The Pharmaceutical Journal Vol 264 No 7098 p810
May 27, 2000 Letters

Alvedon suppositories

Cost questionned

From Mr D. Kitchen, MRPharmS

SIR,-Recently it was brought to my attention that the retail price of 10 Alvedon 125mg suppositories at a community pharmacy was a staggering £20.27. Indeed, this is the recommended price in the Chemist and Druggist price-list. The British National Formulary lists it at £11.50 and 10 250mg suppositories cost £23. A search through our hospital computer revealed that not too recently we purchased six 240mg suppositories from Leighton hospital manufacturing unit for £2.65, but these are no longer available. As a crude comparison to other retail suppositories, Anusol suppositories retail at £2.59 for 12, and Dulcolax 10mg suppositories sell at £2.60 for 10 (MIMS, April, 2000).
A straw poll of a dozen colleagues, many of whom work in community pharmacy, revealed that none of them came remotely close to estimating the price of Alvedon suppositories. Consequently, I am sure that most prescribers and pharmaceutical advisers in both primary and secondary health care are similarly unaware because these items usually appear well down their list of high expenditure items.
It would seem that either Astra Pharmaceuticals or its distribution company Novex Pharma or both are guilty of exploitation of a monopoly market. I fail to see how this seemingly almighty premium can be justified and am left with the impression that the above companies see the National Health Service as nothing more than a cash-cow that is there to be milked. In doing so they are setting up barriers to health care for people who wish to buy non-prescription medicines in an emergency. The alternative is to call out a general practitioner to write a prescription for paracetamol suppositories, which surely is verging on the ridiculous.
Indeed, the community pharmacist is being placed in the unenviable position of having to defend this highly questionable pricing policy. Pharmacists and their representative bodies must stand up to this sale of our professional standards down the river.

David Kitchen
Mossley Hill, Liverpool

Mr Neale Benson (commercial director, Astra Zeneca) replies: Mr Kitchen correctly identified the prices of Alvedon (see Table below).
As your readers will be aware, the price paid for "over-the-counter" medicines includes a standard 50 per cent pharmacist profit margin and also 17.5 per cent VAT.
However, the profit made by a manufacturer is NHS price minus wholesaler discount minus manufacturing, marketing and distribution costs.
So, although Mr Kitchen paid £20.27 for 10 125mg suppositories, £3 went to the Government, £5.75 went to the pharmacist and around £1.15 to the wholesaler. From the remaining £10.35, Novex must cover its own marketing costs, purchase the product from the manufacturer and make a profit. As manufacturers, we incur costs in the production of the product and also wish to make a small profit. As a minor point, please note that the prices we charge for Alvedon have not changed since 1997.
Astra Zeneca is committed to supporting health professionals and patients and we appreciate the opportunity to respond to the points raised in the letter. We do hope that we have helped alleviate readers' concerns.