Wedgewood Pergolide Quote


Deb Walker
 

Called today requesting a price for the 6.2 mg compounded capsules that Scotty is getting (equivalent to 8 mg mesylate)

Last Avrio was $193.85/60 capsules = $3.23/day

Wedgewood only has capsules in 3 mg dosage (and I'm not absolutely sure the person I spoke with understands I meant a capsule, not a capsule shaped pill.) Their price for 100 (which would only be a 50 day supply if it was doubled) is $244.50 = $4.89/day

Yikes!!!!!!

This is really getting out of hand in my humble opinion :(
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Terri Quinn
 

I talked to Wedgewood and Mixlab about pricing.  Both of them are quite a bit more expensive than Avrio for my needs (three horses, 30 capsules ordered every 30 days: 2mg, 2.5 mg and 3.25mg).

Wedgewood would have been $100 more monthly than the new Avrio pricing.  Also in order for me to even obtain pricing, I had to transfer my Rxs to them, only to learn that they were considerably more expensive.  Now I'm switching the Rxs back to Avrio -- I will say Avrio was very accommodating about the inconvenience.  And I had a long discussion with Wedgewood about pricing before I moved the prescriptions, asked about recent and future price increases and talked about how they were asking me to make a leap of faith that their pricing would be more advantageous.  Needless to say, I'm very disappointed all around.

Mixlab would have been $200 more monthly.  I honestly thought the pricing they provided was wrong, challenged them on it and received a non-specific offer for a discount that would get me close to Avrio pricing.  Maybe I should have been enticed but instead it made me feel like the entire price-checking process is a game.

It's frustrating no question but I originally switched from Prascend to compounded because of the economics.  I just checked the price of Prascend and I saw $355 for a box of 160 one mg tablets.  I guess all we can do is figure out which compounding pharmacy offers the best price for each of our situations without sacrificing efficacy.


--
Terri Quinn
Connecticut  2009


ferne fedeli
 

I just realized with all these posts about Pergolide pricing, that I needed to refill Magic's.  I called Avrio to ask how to go about refilling, since his current RX has expired and they said they would contact my vet, but they wanted to check the pricing (and I thought, OH NO!!!).  Anyway, she came back and said that the price would be $264 for 90 days of 7mg (I last paid $260, so not too bad!).  So I told her I would mention the info on our list as others would be interested.
--

Ferne Fedeli  Magic & Jack   2007

Point Arena, Mendocino County, California
Case History

 

 


celestinefarm
 

I have a question regarding the ECIR recommendation that owners of PPID horses only purchase 30 days worth of compounded pergolide at a time. Pet Health had told us that they had third party testing  of their pergolide in oil and their capsules and both had well into the upper 90% of potency left at 90 days.  Considering capsules fully enclose the pergolide powder or granules, are opaque and additionally are enclosed in amber bottles with tight sealing caps, I am wonderting why we don't update the recommendation to 90 days? I don't think 30 days is going to continue to be financially feasible for many owners considering cost, shipping, etc.  Moreover, is that 30 days still a valid recommendation or is it outdated considering the experience compounding pharmacies now have with pergolide prescriptions?
I realize Prascend is a compressed tablet with a coating, which is then placed in a sealed foil packet, but their potency/expiration date  I believe is either 6 or 12 months from date of manufacture. ( as a note, when I looked up shelf life on Prascend, I noticed their insert said that Prascend is manufactured in Japan and packaged in Germany. Yet is still potent.. despite traveling that distance in a quantity)
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Eleanor Kellon, VMD
 

Dawn,

The 30 days was based on published "independent" (but paid for by BI) studies of several compounded pergolide. You have a point that we should accept Pet Health's test results but that may not apply to all compounders. In addition to the formulation itself, how long the compounder may have had the drug, especially after opening it, would influence the life of the product.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Karen Anderson
 

Hi Everyone: 

Fhinland's ACTH levels (TRH stim test) rose a bit this month from last June's results. The case study will be posted tomorrow. He went from 22 pre and 75 post to 31 pre and 122 post.

