Generic Drugs in Canada: Market Structure — Trends and Impacts

December 2010

Generic Drugs in Canada: Market Structure — Trends and Impacts

ISBN: 978-1-100-17492-1
Cat. No.: H82-5/2010E-PDF
PDF version (310 kb)

Executive Summary

This report examines market-structure trends among markets for generic prescription drug products in Canada. It is principally concerned with the degree of sales concentration in Canadian generic markets, as well as the possible impact of such concentration on prices.

Canadian markets for generic drug products are highly concentrated with respect to sales. The two leading suppliers in a typical generic market accounted for 84.5% of sales in 2007, while the top four suppliers accounted for 96.7%. There are high levels of sales concentration in all therapeutic classes. In even the largest generic markets, where one would expect vigorous competition for market share, sales are typically dominated by a few suppliers.

On the other hand, an analysis of various foreign-to-Canadian average price ratios does not point to any simple relationship between market structure and the relative costliness of generic drug products in Canada. These results imply that relatively low sales-concentration ratios and the existence of numerous suppliers in Canada by no means guarantee that the Canadian price of a particular generic drug will be in line with prices in other countries. It follows that while markets for generic drug products definitely are highly concentrated at the manufacturing level, this is not the fundamental source of divergence between Canadian and foreign prices.

Table of Contents

1 Introduction

This report examines market-structure trends among non-patented prescription drug products in Canada. It is principally concerned with the degree of sales concentration in Canadian generic markets, as well as the possible impact of such concentration on prices.

The analysis covers a set of 298 leading generic drug products.1 The analysis is restricted to cases where there were at least two generic versions of the product sold in Canada in 2007. Markets where there is a single generic supplier will be considered separately in a subsequent study.

All data used in this report are from IMS Health's MIDAS database. The data cover only drug purchases made by the retail pharmacy sector.2

1 Note that many of the markets considered in this analysis are “patented markets”, in the sense that the market includes at least one (branded or generic) product reported to the PMPRB as patented between 2003 and 2007. This analysis draws no distinction between such “patented markets” and markets where there are no such patented drug products.

Appendix B provides a detailed description of the process by which drug products were selected for inclusion in the analysis, as well as all other aspects of the methodology. A list of the drug products included in the analysis can be found in Appendix C.

2 Throughout this report the term “price” refers to prices paid by pharmacies to wholesalers or directly to companies, not those paid by consumers or drug plans. These prices are derived from sales data based on invoiced prices and do not include off-invoice discounts, free goods and other forms of price reduction such as rebates. Appendix B provides details on how prices are derived, as well as other aspects of the methodology.

2 Generic Drug Products: Trends in Market Structure

Table 2.1 presents basic market information for the top 10 suppliers of generic drug products (by 2007 sales) in Canada. The first column shows how many of the 298 leading generic drug products each supplier sold in 2007. The second column gives the corresponding estimated value of the supplier's sales revenue. The third column gives the supplier's average share of sales in those generic markets in which it was active. Hence, the first line in Table 2.1 indicates that in 2007 Apotex sold 246 of the 298 leading generic drug products, thereby generating $978.9 million in ex-factory sales. Among the 246 leading generic drug products in which Apotex was active, it had an average market share of 48.4%.

Table 2.1. Leading suppliers, generic drug products, 2007
Supplier Number of drug products Sales ($ millions) Average market share (%)
Apotex 246 978.9 48.4
Teva 209 525.1 25.3
Mylan 154 300.0 21.5
ratiopharm 137 263.1 19.3
Pharmascience(Cdn) 168 196.8 17.2
Novartis 98 99.2 12.0
Cobalt Pharmaceuticals 70 92.8 12.7
Ranbaxy 32 45.7 15.5
Riva 79 23.0 2.0
Johnson & Johnson 6 15.1 27.2

Table 2.2 provides basic results on the sales concentration in generic markets. These results indicate that, although sales concentration may have declined slightly from 2003 to 2007, Canadian generic markets remain highly concentrated. In particular, Table 2.2 indicates that in 2007 the two leading suppliers in a typical generic market accounted for 84.5% of sales, while the four leading firms accounted for 96.7% of sales. The Herfindahl index3 reinforces the finding of high concentration: this has a value of 49.1% for 2007, which is extraordinarily high by the standards usually applied in the interpretation of this measure.

