Par, generic Toprol XL, and getting even.

Unless you live in a box, you all are well aware that we are in a nationwide Metoprolol Succinate (Toprol XL) shortage. This is caused by Ethex getting spanked by the FDA and not allowing to sell drugs in the US.

Now what makes me angry about this, is that the only other manufacturer of generic Toprol XL is Par. Par, upon Ethex biting the big one, decided to jack up the price about 75-100% THEN back-order us to kingdom come. You know, Fuck you Par. It would be one thing if you would of kept the price the same and been back-ordered, that’s understandable. However you totally screwed us over both price-wise (since most insurance companies were reimbursing based on the OLD MAC price) AND you cannot supply! I’m not sure if this shortage is intentional so they can squeeze some extra bucks out of us (if so, go fuck yourself), or why they would need to raise the price as high as they did (other than “because they can”).

So here is a big TAP fuck-you to you Par. Since you can’t supply to us, I’m getting everyone switched over to another product, and when your shitty product does come back in stock, I’m not going to switch them back.

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41 Comments

  1. MrMedSaver says:

    Par’s product is actually an authorized generic, which means that AstraZeneca is actually the one manufacturing it. Par is just distributing it. I’m sure that Par is just passing along the price hike brought about by AstraZeneca.
    As for the shortage, I’m actually suprised that AstraZeneca is even willing to ship any product at all to Par. I would think that they would just want everyone to move back over to brand-name Toprol XL. Then again, there’s probably some sort of contractual language in their agreement with Par that forbids them from doing this

  2. Phex says:

    isn’t this price gouging? They obviously have a temporary monopoly on the product and in doing so price jack us for more money. I don’t know of any federal laws that protect the public from price gouging. It would have to be done on a state level. Perhaps TAP you should contact the attorney general in your state about this. Perhaps federal anti-trust laws would apply to this as well. I don’t know.
    Would be nice if one of the big companies would tell them, “your gonna give us the standard price for this or we will drop all of your generics for the next year.”
    Perhaps that would get their attention.
    http://ncseonline.org/NLE/CRSreports/07Jul/RS22236.pdf
    This is a nice link that explains price gouging based on gasoline and states of emergencies.
    Perhaps the Toprol shortage could be declared an emergency to a degree since patients can’t get blood pressure medications.
    Unfortunately, I don’t think there is much we can do about this. =[
    -Phex
    -3rd Year PharmD/MBA Candidate

  3. Scott says:

    Sandoz has also ceased production of generic Toprol XL at the same time. I’m lucky to only have 3 out of 120 patients who require Brand, everyone else has metoprolol tartrate (except for the douchebag doc who put 2 of his patients on Bystolic-prior auth!)

  4. EC says:

    Nope. I don’t live in a box and not only did I not know we had a shortage I didn’t even know what the drug treats. It is not part of my life or the lives of anyone I know.
    I drop by here occasionally b/c sometimes I learn something about an industry with which I have very little contact (that and sometimes I find humor in how worked up you get about a few topics…though I’m guessing you’d find the complaints I have with my profession even more meaningless).
    Today I learned something, and I completely agree with your economic boycott. It’s the only weapon we have at times.

  5. RxTech808 says:

    *cough* AstraZeneca manufactures Par brand metoprolol succinate *cough*

  6. Dr. S says:

    In my office, the protocol is simple when it comes to pharmacy calls for Metoprolol Succinate (Toprol XL)
    If it was prescribed for hypertension: You get switched to generic Metoprol twice daily (pills are half the dose of the XL, total daily dose is the same)
    If it was for heart-failure: You either go to brand-name Toprol XL, or you get an appointment to discuss other options (probably going to carvedilol, can’t bring myself to write for Bystolic).
    We’ve had a few pharmacy techs call requesting to change “Toprol XL 100mg q-day to Metoprolol 100mg BID” (instead of 50mg BID).
    Pretty rotten of Par to jack up the price in time of shortage. They should get pissed on for that.
    Not a big deal… my M.A.’s are too stupid to be trusted with pharmacy issues. So I always review those calls myself.

