The Nogales border checkpoint separates the United States from Mexico. It only takes a few seconds to walk south from Arizona, through a gate in the middle of a hallway, ending up in a foreign country.
About 20 steps into Mexico, you stumble into the first business south of the border. It’s one of the ubiquitous "farmacias" that pop up every couple dozen feet along the streets and sidewalks. They’re popular with Americans who want prescription drugs at a fraction of the cost that big pharmaceutical companies charge in the United States.
On a warm night in August, I walked into Farmacia La Plaza, looking for scorpion antivenin, commonly known as anti-venom.
Antivenin counteracts the potentially deadly effects of a scorpion sting. The product is made in Mexico, by a Mexican company, but sold in the United States under the name Anascorp.
The pharmacist at Farmacia La Plaza said they sometimes carry the drug but didn’t currently have it in stock.
“No, it's very rare. It's very rare that we ever have any,” said the pharmacist in Spanish. Another pharmacist told us it’s almost always found in hospitals because that’s where it is administered.
But the Farmacia La Plaza was kind enough to share the price-tag when they do have antivenin in stock: $48.60 per vial.
Back on Uncle Sam's side of the line, one vial of Anascorp is liquid gold. American hospitals generally charge a minimum of $10,000 per vial.
All scorpion antivenin is made in Mexico by a Mexican pharmaceutical company. Venom is extracted from thousands of scorpions and injected into horses over several months. The horses develop immunity and scientists use the immunized horse plasma to make the medicine.
Rare Disease Therapeutics is a Tennessee based pharmaceutical company that licenses and distributes Anascorp in the United States. Jude McNally, a scientist with Rare Disease Therapeutics, said Anascorp is considered an orphan drug, which means it treats a rare medical condition not widely treated in the U.S.
“This is a really uniquely Arizona problem with some interest from our friends in Nevada,” said McNally.
McNally said his company sells Anascorp to hospitals at $4,000 per vial.
Why so much?
First, there’s expensive regulation in the United States that doesn’t exist in Mexico. RDT pays more than $1 million per year to license Anascorp with the Food and Drug Administration. Further, the FDA requires additional steps for making the U.S. version of Anascorp. He said the Mexican manufacturer refers to the U.S. version as “the long process.”
“The process approved by the FDA is about three times longer than the process approved by the Mexican heath authority,” said McNally.
That brings us to the second problem with Anascorp’s high price. Orphan drugs are generally more expensive because the cost of the regulatory process is spread over a much smaller number of patients.
In Mexico, deadly scorpions are more widespread over a larger geographical area. Stings are more common and doctors there treat nearly 250,000 patients per year.
In the United States, there are only about 10,000 scorpion stings treated at hospitals in the desert Southwest and almost all are in Arizona. Of those stings, only about 200 require doctors to administer Anascorp according to McNally.
“It becomes a pretty big burden for each and every patient.”
McNally also said hospitals often mark up the price of the drug between two to seven times over what they pay to buy it from Rare Disease Therapeutics, which is a relatively standard practice for drugs sold in U.S. hospitals.