Table 2.2. Concentration statistics, generic drug products, 2003–2007
Year Average number of suppliers Average two-firm concentration ratio (%) Average four-firm concentration ratio (%) Average Herfindahl index (%)
2003 3.8 88.8 98.5 57.0
2004 4.1 87.7 98.3 55.2
2005 4.3 86.3 98.1 53.2
2006 4.6 85.4 97.6 52.7
2007 4.9 84.5 96.7 49.1

Table 2.3 provides additional information on the individual ratios summarized by the average two-firm concentration ratio reported in Table 2.2. The results in this table show that in 2007, 117 (39.3%) of the 298 leading generic drug products were sold in markets where the two leading suppliers accounted for 95% or more of sales. Another 95 drug products (31.2%) were sold in markets where the two leading suppliers had between 75% and 95% of sales. In contrast, only 5 drug products (1.7%) were sold in markets where the two leading suppliers had less than 50% of sales.

Table 2.3. Range distribution, two-firm concentration ratio, generic drug products, 2007
Range: Two-firm concentration ratio (CR2) Number of drug products Share of drug products (%) Sales ($ millions) Share of sales (%)
45% ≤ CR2 < 50% 5 1.7 49.6 1.9
50% ≤ CR2 < 55% 4 1.3 88.3 3.4
55% ≤ CR2 < 60% 12 4.0 150.5 5.8
60% ≤ CR2 < 65% 23 7.7 485.3 18.6
65% ≤ CR2 < 70% 19 6.4 190.8 7.3
70% ≤ CR2 < 75% 23 7.7 197.7 7.6
75% ≤ CR2 < 80% 20 6.7 159.6 6.1
80% ≤ CR2 < 85% 31 10.4 225.8 8.7
85% ≤ CR2 < 90% 21 7.0 98.7 3.8
90% ≤ CR2 < 95% 23 7.7 119.0 4.6
95% ≤ CR2 117 39.3 839.6 32.2
Total 298 100.0 2,604.8 100.0

Table 2.4 provides concentration statistics by major therapeutic class. These results are entirely consistent with the aggregate results of Table 2.2. No matter the therapeutic class, all measures indicate a very high degree of sales concentration.

Table 2.4. Concentration statistics, generic drug products, by major therapeutic class, 2007
Therapeutic class Average number of suppliers Average two-firm concentration ratio (%) Average four-firm concentration ratio (%) Average Herfindahl index (%)
Alimentary Tract and Metabolism 5.6 82.5 96.2 45.5
Blood and Blood Forming Organs 4.0 88.7 99.9 48.5
Cardiovascular System 5.3 83.7 96.5 46.8
Dermatological 4.0 82.8 97.1 50.0
Genito-urinary System and Sex Hormones 4.4 85.7 98.5 46.5
Systemic Hormonal Preparations 3.0 95.0 100.0 70.6
General Antiinfectives for Systemic Use 4.4 86.0 98.0 51.2
Antineoplastics and Immunomodulating Agents 3.5 83.2 98.6 46.4
Musculo-skeletal System 4.1 86.1 98.4 57.8
Nervous System 5.1 82.7 95.3 48.4
Antiparasitics 3.0 93.3 100.0 56.4
Respiratory System 3.2 90.6 99.0 49.5
Sensory Organs 3.3 84.7 98.4 41.8

Table 2.5 reports concentration statistics by the size of market. As might be expected, the results in the table indicate that the larger the market, the more entrants it can support, and hence, the smaller the degree of sales concentration. However, this relationship is not nearly as strong as one might expect. For example, the table shows that in markets with total sales of less than $5 million, there were typically 4.0 suppliers, with the two leading firms accounting for 89.1% of sales. By comparison, the 20 markets where there were sales of at least $25 million typically sustained 7.6 suppliers. Despite this, the two leading suppliers still accounted for 73.9% of sales, while the top four suppliers accounted for 92.8%. Thus it appears that in even the largest generic markets, where one would expect vigorous competition for market share, sales are usually dominated by a few suppliers.