  7. jon rph says:

    You know how everybody was on toprol xl instead of the tartrate because nobody studied the tartrate because it was a dirt cheap generic? Funny how a little shortage gets around 100 people switched to a cheap alternative.
    If they ask, I’ll switch them back… but not otherwise.

  8. CT says:

    Yeah, I forget right now who makes our generic Lopressor (Metoprolol Tartrate), but they’re getting plenty of our business now.

  9. Ken says:

    TAP –
    Par is the auth generic…mfg’d by AstraZenica. I don’t know what the deal between PAR and AZ is like, but my guess is that now that the brand is pretty much the only game in town, they are doing everything possible to either jack up the price of the auth generic or clamp down on the supply.

  10. andrew the tech says:

    dont forget that the generic toprol is made my astrazeneca. its just toprol in a different bottle.

    • Joe says:

      dont forget that the generic toprol is made my astrazeneca. its just toprol in a different bottle.

      Not really. I used it for a week and had many side effects that I do NOT have with the brand name. What’s up with that?

  11. Mark says:

    I like Dr. S’s comments – something that deserves a little discussion…I would say that a good 40% of the conversion rx’s are wrong…assuming that the prescriber wants to keep the dose the same.
    I don’t know about you guys, but I had a pretty significant realization as a result of this whole mess. At the start of the shortage, I COULDN’T BELIEVE how many MD’s respone was “OK if you don’t have generic for Toprol XL, just give the generic for Toprol.”!!!!!! Now I’m convinced that a LOT of them REALLY had no clue until this happened. YES- they knew Lopressor vs Toprol, but beyond that, It got fuzzy for WAY WAY TO MANY OF THEM. Unless the drug rep comes in and hands them a glossy sheet with easy conversions, it isn’t going to happen. How many patients do you have re-converting to generic Sular now that it’s avail in the OLD dosage? It is CRAZY!

  12. http://openid.aol.com/nyrisha14 says:

    REQUEST A SCRIPT FROM DOCTORS FOR HALF THE STRENGTH OF WHAT EVER THEY WERE TAKING XL AND DOSE IT TWICE DAILY. BECAUSE EVEN IF YOU SWITCH THEM TO BRAND TOPROL XL THE INSURANCE COMPANIES DON’T CARE ABOUT SHORTAGES. THE PATIENT’S COPAY WILL BE HIGHER FOR THE BRAND SO JUST BY-PASS THE SHORTAGE AND SWITCH TO TWICE DAILY. ONE MORE PILL A DAY SHOULD NOT INCONVENIENCE THEM.

  13. B Short says:

    I agree this issue is getting out of hand.

  14. Rob, tech says:

    Kremers-Urban did the same thing with generic Imdur. It now costs $24/100 instead of $4.

  15. techgirl says:

    oh yeah, when we first realized the generic toprol xl was in short supply we started switching as many customers as we could to generic lopressor right away. i’m thinking more than half of the toprol patients have been switched at this point and unless they have an adverse experience, it’s likely they’re never going to get switched back. SCREW YOU, PAR!

  16. http://openid.aol.com/kiz707 says:

    As much as this Toprol thing has annoyed me, I don’t believe raising the prices on generics is price-guaging. This is how the business world works. When the competition does not exist, you can raise your prices. Besides, it’s not like there aren’t other choices. If they are a heart failure patient, you can switch them to carvedilol BID, which is cheap. If they are just taking it for benign HTN, then you can pick pretty much any BB. It might give us pharmacy folks a little more work than normal, but it’s not like our hands are tied.

  17. scriptgal says:

    remember when this happened with oxycodone? we had people so desperate that they drove from 50+ miles away for brand name Roxicodone!! And no problems paying cash for it either.

  18. Bob says:

    Everyone here realizes that:
    “No one gives a fuck about the patient, Treey. no one gives a fuck.”
    Please tell me you all know that.

