Longer blog readers will remember that Tristan has Cushing’s disease, or more accurately pituitary pars intermedia dysfunction, PPID. He was diagnosed a number of years ago based on observed symptoms and then a blood test. We started him on 1mg daily of compounded pergolide and he responded beautifully. He’s been on that pergolide for several years now, and is maintaining well. I’ve written regular update posts about that.
Last week, I reached out to my vet to renew Tristan’s pergolide prescription at Wedgewood Pharmacy, since he was running low, and she gave me some bad news.
See, for a long time, the only way to get pergolide was just the way that I was buying it, through a compounding pharmacy. “Compounding” just means that they follow the recipe for mixing up a drug and then make that drug and sell it. The pergolide they were making was actually mixed up for humans and prescribed off-label for horses. As I understand it, the FDA agreed to allow this because there was a demonstrated need.
A few years ago, a company called Boehringer Ingelheim developed, tested, and patented an equine-specific formulation of pergolide. They put it into a pill form and named it Prascend. The new drug offered some good benefits: it could promise a more accurate dosage, in pill form it might be easier to feed, and it had jumped through all the hoops and so on.
Tristan was doing just fine on the compounded pergolide, and I had no intention of moving him to Prascend. It was in the back of my mind but seemingly unnecessary.
Until last week, when my vet filled in the last piece of the puzzle. As soon as Boehringer Ingelheim put Prascend on the market, that meant that technically the off-label use of compounded pergolide was no longer allowed by the FDA. A lot of vets still prescribed it, because it worked just fine and for many, even most horses, there was no medical reason to switch.
But the company has been putting pressure on vet boards to remind vets that they’re technically not supposed to prescribe the compounded pergolide, and my vet has decided that she can no longer prescribe it. I totally support her decision. I adore her and she’s saved Tristan’s life on more than one occasion. Reading through the PPID groups, it seems there is a legal basis to challenge and keep him on the pergolide, but it’s not without risks and is a huge pain, and I don’t want my vet to have to deal with any of that. So he’s switching to Prascend.
Here’s the catch. Of course there’s a catch. I wouldn’t be writing a long-winded blog post if there weren’t a catch.
I was paying $0.55/day to keep Tristan on pergolide. Because Prascend has the market cornered, the cheapest I can find it is $1.75/day. That means an increase from $200 a year to about $640 a year. That’s assuming he stays stable on 1mg a day – which is not a safe assumption. Cushing’s is a progressive disease and it could easily – and probably will – require an increased dosage to keep him happy and healthy.
Horses are expensive, and I got this news literally about two hours after writing my first Finance Friday post and scheduling it. I went through all the stages of grief, and landed on acceptance after a few days.
Tristan gets what he needs, always. That’s not in question. I’ll figure out a way to pay for it. But wow, do I feel kind of sucker punched right now. He was doing fine on the compounded pergolide, and the only reason we have to switch now is because of a drug company’s greed.