Table 2.5. Concentration statistics, generic drug products, by size of market, 2007
Range: Market size

Number
of drug products

Sales ($ millions) Average number of suppliers Average two-firm concentration ratio (%) Average four-firm concentration ratio (%) Average Herfindahl index (%)
$25 million ≤ sales 20 1,079.1 7.6 73.9 92.8 40.2
$10 million ≤ sales < $25 million 48 701.9 6.1 75.4 94.0 37.1
$5 million ≤ sales < $10 million 53 390.6 5.5 81.3 95.8 44.6
Sales < $5 million 177 433.2 4.0 89.1 98.2 54.7

Table 2.6 gives results specifically for the 20 drug products among the set of 298 with 2007 sales of $25 million or more. Although there were five or more suppliers in most of these markets, the two leading firms accounted for more than half of the sales in every case. These results permit only one conclusion: there are factors at work in the Canadian generic sector that bring about a high degree of sales concentration even where market entry is uninhibited and the number of active suppliers is large.

Table 2.6. Concentration statistics, generic drug products, by size of market, 2007
Ingredient Strength Form Number of suppliers Two-firm concentration ratio (%) Four-firm concentration ratio (%) Herfindahl index (%)
Omeprazole 20 mg Capsule 2 100.0 100.0 99.0
Ramipril 10 mg Capsule 4 95.3 100.0 49.1
Venlafaxine 75 mg Delayed-action capsule 3 98.9 100.0 93.6
Citalopram 20 mg Coated tablet 8 65.4 91.0 25.1
Metformin 5 mg Tablet 10 53.9 83.5 19.9
Venlafaxine 50 mg Delayed-action capsule 3 99.1 100.0 94.1
Simvastatin 20 mg Coated tablet 8 61.6 91.1 23.7
Ranitidine 50 mg Coated tablet 12 64.9 88.3 27.6
Paroxetine 20 mg Coated tablet 8 81.4 95.0 36.7
Alendronic acid 70 mg Tablet 8 77.2 92.8 31.4
Fluoxetine 20 mg Capsule 10 59.0 82.3 21.4
Simvastatin 40 mg Coated tablet 8 62.0 91.1 23.8
Gabapentin 3 mg Capsule 8 62.2 91.7 26.2
Ramipril 5 mg Capsule 4 95.2 100.0 49.0
Sertraline 50 mg Capsule 11 71.2 87.5 39.8
Diltiazem 240 mg Delayed-action capsule 6 61.0 97.1 25.7
Zopiclone 7.5 mg Coated tablet 9 63.0 92.8 24.6
Pravastatin 20 mg Tablet 12 74.0 88.5 29.1
Sertraline 100 mg Capsule 11 69.3 87.1 37.4
Diltiazem 80 mg Delayed-action capsule 6 62.5 95.6 27.3

For the sake of comparison, Table 2.7 provides concentration statistics for foreign markets. These have been calculated in exactly the same way as the corresponding statistics given in Table 2.2. In particular, underlying observations are again restricted to the set of 298 leading generic drug products in Canada.

The results in Table 2.7 imply that Canadian generic markets are more concentrated than generic markets in other countries. Average Canadian two- and four-firm concentration ratios are higher — in most instances, substantially higher — than concentration ratios seen elsewhere. The value of the Herfindahl index in Canada is higher than that obtained for any country except the United Kingdom, whose value of 72.8 indicates a remarkable degree of sales concentration.4 Somewhat surprisingly, given the difference in scale of the two markets, the Canadian market structure appears to most closely resemble that prevailing in the United States.

Table 2.7. Concentration statistics, generic drug products, by country, 2007
Country Number of drug products Average number of suppliers Average two-firm concentration ratio (%) Average four-firm concentration ratio (%) Average Herfindahl index (%)
Canada 298 4.9 84.5 96.7 49.1
Australia 77 4.3 76.5 89.2 58.5
France 110 7.6 64.2 85.5 33.2
Germany 159 8.5 66.8 90.0 32.9
Italy 92 7.8 60.8 81.3 33.8
Netherlands 140 6.3 61.4 86.4 29.0
New Zealand 36 5.4 52.7 76.1 28.9
Sweden 102 5.4 70.7 88.5 41.4
Spain 101 8.7 61.4 85.1 28.6
Switzerland 68 5.4 67.6 85.7 39.4
United Kingdom 141 4.8 86.2 94.9 72.1
United States 208 7.4 80.5 96.4 47.0

It is of interest to know whether, on a market-by-market basis, the extent of market concentration in Canada correlates with levels of concentration in other countries. To this end, Table 2.8 gives the average number of generic suppliers by country for those markets where there are one or two suppliers, three or four suppliers and five or more suppliers in Canada.

The results in Table 2.8 provide clear evidence of a positive correlation between the number of generic suppliers active in Canada and the number of suppliers in individual foreign markets. This tendency is especially pronounced at the top end: where a drug has at least five suppliers in Canada, it will typically have at least that number of generic suppliers in every foreign market.