For the last nine months, Fhin has been getting 5 mg compounded pergolide gel capsules from Wedgewood Pharmacy. He takes it readily in a small handful of feed.  I asked my vet to call in a prescription to Wedgewood for 5.5 mg gel capsules. She did so, and they told her that since it was "an unusual formulation" they would have to get approval from their "team" and then call her back. They did finally approve the dosage and I should be getting 100 capsules for a cost of $349. 
Wedgewood technicians told me they can put up to 5 mg in a capsule but that most of their orders are for much lower dosages. My vet also says that 90% of her PPID patients are controlled with 1 or 2 Prascend daily. 

PS  The price quoted to me today for 30 capsules of 5.5 mg was $149, so there clearly is an economic advantage in ordering larger quantities.

--
Karen and Fhinland in Maryland

Case Study:   https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Fhinland


Deb Walker
 

I specifically asked the person I spoke with at Wedgewood, who told me I could ONLY get 3mg capsules @ 100 a time for $244.50. I asked if there was a discount for ordering more than 100 at a time, as I would have to give 2 per day, and she said no.

These pharmacies have us by our throats, and there is no regulatory measures in place.
--
Deb and Scotty I/R, PPID
Pecatonica Illinois, May 13, 2019
Case History:
 https://ecir.groups.io/g/CaseHistory/files/Deb%20and%20Scotty
Photos:
https://ecir.groups.io/g/CaseHistory/album?id=90619


Karen Anderson
 

Hi Deb:   Would your vet be willing to call Wedgewood and talk with them directly?  If enough vets do that, I suspect the pharmacies will come around. . .  You shouldn't have to pay for two 3 mg capsules per day!!
--
Karen and Fhinland in Maryland

Case Study:   https://ecir.groups.io/g/CaseHistory/files/Karen%20and%20Fhinland


cathyjomitchell
 
Edited

I have been ordering 5mg capsules from Wedgewood for almost a year now. They were not my first choice but I have also been struggling with getting a vet to work with me on this stuff and that was one of the pharmacies he was familiar with.

I have had to have some "interesting" conversations with Wedgewood from time to time.  What I found is you have to be polite and persistent.  I think they operate out of more than 1 location and that may be part of why you get some occasional confusion on the part of whomever you are speaking with.   I won't go into all the confusion here, but it seems to be one of those times when you need to "ask for a supervisor". 
It was a pain, but I eventually got 5 mgs ordered. 

They have not been the easiest to work with, but I have to work with my vet as well, so I keep muddling through.  Let me know if you could use some additional information from me like my address to see if they can find my prescription and duplicate it for you. I can send you a pm.

On another note, Prascend must do a heck of a job "marketing" to vets, because most vets respond with almost the exact same verbiage on why you have to use Prascend and why your horse should only need 1 or 2 tabs of it.  It is incredibly frustrating, and can be actually detrimental to the horse.
--
Cathy and Mikey (Arabian)  in MN
joined 2008


celestinefarm
 

This is rather confusing. Wedgewood has a post on their website stating that they compound pergolide capsules in 22 strengths. Here is the copy.

Strengths:

22 strengths of Pergolide Capsule are available, ranging from 0.2 mg/cap to 5 mg/cap.

So there shouldn't be an issue with getting at least 5 mg capsules. When I was using Wedgewood several years ago, Tipperary was on 6.5 mgs of pergolide mesylate and yes, I had to get two Rx. one for 5 mgs and one for 1.5mgs. Yes, it was more expensive than Pet Health who could compound the entire amount into one capsule. I talked to Pet Health/Avrio when I returned to using capsules last month and asked if they could compound a 13 mg.pergolide mesylate capsule.( ten mgs. pergolide) . They were puzzled I was asking, the person I talked to checked with the pharmacist and said that they had compounded 20mgs in one capsule and felt capsule size was not an issue. Why Wedgewood will limit pergolide to 5 mgs is beyond me, I suspect it has something to do with all the FDA/court case over bulk pergolide. But I have no idea.