  19. neumeindil says:

    I work in a “$4.00 list” pharmacy. Guess what one of our biggest $4.00 sellers has always been? DING DING DING. Generic Lopressor at a dose of 1qd. So, Metoprolol Tartate, 1bid, qty: 60 costs my former XL customers $8.00 instead of $15+ like they were paying before. Get creative and prescribe 1/2 of a 50 mg tab bid @ qty: 30, and it’s $4.00 for 2 months. We’ve switched everyone that’s come through for their Toprol to the generic (unless the doctor randomly said “Give Sular” or “Give brand”, but those were rare), but would switch them back if Par et all ever pull their heads out. Somehow, though, I have a feeling most of our patients won’t want us to, and same with the people at nearly *every* pharmacy in town that either has a list of their own or runs a pricematch on ours. Par/AstraZeneca is cutting off their own nose, I think.

  20. Eddie says:

    The immediate release is better absorbed by up to 30%. That being said, the recommendation still is to cut the dose in 1/2 and give it twice a day.

  21. Angry Tech says:

    Granted, since it’s been so long since Toprol XL has been available, I haven’t seen any new prescriptions for it for a while now, and almost everybody has been switched over to metoprolol tartrate. But the switch caused all kinds of fun experiences for me.
    Customer: “My pills look different, and the bottle doesn’t say the same thing, you guys gave me the wrong medication!”
    *Me, checking out her profile*: “No ma’am, the generic of Toprol XL, what you were taking, is not available, and has remained that way for a while now, so we called your doctor and they switched you over to the regular release version,” blah blah..
    Customer: You aren’t allowed to change my medications, you’re breaking the law!
    Me: No, this is a legal, regular practice for pharmacies.
    Customer: Well I want to know WHO called my doctor to change it!
    Me: I can’t tell you who specifically called.
    Customer: You changed my medications and don’t know who changed them!?
    Me: No, someone here calls the office, we don’t keep a record of whom, but we do keep a record of who approved the change. Happens all the time, otherwise you wouldn’t have any medication to control your blood pressure right now.
    I’m sure the DEA is on their way to shut us down any moment :)

  22. ayeaye cap'n says:

    We’ve been doing the same as techgirl – we’ve been talking everyone into switching over to lopressor. I wish I could get the medicaid folks switched over to lopressor instead of getting them overrides for brand toprol – they won’t have any of it though and I know that medicaid is only reimbursing us the cost of the generic just like they do for any other time a patient gets brand name with a DAW 1.

  23. Pharm Cashier says:

    This is completely off topic…but is anyone else out there getting tired of explaining to (the same) patients why they can’t get their Pangestyme? Since Ethex is the only producer, at least as far as our suppliers are concerned, none of our patients who take it haven’t been able to get it for a while, and I’ve had some grandmas and grandpas scream in my face and cuss me out because apparently I’m purposely holding medicine from them so they can suffer. No, they don’t want the brand, even though it’s covered by their insurance, they want the one they were taking before because it works better.
    Oh, did I mention some even had their doctors call me and scold me(the cashier….)? The very same doctors that the pharmacist, technicians, AND myself explained to over the phone on several previous occasions WHY we couldn’t dispense Pangestyme?
    But hey, I haven’t had anyone spit at me or throw feces at me yet, so I guess I still have it easy.

  24. Wes says:

    We switched everyone too. My secondary wholesaler warned me about the impending crisis, so I hoarded a mess of Par Fake Toprol XL at a really cheep price. Just running out in the last few days and started recommending to doctors to go for plain metoprolol 1/2 dose at twice daily dosing. Not a bad sale most times.
    And, best of all. No sales either way for the cheating MBA’s at Astra-Z
    And inexpensive for patients too.
    Victory!
    W

  25. rph3664 says:

    TAP, you’re gonna LOVE this.
    http://www.kapidex.com/
    Deslansoprazole – need I say more?

  26. Vos Rph says:

    What the hell is goin on with the FDA? Someone is getting big time kickbacks. Has any one seen soooooooo many recalls ever in thier life as there has been in the last year and a half?
    AND How about all the rebranding of the dumbest crap ever?! Thank God for Moxatag– R u Fing kidding me?
    I’ld like to think this is all being done in the best interest of the public but all this behavior smells really fishy! I can’t be the only suspious one.

  27. chris says:

    I wonder how long it will be before we see Obecalp XL for a significant mark up.

  28. Dr. Grumpy says:

    A nightmare at my practice has been the recent shortage of immediate release Oxycodone pills. I have a number of old patients who can’t take Percocet because they’re on Coumadin.
    So, because of this stupid shortage, I have 2 choices: I can switch them to Oxycodone liquid (and, like your welfare family, these people can’t use a dropper, if they can even see the markings) or try converting them to long-acting Oxycontin.
    Just a freaking blast.

  29. Ethnic Redneck says:

    Ah, the free-market economy at work. The neocons must be so proud.

  30. Todd says:

    also any pharmacies dependent on McKesson are going to get shafted when Rite Aid goes out of business because Rite Aid is the single largest customer of McKesson, and McKesson is going to have to gauge the rest of their customers to make up for revenue loss.
    We also have had to deal with a digoxin recall on top of this generic toprol xl mess.

  31. Sell-out says:

    I thought something was fishy w/ A.Zeneca when I found out their new generic (PAR) was equal to brand only in WHOLE pill form. It was NOT the same when cut in half, as was commonly being done with their Toprol XL! What’s with THAT??? At the time, some insurances were insisting on 1/2-tabbing for reimbursement.
    In light of all the drug and food recalls lately, does anyone else think the FDA needs to be split into 2 separate entities?

  32. rph3664 says:

    And speaking of Kapidex, today an ER nurse called me to ask what it was.
    It’s here, folks.

  33. Nicole Jonetti says:

    I knew it. Astra Zeneca makes the stuff shipped out by Par. However, it is not the same as the brand name — the “Par” generic is the same as the generic crap put out by Astra (the junk that was recalled by the FDA). Who do they think they’re fooling? (Obviously, many, even some of the pharmacists, including my own who is still insisting that the generic is identical to the brand, even in the case of the Toprol XL debacle.

  34. Unhappy Consumer says:

    I was on Toprol XL for PVB, not any other reason (blood pressure, etc). It worked great. Then out came the generic… and, of course, my ins. co. required me to take that one. It worked just fine – at first. Then quit working and it was like I wasn’t taking anything. it was metoprolol by Sandoz). I had my doc. put me back on the Toprol XL, and it was great again. then even when no generic was available, the ins. co. wouldn’t pay much on the brand (didn’t matter that that was all that was avaiable).
    Taking 2 pills a day isn’t an option because it makes me pretty drowsy so I take it at night, when being drowsy doesn’t matter, haha!.

    I just think it sucks that the drug companies can get away with so much, and put out such a poor quality product, and the consumers are the ones who suffer for it. Yes, I agree – kickbacks, lobbyists, and the FDA. hah!

  35. IM SUPER Pissed about PAR..AZ.. The whole shebam! Im in sales.. Phamraceutical Sales.. Think its tough switching medications over to cheaper ones.. Yeah right, try selling a product 100x’s the market value- which no-body wants b/c of the price. Thats Hard.. How about trying to inform pharmacists about up coming shortages- and get hung up all day- Then when the shortage has hit and the price goes up- ..All are upset b/c they didnt get the product when they should have- “All set” “No needs”- Take me off your list.” You just wait.. you will have needs..
    Generic Oxycontin/Clozapine/Carraco plant shut down(some products will be affected).. … these are next.. So all you angry Pharmacists.. please get a handle on this!
    Have a great day!

  36. crazylady says:

    i think u all talk like morons….and u dispense meds..aye ve””’–now i know why kids get wrong meds and older people die in their sleep–crazy pharmacists!

  37. James Guess says:

    Parke-Davis took action (through the FDA)to force Whitehall and another generic brand of nitro glycerene tabs off the market citing the lack of effectivity studies, although both had been on the market and prescrtibed for some time. Reault= $40.00 for the Brand. This one is unconsincable becaus people with angina pain often face life or death with an episode.

  38. "Farm Girl" says:

    Nyan has made generic for Toprol XL, just recently released 2012. Would you try this after all these shortages and be the guinea pig, or go to brand name if you WERE the patient?

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