Table 2.8. Average number of generic suppliers, by number of Canadian suppliers, 2007
Number of Canadian suppliers AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
1–2 suppliers 1.8 5.7 6.1 3.8 4.7 2.2 7.7 2.6 2.6 2.2 4.4
3–4 suppliers 2.6 5.9 5.6 6.7 5.8 3.2 6.7 3.7 3.7 3.3 6.6
5 or more suppliers 5.6 8.7 10.8 9.3 7.0 7.6 10.1 6.9 7.2 6.5 9.4

3 The Herfindahl index (sometimes called the Herfindahl-Hirschmann index) is calculated by squaring the market share of each supplier and then summing the resulting values. This calculation can return a value of 50% or more only if sales are dominated by one or two firms. If, in contrast, sales are evenly distributed among three firms, the Herfindahl index will have a value of 33%. This falls to 25% if sales are evenly divided among four firms, and so forth. Very high values of the Herfindahl index — values in the range of 70% to 100% — are possible, but can only occur if a single supplier accounts for at least 80% of sales.

4 The UK data includes many instances in which a single company accounts for 85% or more of sales (in which case the Herfindahl index will have a minimum value of 72%). This explains the extraordinarily high average Herfindahl index value obtained for this country.

3 Generic drug products: International Price Comparisons by Level of Concentration

Conventional economic theory acknowledges that market structure can affect price. In particular, standard models of price determination suggest that markets where sales are dominated by only a few firms may produce prices substantially exceeding the economic costs of manufacturing and distribution. Such models usually imply that the greater the concentration of sales among leading firms, the higher the price, all other things being equal. It, therefore, is of some interest to compare prices in Canada's highly concentrated generic markets with those prevailing elsewhere.

Tables 3.1a and 3.1b provide average foreign-to-Canadian price ratios for three distinct sets of generic drug products: those sold by one or two suppliers in Canada, those sold by three or four suppliers and those sold by five or more suppliers. Table 3.1a provides bilateral comparisons. It might be expected that Canadian prices would be highest relative to foreign prices where there are the fewest domestic suppliers and closer to international prices where there are more suppliers and, therefore, more competition in the Canadian market. In fact, the results Table 3.1a point in the opposite direction: where a pattern is discernible, it is that Canadian prices are relatively higher when there are a greater number of Canadian suppliers.

Table 3.1b provides multilateral comparisons for two sets of countries. The first of these encompasses the seven countries that the PMPRB normally considers in carrying out its price reviews: France, Germany, Italy, Sweden, Switzerland, the UK and the US. The second set encompasses all 11 foreign countries represented in the entire extract of MIDAS dataset available to PMPRB. Here again, we have the counterintuitive result of an inverse relationship between foreign-to-Canadian price ratios and the number of Canadian suppliers. The results for the case of five or more Canadian suppliers are especially striking: it appears Canadian prices are the highest relative to foreign prices in precisely those cases where one would expect price competition to be strongest in Canadian markets.

Table 3.1a. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by number of Canadian suppliers, bilateral comparators, 2007
Range: Number of Canadian suppliers AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
1–2 suppliers Price ratio 1.92 0.64 0.53 1.00 0.50 0.12 0.24 0.70 0.92 0.61 0.71
Number of drug products 7 10 21 14 16 5 12 16 13 18 40
3–4 suppliers Price ratio 0.92 0.65 0.46 0.64 0.78 0.35 0.69 0.36 0.66 0.68 0.77
Number of drug products 19 31 48 22 42 10 31 22 13 45 69
5 or more suppliers Price ratio 0.90 0.62 0.61 0.68 0.81 0.20 0.57 0.41 0.70 0.62 0.36
Number of drug products 51 69 90 56 82 21 58 63 40 78 99
Table 3.1b. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by number of Canadian suppliers, multilateral comparators, 2007
Range: Number of Canadian suppliers PMPRB comparator countries All countries
Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
1–2 suppliers Price ratio 0.54 1.35 0.88 0.71 0.80 0.48 1.44 0.86 0.68 0.81
Number of drug products 48 48 48 48 48 49 49 49 49 49
3–4 suppliers Price ratio 0.38 0.93 0.62 0.51 0.57 0.37 1.16 0.71 0.53 0.72
Number of drug products 89 89 89 89 89 90 90 90 90 90
5 or more suppliers Price ratio 0.29 0.98 0.59 0.48 0.56 0.28 1.06 0.62 0.50 0.60
Number of drug products 125 125 125 125 125 129 129 129 129 129

Tables 3.2a and 3.2b again give average foreign-to-Canadian price ratios for three sets of generic drug products, with the division in this case based on the Canadian two-firm concentration ratios. The results in these tables indicate that foreign generic prices tend to be substantially less than Canadian prices even in those cases where the Canadian sales concentration is relatively low. This is especially striking when one considers the results for the foreign mean, weighted mean and median reported in Table 3.2b.