I know members are upset over the price increases of pergolide and with the limited pharmacys that compound it. If you don't know the history of using pergolide mesylate for horses after it was taken off the human market( Permax, long term use in humans could cause heart problems and the newer parkinson drugs worked better that replaced it), I believe in the files here is a record of some of the fight that ensued to allow vets to Rx. it.  If memory serves me right,, we had a member here who went back through the different veterinary trials to try to figure out where the hysteria in the vet community originated over giving horses more than 3 or 4 mgs of pergolide if ACTH numbers remained high.  Apparently when pergolide was first tried on horses, no one knew what dose to use, so they went with human doses, which were in the 100 mg plus range.  You can imagine how that went . Lots of serious side effects immediately.  Then eventually, when the dosage was figured out better, Boehringer Ingleheim developed Prascend and trialed it at 1-2 mgs. Trials were small, horses were not managed as we know how to manage PPID horses, some horses didn't respond and developed laminitis, etc. But the trial went well enough that the FDA approved BI to market Prascend.  So you have a combination of a major drug company with FDA approval and the memory of large doses of pergolide in the vet community to combine to make vet's fearful of anything more than 1-2 mgs. ( in Europe it's 4 mgs, for the exact same drug) .  Add in issues with illegal compounding by veterinarians themselves in the racing and competition equestrian community for joint injections, etc. at the time and the FDA started cracking down on compounding and vets who were doing so and selling the compounds themselves were prosecuted. Pergolide got lumped into that fight, because now there was a FDA approved med ( that was unaffordable at the higher doses many horses require) and for a while it was scary that pergolide would be forbidden to be compounded. It took a court case , a lot of letters from owners ( I was one) and written professional testimony( Dr. Kellon was involved in that) to get a court order issued that said the FDA could not restrict compounding in animal drugs.  It's a very tenuous victory and one that could be overturned any time. We should be grateful there are compounding pharmacies willing to compound pergolide as there are many prominent ones that wont.( Rood and Riddle and Hagyard in Lexington Kentucky come to mind). We need to work with them, not be angry with them.
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Eleanor Kellon, VMD
 

Dawn,

Your history is off a bit. Human doses are not 100 mg. Depending on the condition being treated a human dose is less than 1 mg to 5 mg. Permax or compounded pergolide has been in use in horses since the late 1970s. Prascend was FDA approved in the US in 2011. Their dosages were based on dosages commonly reported in the literature, which is up to 5 mg/day, the upper suggested dose in the EU. The hysteria in general is more related to human exposure than anything equine. There have been no court decisions addressing pergolide. There have been two federal district court decisions that declared animal compounding from bulk drug was outside the FDA's scope but they are only binding in those regions. Where I was active was after the 2007 banning of pergolide in the US. We petitioned to get a special allowance for pergolide compounding since Permax was banned. The FDA was very reluctant to do that, to put it mildly, and it was quite the battle but we won and they agreed to at least look the other way.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 

I agree we need to work with the tiny number of compounding pharmacies we have available to supply this critical medication to our horses. Cost of living increases are no doubt different in different parts of North America. In California we’re seeing large price increases in everything from feed to fuel to groceries to rents. Recent articles detail critical drug shortages and delays. So while I wish CP prices weren’t going up, I’m not shocked or offended, just saddened by the impact increases have on our community. 
--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos


cathyjomitchell
 
Edited

Based on my experience lately, not just with Wedgewood, but other companies, is they are facing supply chain issues and cost increases themselves. I also get the impression that they are facing staffing challenges as well. So sometimes when you call in you are getting someone with less training and/or experience. Or I think sometimes it is some sort of answering service which is fielding some of these calls, so they do fine with basic questions, but struggle with stuff that requires more know how.

That being said, the price increases, overall costs and the challenges in even trying to get a vet on board to work with you and think outside the "Prascend Box" can wear you down. In addition to the emotional struggle of trying to help your horse.
--
Cathy and Mikey (Arabian)  in MN
joined 2008


celestinefarm
 

Dr. Kellon, thank you for clarifying the history. I thought I read about the high dose trials here, but it's possible I read it at another site. It was a long time ago. 
--
Dawn Wagstaff and Tipperary   

Saline, MI  2003

Tipperary Case History

Juniper Case history: https://ecir.groups.io/g/CaseHistory/files/Dawn%20and%20Juniper/Case%20history%20Juniper.pdf .


