharmacist only comes in a few hours a week to keep the license is my guess and the guy who is usually there and speaks excellent English quoted me 17 baht.
Since it is a patented drug, no hope for cheaper generics, which is the way I go when I can. I have now established a good relationship with this guy and always ask for my special price.
Since most Thai generics are well made and exact in their formulation, I feel comfortable in taking a generic manufactured by large Thai drug companies and merely look at the formulation to make sure it is close to or exactly the same as the name brand.
Example: Started to take Norgesic lately for torn rotator cuff and its formulation is 450 mg of paracetamol and 35 mg of something citrate. The generic was 500 mg paracetamol and 35 mg of the something citrate. Price differential is from 2.5 baht the lowest quoted price per pill to 800 baht for 1000 pills at my local pharmacy. Since I take two a day, in time the savings encourages me.
Expensive drugs prescribed in hospitals can be bought very much cheaper in your local pharmacy once they know you are very price conscious. Likewise, if you break down the formulation, sometimes taking separate pills of the generic medicines that are combined and charged more for as a result, you save considerably. Always buying double strength pills, if available from the medicine prescribed and splitting them with a splitter or razor blade saves a great deal as well.
Since I take 5 pills a day, plus 3 madiplots, 20mg cut in two, medicine expense can really get expensive if you are on a fixed income. Granted, if you believe the propaganda put out by the major drug companies that generics are not pure and are not as effective or as strong as advertised medicines, you should ignore all of the foregoing.
Low cost medicines and their availability over the counter in Thailand is in my list of the top five great things about Thailand. I may be more comfortable with medicine that many as I worked my four college years in a pharmacy as a pharmacist's assistant. My best friend in Thailand thinks I a certifiable and wouldn't take anything but the most expensive cutting edge newest medicine available. To each his own.
Posted 2011-02-01 21:59:31
Even on the same brand medicines I have seen differences up to nearly 100% from different pharmacies. Well worth shopping around. For example Enaril, an ACE inhibiter (BP medication), strip of 10 x 20 mg, 50 baht at "Save Drug" in Carrefour Pattaya, 28 baht at Fascino.
Posted 2011-02-01 22:11:46
The above strategy is potentially extremely dangerous. The active component of the medicine does not necessarily spread across the whole pill. You could be effectively be taking a placebo and then double-strength the next day. Not recommended.
Your local doc.
Posted 2011-02-01 22:29:13
If that is the case how come most pills come with a groove to make it easier to split ?
Posted 2011-02-02 08:49:01
You have used enough qualifiers, such as "potentially extremely dangerous" and "could be effectively" to temper your advice to apply to those who operate from fear and listen to what major drug companies advertise. What I get from what you posted, that major drug companies manufacture their pills in such a way that half of a scored pill is without medication and only the other half contains the effective drug. That is quite a manufacturing feat, especially when the pill color, texture and appearance are consistent through the pill. My kidney specialist, who is a master internist, would most certainly have advised me against splitting my Madiplot, when I advised him how I was going to treat his new prescription. He has demonstrated to me over the last six months that his knowledge of pharmacology is excellent so I blunder forward splitting my Madiplot 20 mg so my thrice daily 10 mg doses keeps my blood pressure below normal. By the way, I monitored my blood pressure six times daily for the two weeks I first went on Madiplot and was pleased with the result. Wouldn't have happened if any of the split pills had their effective chemicals been distributed as you suggested.
Posted 2011-02-02 09:28:48
There are pharmacies that sell wholesale, so if it is something you take every day well worth the saving.. As for Enaril cost me 210 baht for a box of 10 strips....
Metformin last time I bought a strip of 10 a few years ago cost 35 baht, I always buy a Tub of 500 cost is 289 baht [bought another tub last week]
Posted 2011-02-02 09:30:57
My understanding subject to correction is pharmacies can determine their own price for all medication apart from items manufactured by GPO Government Pharmaceutical Organization which must be sold at the price listed on the packaging.
You may find he has a full time day job with the Govt or with a hospital or university. He opens his private practice after work.
Posted 2011-02-02 10:08:54
Your probably right. Smart pharmacy assistants can usually fill most prescriptions, as I used to do more than fifty years ago when I used to do it. Only stayed away from concoctions using the mortar and pestle. I wouldn't buy anything that wasn't factory manufactured under license from Thai government with ingredients clearly detailed on the packaging. I haven't used a doctor authored prescription since I have been in Thailand as most ordinary drugs in Thailand can be obtained without them. Fortunately, the medical profession here doesn't have the lobby that they have in other countries that force the government to make prescriptions mandatory for almost any medication.
I didn't realize until I saw the guy consult google and another website in Thai, that he can research almost any medicine you ask for to see if he can order it for you. I had a great antibiotic and cortisone cream generic ointment for healing incisions and cuts I obtained in Australia, not available in Thailand nor was there an equivalent available with the same formulation. The plastic surgeon said don't use it as the cortisone ingredient would hinder his incisions healing. The surgeon in Australia prescribed it and it worked great on his incisions. Incisions on the back are particularly itchy when healing and can drive you nuts if you don't stop the itch while it is healing. That stuff worked great and I suspect that my Thai plastic surgeon's opinion about the cortisone component hindering healing may be the prevailing opinion of the medical people in Thailand and the government doctors who regulate any given medicines availability in Thailand. Example: Codeine, not available in Thailand in any form over the counter but available in many analgesics over the counter in Australia.
Posted 2011-02-02 10:41:58
There is an association of community pharmacists in Thailand. They are not easy to find but they are in most major centres. They are committed to finding customers the best options especially generics if they exist.. They mostly speak good English and are not part of the larger chains. They have a sign above their shops. I used one in Kanchanaburi that would source generic meds. for me to treat hypertension, that were unavailable in the right dosage anywhere else.
They will also tell you about the process of 'evergreening' - where large pharma companies try to extend the life of popular drugs like NORVASC, COVERSYL, and others used in hypertension treatment, beyond the life of the patent, to stop more generics coming onto the market.
Obviously many pharmacists are trying to make a reasonable profit, so won't really try to find you cheaper generic drugs,or don't have actual chemists available who understand English enough to advise on the subtleties of generic drug descriptions.
Other than the community pharmacists mentioned, I find Fascino to be one of the more informed larger chains. But I still find reasons sometimes, to drive 4hrs to Kanchanaburi so I can stock up at the chemist there.
Posted 2011-02-02 13:43:43
You should definitely shop around! I ran out of a med I take regularly recently and it was 360 in a small pharmacy and 112 baht at Fascino.
Posted 2011-02-03 12:34:40
As a general rule of thumb, tables which are scored can be broken in half without any adverse effects except the dosage of course. Cracking that same tab in 4 is not so reliable or predictable as far as dosage is concerned.
Solid coated tabs are intended to pass through the stomach and dissolve only in the smaller intestine. Braking these will result in either the active ingredient being destroyed by gastric acid or in reduced or complete non-absorption of the meds.
Capsules should not be broken or opened at all.
Posted 2011-02-04 18:38:14
I've never seen a scored pill that could not be broken in half, or one scored quartered that should not be.
Solid coated tabs that are "enteric coated" indeed are designed to pass through the stomach undissolved and dissolve in the alkaline environment farther down and I agree, capsules should not be broken. There are some extended release tablets that are structurally limited, for instance a tiny hole might dissolve allowing the medication to leach out slowly, and these must never be split.
The easy answer is to ask your medical practitioner and/or do the research yourself. Some medications are amenable to being split, and some, where dosage is critical should not be split. An anti-lipid med that I take (Crestor, ie Rosuvastatin) comes as solid coated tablet. Though for years I have taken a 20 milligram pill and with a razor I divide it into 6 parts. Though the pieces might range from 3-4mg @ the pharmacodynamic curve of the med and the non-critical nature of it makes me feel quite comfortable with that sort of a range. Further when I get a lipid profile done, the level of lipids are exactly where I expect them to be. However, I would never, ever do the same with digoxin (a heart med whose level must be critically maintained) or thyroxin (a hormone).
Four years ago my MD was telling me that he could not recommend splitting pills, that it was illegal. Now many insurance companies are requiring that the insured purchase splittable pills. If the Pharmaking would make 5, 10, 20 and 40 milligram dosages proportionally priced there would be no need, but in many cases the 5mg dose costs (in America) more than the 40mg. I now have zero insurance--nada. Understanding this is not a matter of what the "law = Pharmaking" wants, it's a matter of survival.
Pills that should not be split, when you do research on them will clearly tell you so, and tell you why the case. It is always best to not assume but rather do good research and if possible utilize a medical practitioner (if your insurance company will allow her the time to actually talk to her these days).
Posted 2011-02-04 18:46:47
Related to med prices so here goes.
Are legal generics made in Thailand to be trusted?
For example I take Zestril, a branded blood pressure med, made in the UK and sold in Thailand.
The exact same chemical, a generic, made in Thailand (Lispril) is priced about 1/3 or less than the non-generic.
Now in the US I never had any issue with taking made in the US generics, so am I being unfairly biased to be overly concerned about the quality of a generic med made in Thailand? The thing is, I don't want a med that is 80 percent the same; I want the effect to be the same.
Edited by Jingthing, 2011-02-04 18:48:51.
Posted 2011-02-04 22:08:43
Zestril = Lisinopril and is made my many manufacturers including Teva Pharmaceuticals, Mylan Labs.; Sandoz, Watson Pharmaceuticals, Eon Labs, and more...
It is possible that it is made in Thailand but I would suspect that it's made, most likely, in India, and perhaps formulated into pills here.
At any rate, I would imagine that it is the same exact medication. Watch your BP before and after to see if there's a change.
There are generics and virtually all are safe--the problem is when someone "counterfeits" a med, the notable ones are the Erectile Dysfunction Drugs. If it's commonly sold in Thailand at many pharmacies I would suspect it would be as good as any.
There are a few meds where generics are not the same and sometimes there is controversy about them. For instance look at both of your hands. One is left, one is right--they do NOT superimpose, they are different. Some branded meds use a, for instance, Left handed molecule (Levo) exclusively, and there may be another generic manufacturer that creates the drug with 50% left handed molecules and 50% right handed molecules, and in some cases doctors will specify "brand only" for this reason as they believe (in this theoretical case) that only the Levo (left handed molecules) work properly. I do not believe that Lisinopril falls into this category.
I don't think that is an issue in Thailand. Places that I know where pharmaceuticals are properly controlled include UK, Australia, US, Haiti, Singapore, India, Canada, Barbados, Italy and Turkey. I've never heard about Thailand but if it were me I'd try, as using a blood pressure cuff would let me know pretty fast if the Lisinopril was not working.
20 mg tablets without HCTZ cost as low as US$0.15/tablet through some of the suppliers listed on pharmacychecker.com but I do not think any will ship to Thailand. It is possible if cost effective to ship to a relative or friend and then ship here including a copy of the prescription but I don't know if customs would interfere.
Posted 2011-02-04 22:26:53
My branded Zestril box clearly states Made in the UK by AstraZeneca UK, so I would tend to think they can't print that if it's made in India, assuming it's a real drug.
The generic I saw is called Lispril.
Sometimes I have asked Thai pharmacists about Thai generics and asked if they are the same, and the answer I have gotten, is either not the same, or 80 percent. Yes I realize they are motivated to sell the more expensive branded item.
Edited by Jingthing, 2011-02-04 22:37:30.
Posted 2011-02-05 08:23:01
Fear is a powerful weapon to sell insurance and have the public buy only brand name products, thus much advertising is used to reinforce the fear and that advertising cost is passed on to the consumer. By adverting I mean phony studies paid for by drug manufacturers, publicity releases with broad distribution as "news" of isolated instances of adverse reactions to generics, when such an adverse reaction might well have occurred when the brand name product is used and constant "informed advice" that generics are not to be trusted.
When you are in an introspective mood, try to find out where your distrust of generics manufactured in Thailand comes from. There are so many "adverts" cloaked as news by major drug manufacturers about fake medicine, granted, largely in the erectile malfunction area, that it is a wonder anyone would use a generic.
Step one is to ask the MD you trust if a specific generic drug manufactured by specific company is OK to take and go accordingly. As previously posted, chronic conditions of mature people such as BP meds, cholesterol meds, gout meds etc, can all be monitored by blood tests or bp tests so you can see if they work or not on you.
The lobbying efforts of the AMA are considered by most in the know as one of the most powerful lobbies ever. They have effectively caused most of the drugs sold in the US to be unavailable to the public unless by prescription and most doctors require a office visit before prescribing. We have all read about "subsidies" drug manufacturers give to doctors to prescribe their specific drug. All of these efforts by drug manufacturers are built into their cost of any given medicine. No wonder medicine in Thailand is so much less expensive if manufactured here especially if labor intensive as labor costs here are so much less than in the west.
Posted 2011-02-05 15:01:03
I totally agree I have been brainwashed by marketing as I am American, and it's difficult to shake completely. However, there is a specific thing about the chemical in Zestril that a US doctor told me, how it is good for the heart in a specific way other BP meds are not that could not ever be measured with a BP test, which obviously is easy to measure. So for me it really is about is the generic exactly the same as the name brand, and frankly (brain washing again) I am not even sure I would trust a doctor in Thailand to verify that. I have an experience with this type of issue in the US with a US made generic, to complicate this. Over time for another condition the results (yes they were measurable with a number) for the generic turned out differently than the branded med so my doctor ordered going back to the branded as medically justified. Weird, huh?
Edited by Jingthing, 2011-02-05 15:19:33.
Posted 2011-02-05 19:56:01
I personally buy Thai made generics, always have, never a problem.
If there is a choice and if GPO brand is available, this is a government agency with good quality control and low prices.
Posted 2011-02-06 20:50:11
Indeed it is worth shopping around. Prices at pharmacies in Thailand fluctuate rather dramatically. Like one poster said, could be as much as 100% difference from one to another. There is one pharmacy in C.M. that is about 200% higher than anywhere else. But it is in a central location where many farangs like to shop...
I always buy from one of the wholesale pharmacies where prices are at the lowest. But I have to buy in large quantities in order to get the same price clinics pay. In fact the pharmacy will not sell small quantities.
Regarding the claim that you should not cut a tablet in half; nonsense. Doctors have always told me to cut tablets in half. It is cheaper to buy for example 20 mg. tablets and cut them in half than to buy 10 mg. tablets.
Posted 2011-02-08 16:44:36
Definitely shop around. Not only do prices change a lot from place to place, in some stores they change from person to person. Dual Thai/Farang pricing is quite common.
Just want to add, as jingthing says below, you can negotiate - especially if you know its sold cheaper elsewhere. Also if you want to buy in bulk or its something you take for a chronic condition and you will be buying it every week or month, you can ask for a better price.
Edited by SiamRose, 2011-02-08 17:10:41.
Posted 2011-02-08 16:52:23
Sometimes you can negotiate as well. The other day I wanted to pick up something quick from a local place and when they quoted the price, I said, no thanks I always pay this (lower) price at the place I usually go, and they instantly offered the lower price. They won't always do that, but if you know the local prices, they might.
Posted 2011-02-11 08:23:27
While on the subject of generics....
Is there a generic equivalent of Abbott Laboratories Niaspan available in Thailand and if so in what strengths...?
Posted 2011-02-12 16:00:45
Niacin is nicotonic acid aka Vitamin B3. You are probably referring to Niaspan ER (= niacin extended release)
It is available under many generic names such as Niacin SR (sustained release); Slo-niacin; Neasyn SR; Neaspan, Nealip and others.
Thai pharmacists most likely have it, and you simply might ask for "extended or sustained release niacin."
Be careful to stick with the same strength and note that going from an extended release to an instant release or visa versa can be a no-no. Check with medical practitioner first, as always.
Tell your doctor about all other cholesterol-lowering drugs you are taking with Niaspan, especially atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), or simvastatin (Zocor).
Also be careful if you are taking an heart, or cardiac, or Blood pressure meds, including occasional use of nitroglycerine. In short, make sure that a knowledgeable practitioner, pharmacist or pharmacologist reviews everything else that you take. (These notes for others that might be thinking that niacin is a good idea and who have not been prescribed Niaspan)
Posted 2011-02-13 22:40:00
Yes you are correct, I am using Niaspan ER (prolonged-release).
My dosage is 2000mg Niaspan per day and I am also on 10 mg Ezetrol-ezetimibe (Scehering-Plough) for cholesterol lowering and 50mg Betaloc for lowering blood pressure.
All of these medicines has been prescribed to me by my doctor.
Would it be safe to find generics for at least the Niaspan since the cost is quite high with my dosage..?