Efient Tabs 10mg 28 first appeared in Wavedata’s data, collected from pharmacies and dispensing doctors, in April 2011. Parallel Imports appeared before UK packs, which suggests there was a period during which Efient was sold to pharmacies through linked systems without appearing in price lists. There is normally a two year ‘honeymoon’ period before parallel imports start to threaten UK sales and as Daiichi Sankyo’s media website says that Efient was launched in the UK on the 8th April 2009, a two year honeymoon period sounds about right.
There then followed a long eight year period till March 2019 during which UK and PI packs competed to fill Efient prescriptions. Then Efient lost its exclusivity and patent protection and generics were launched. In the first month prices fell from £43.00 to £21.11, and by October 2019 they had reached £8.64.
The speed of the decline is normally controlled by the sales value of the brand and the number of generic manufacturers competing for market share. In this case Accord and Teva were early entrants, but there may have been other generic suppliers as well. The value of prescriptions written by GPs in England between April 2018 and March 2019 was £14,684 for Efient Tabs 10mg 28 and £2,824,278 for Prasugrel Tabs 10mg 28, which means the market was ready for the generic launch and had generisised itself well in advance.
After October 2019 the rate of decline of the average UK retail price levelled off, and stabilised at around £5.00. Then in February 2022 prices began rising again, reaching a peak at £11.21 in April 2022. This was accompanied by the granting of a price concession in December 2021. This price peak looks like the start of a repeating cycle, and the time between launch in April 2019 and the April 2022 price spike is exactly 3 years which is a very common period between peaks in previously observed price bounce cycles.
These cycles are often triggered by prices reaching levels at which manufacturers can no longer make a profit, causing manufacturer withdrawal and a reduction in stock available for dispensing. Prices rise as the amount of available stock declines, and higher prices prompt manufacturers to commission more stock again. The arrival of the fresh stock results in the price falling again to levels at which profit is once again possible.
The time between launch and the price peak suggests that the next price rise will peak in April 2025, and the low average price of £4.38 before the February 2022 rise is the ‘trigger’ price at which manufacturers experience loss rather than profit. This also means that if companies monitor the average price of Prasugrel Tabs 10mg 28 over the next few years, then prices below £4.50 are a warning of an impending price rise and a shortage.