Melanie Pewe
 

I was quoted $320.50 for 30 pills of 5mg pergolide from Wedgewood.  My horse is currently on 6 mg and needs more.  This pharmacy will be cost prohibitive.  I was using Pet Health and Avrio merged with them.  As Im sure you know they grandfathered in prices till January. Now they are nearly double.  My 30 day auto ship of 6mg capsules was about $63, now the quote is $98. 

--
Melanie
North Dakota 
2005?


Starshine Ranch
 
Edited

Yesterday, I reordered my Pergolide for my two horses... 90 ml each of 3.5 (used to be 5) ml/mg.  The last time I ordered it was $186. each.  This time it is $246. each and those bottles last less than 2 months.  That's over $3000./year!  Over $8.50/day!!!  Along with the very expensive tested, low sugar hay (no good deals on hay for us) and the 2x/year bloodwork, I don't see how I can keep up with 2 PPID/IR horses.  And now that gas is so crazy expensive, trailering to ride is just stretching my finances to beyond what I ever imagined.  It used to be fun having horses... the joy is fast diminishing.  ):
--
Linda in CA  2020  Midnight and Ostara
https://ecir.groups.io/g/CaseHistory/files/Linda%20Midnight%20OStara


Sharon Manning
 

Try Mix lab in New York. My horse gets 16 mg and it’s 135.84 per month on auto ship. Their customer service is excellent .


Sharon
Knoxville TN

Please forgive any errors 


Tracy
 

Linda I feel your pain - and like you said - the joy is diminishing.  I'm waiting on new lab results for Salsa (sent to Cornell last Friday) and suspect will need to go to 2 Prascend.  Vet so far has refused pergolide - but now seeing these posts - UGH!  Even perg is this expensive?

I love Salsa and he will get what he needs - but when he crosses over someday I don't plan to have another horse.  I'm done.
All the breeds I enjoy are prone to metabolic issues - and I'm....well...beat.  It's exhausting.
I'm getting my motorcycle endorsement on my license this summer - that will get me my "wild and free" kick and for a lot less money and emotional ups and downs.

Prascend is the biggest insult though.  My vet and I were talking about it last week - isn't this crap off patent now?
Sigh.

Good luck to us all and our beloved equines!

--
Tracy and Salsa (1999 model year Paso Fino)
Middle TN USA, September 2019
Case History  https://ecir.groups.io/g/CaseHistory/files/Tracy%20and%20Salsa
Photos https://ecir.groups.io/g/CaseHistory/album?id=95827


Eleanor Kellon, VMD
 

Tracy,

Going off patent isn't likely to help for pergolide since it's banned for human use.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 
Edited

Hi, Tracy. In brief: Prascend is only one formulation of pergolide that was effectively marketed to veterinarians as the only safe way to prescribe pergolide to horses. As Dr Kellon hinted, a big problem is that animal drugs are a tiny fraction of the pharmaceutical market, and there is no rush to market a generic to compete with Prascend.

The list of patented animal drugs is in the Green Book, and Prascend is NOT on the list.  It’s detailed, but Prascend is an FDA-approved formulation (packaging tablets in foil) shown as "effective." The manufacturer  BI *had* a period of exclusivity for that formulation that is a standard benefit of FDA approval. It is not a patent but did give the manufacturer the exclusive right to sell that formulation for 5 years. The period of exclusivity expired on September 7, 2016.

Part of BI’s business model was to convince vets that other formulations of pergolide were unstable. It’s been very effective, in part because some of those formulations really are unstable — old capsules, loose powder or pergolide suspension in water. CP in capsules, properly compounded to appropriate potency, used within 30 days, safely stored at the same temperatures as Prascend and protected from moisture, was shown in studies to be retain potency. Here's one study: https://aaep.org/sites/default/files/issues/proceedings-10proceedings-z9100110000274.pdf  

Another part of the model was to convince vets they could not prescribe compounded pergolide without risking personal liability. This was very effective initially. Broad language adopted by AAEP guidelines makes it sound like compounding is illegal and substandard, using language like, "The prescribing veterinarian should understand that his/her professional liability policy may or may not respond to allegations of negligence arising from the use of compounded drugs." As veterinarians gain more experience with CP, they find that the dire consequences of prescribing compounded pergolide are overstated.

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos