Pharma firm hikes cost of epilepsy drug 24 times

Epanutin capsules were costing the NHS just over £2m a year until Flynn Pharma, a British company, bought the rights to sell the anti-seizure medicine from Pfizer, repackaged it, and raised the price. Now the annual bill will be £46.6m.

The capsules are identical to those being sold before, even down to the 'Epanutin' markings on them. Only the packaging has changed. Now packs read 'Phenytoin Sodium Flynn Hard Capsules'.

The extra money that will be spent on the drug could have paid for about 1,800 more nurses.

One doctor described the price increase as a "scandalous abuse of a monopoly position".

Flynn accepted the price rise was "significant" but said the NHS had been getting it for an "exceptionally low" price beforehand.

The Stevenage-based firm has been able to raise the price by switching it from being a 'branded' drug - whose prices are set by industry agreement with the Department of Health - to a 'generic' version.

Anyone can make generics and so market forces usually drive prices down.

But in this case Pfizer has become virtually the sole manufacturer of the product, according to Dr Martin Brunet, a Surrey GP.

He said: "In my opinion, this is a quite scandalous abuse of a monopoly position. I don't know about legally, but ethically and morally that's what it strikes me as."

Although tablet and syrup forms do exist, the capsules account for 85 per cent of the market. Some 100,000 people in Britain take them.

Doctors are very reluctant to switch from the capsules because epilepsy patients can be extremely sensitive to changes in the amount of the drug in their blood, Dr Brunet said.

"For some sufferers this drug is a vital part of their treatment," he said.

"But a tiny change in dose can result in a big change in their blood level of phenytoin.

"Any change to their medicine could have dramatic consequences, such as having a seizure and losing their driving licence for 12 months."

He continued: "Because it's difficult to manufacture well the guidance for doctors has been to prescribe the branded version - Epanutin. As a result there's been no competition to make it."

Doctors could be liable if they switched to a cheaper version on cost-grounds, he feared.

The change means the NHS is now being charged £15.74 for a 28-pack of 25mg capsules, up from 66p. Other versions have been increased by the same margin, a factor of 23.84.

The capsules are still being made in the same factory - by Pfizer - and still bear the legend 'Epanutin' on them.

David Fakes, a director at Flynn Pharma, defended the price rise.

He said: "It is a significant increase but to put it in context, it comes out at about 80p a dose.

"The historical cost of Epanutin has been exceptionally low."

The rise was "not within the philosophy of Flynn", he said, noting that unlike Pfizer, the firm was a small company unable to cross-subsidise some drugs with others.

But he said of the rise: "For us to continue to make the drug available in the UK, that's what we had to do. In terms of profitability, in the context of our portfolio, it's below average."

The tablet form of the drug was also available, but this was about 25 per cent more expensive, he went on.

Although he emphasised he had no information about Pfizer's former pricing strategy, he ventured: "It's reasonable to say that the true cost of Epanutin was significantly higher than the selling price."

A Pfizer spokesman declined to say whether it had made a loss on selling Epanutin to the NHS, or how much Flynn was now paying the firm to make the capsules. She said the information was "commercially sensitive and confidential".

A Department of Health spokesman said: "Prices for generic drugs are set by the manufacturer. Our main concern is making sure epilepsy patients continue to get phenytoin.

"Systems are in place ensure the NHS gets the best value from medicines - but making sure patients have access to them is the priority."