Table 3.2a. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by range of two-firm concentration ratio, bilateral comparators, 2007
Range: Two-firm concentration ratio (CR2) in Canada AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
CR2 < 50% Price ratio 1.19 1.41 2.49 1.09 1.59 0.87 0.72 1.61 1.60
Number of drug products 4 2 5 3 4 1 3 3 0 4 0
50% ≤ CR2 < 75% Price ratio 0.76 0.56 0.44 0.54 0.64 0.12 0.47 0.30 0.66 0.46 0.36
Number of drug products 26 43 54 32 46 12 32 37 28 48 61
75% ≤ CR2 Price ratio 1.09 0.68 0.59 0.92 0.84 0.20 0.63 0.57 0.84 0.75 0.59
Number of drug products 47 65 100 57 90 23 66 61 38 89 147
Table 3.2b. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by range of two-firm concentration ratio, multilateral comparators, 2007
PMPRB comparator countries All countries
Range: Two-firm concentration ratio (CR2) in Canada Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
CR2 < 50% Price ratio 1.29 2.49 1.81 1.97 1.79 0.92 2.49 1.57 1.76 1.57
Number of drug products 5 5 5 5 5 5 5 5 5 5
50% ≤ CR2 < 75% Price ratio 0.22 0.81 0.48 0.39 0.46 0.24 0.87 0.51 0.41 0.49
Number of drug products 74 74 74 74 74 78 78 78 78 78
75% ≤ CR2 Price ratio 0.41 1.13 0.72 0.58 0.67 0.39 1.31 0.78 0.59 0.76
Number of drug products 183 183 183 183 183 185 185 185 185 185

Tables 3.3a and 3.3b give foreign-to-Canadian price ratios based on a division of drug products according to the size of the Canadian market. The results in these tables indicate that foreign generic prices tend to be substantially less than Canadian prices in even those cases where Canadian sales are the highest. Here again, the multilateral results are very striking: whether one considers the foreign mean, weighted mean or median, foreign prices appear to be no more than two-thirds of corresponding Canadian prices in those generic markets that are largest in Canada.

Table 3.3a. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by market size, bilateral comparators, 2007
Range: Market size in Canada AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
$25 million ≤ sales Price ratio 0.88 0.64 0.43 0.69 0.65 0.09 0.55 0.28 0.71 0.30 0.30
Number of drug products 7 14 15 13 14 2 12 11 9 15 12
$10 million ≤ sales < $25 million Price ratio 1.12 0.58 0.68 0.71 0.92 0.32 0.59 0.60 0.78 0.79 0.67
Number of drug products 17 25 28 19 28 7 20 24 17 29 35
$5 million ≤ sales < $10 million Price ratio 0.72 0.63 0.72 0.72 0.80 0.16 0.53 0.52 0.66 1.14 0.41
Number of drug products 20 24 35 22 31 7 24 21 8 29 37
Sales < $5 million Price ratio 1.08 0.73 0.72 0.93 0.87 0.35 0.57 0.89 0.82 1.15 0.56
Number of drug products 33 47 81 38 67 20 45 45 32 68 124
Table 3.3b. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by market size, multilateral comparators, 2007
PMPRB comparator countries All countries
Range: Market size in Canada Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
$25 million ≤ sales Price ratio 0.20 0.82 0.46 0.38 0.44 0.19 0.93 0.52 0.39 0.54
Number of drug products 17 17 17 17 17 17 17 17 17 17
$10 million ≤ sales < $25 million Price ratio 0.41 1.10 0.70 0.61 0.66 0.38 1.24 0.75 0.64 0.71
Number of drug products 45 45 45 45 45 47 47 47 47 47
$5 million ≤ sales < $10 million Price ratio 0.40 1.10 0.69 0.56 0.62 0.39 1.16 0.69 0.56 0.64
Number of drug products 49 49 49 49 49 51 51 51 51 51
Sales < $5 million Price ratio 0.52 1.28 0.87 0.66 0.83 0.51 1.38 0.88 0.66 0.84
Number of drug products 151 151 151 151 151 153 153 153 153 153

Table 3.4 provides supplementary bilateral price comparisons that directly address the question of how differences in concentration influence relative prices. In this case, before calculating average price ratios, drugs were assigned to one of four groups. Each group was defined by the extent of concentration in Canada and the relevant comparator country, with concentration measured by the two-firm concentration ratio (CR2). In particular, concentration was designated as “low” where the CR2 was less than or equal to 75%, and “high” where the concentration was greater than 75%. This low/high distinction applied in turn to the Canadian and foreign market yields the four-way division mentioned above.

Table 3.4. Average foreign-to-Canadian price ratios, generic drug products, at market exchange rates, by ranges of two-firm concentration ratios (CR2), bilateral comparators, 2007
CR2-Canada
CR2-Comparator
≤ 75%
≤ 75%
≤ 75%
>75%
>75%
≤ 75%
>75%
>75%
Australia 0.80 1.09
France 0.58 0.62 0.71 0.62
Germany 0.55 0.57 0.58 0.59
Italy 0.53 0.60 0.81 0.98
Netherlands 0.65 0.81 0.83 0.86
New Zealand 0.18 0.20
Sweden 0.40 0.62 0.56 0.72
Spain 0.12 0.63 0.35 0.63
Switzerland 0.48 0.67 0.54 0.86
United Kingdom 0.52 0.75
United States 0.31 0.39 0.38 0.70

The third column of Table 3.4 (CR2-Canada ≤ 75%, CR2-Comparator > 75%) represents instances where the concentration was low in the Canadian market but high in the corresponding foreign market. Comparing average price ratios in this column to those in the second column (CR2-Canada ≤ 75%, CR2-Comparator ≤ 75%), it appears that a higher foreign concentration tends to be associated with relatively higher foreign prices, as might be expected. The same pattern emerges when comparing the fourth (CR2-Canada > 75%, CR2-Comparator ≤ 75%) and fifth columns (CR2-Canada > 75%, CR2-Comparator > 75%).

Note, however, that this pattern does not emerge when it is the extent of Canadian concentration that is varied. Comparing results in the second and fourth columns of Table 3.4, it appears that foreign-to-Canadian price ratios are unaffected or even tend to rise as Canadian concentration levels rise. (Comparing results in the third and fifth columns leads to the same conclusion.)

The average price ratios obtained for the United States illustrate the overall trend of the results. In this case, no matter whether Canadian concentration is low or high, the US-to-Canadian price ratios tend to be higher in markets where the US concentration is high. The converse is decidedly not true: the average price ratio in markets where concentration is high in both the US and Canada, 0.70, drops to 0.39 in markets where the US concentration is high and the Canadian concentration is low. Canadian generic prices appear to be closest to their US counterparts where market concentration is high in both countries.

4 Conclusion

This report is principally concerned with the degree of sales concentration in Canadian generic markets, as well as the possible impact of such concentration on prices.

Canadian markets for generic drug products are highly concentrated with respect to sales. The two leading suppliers in a typical generic market accounted for 84.5% of sales in 2007, while the top four suppliers accounted for 96.7%. There are high levels of sales concentration in all therapeutic classes. In even the largest generic markets, where one would expect vigorous competition for market share, sales are typically dominated by a few suppliers.

On the other hand, an analysis of various foreign-to-Canadian average price ratios does not point to any simple relationship between market structure and the relative costliness of generic drug products in Canada. These results imply that relatively low sales-concentration ratios and the existence of numerous suppliers in Canada by no means guarantee that the Canadian price of a particular generic drug will be in line with prices in other countries. It follows that while markets for generic drug products definitely are highly concentrated at the level of the supplier, this is not the fundamental source of differences between Canadian and foreign prices.5

5 A recent study of the Canadian Competition Bureau concludes that “until recently, prices paid for generic drugs across the country tended to reflect the maximum generic drug prices allowed under Ontario's drug plan”. The study also concludes that competition among Canadian companies occurs principally through rebates provided to retailers. In a market framework of this sort one would expect more vigourous competition among companies to produce larger off-invoice rebates rather than lower prices. See Canadian Competition Bureau, Canadian Drug Sector Study, 2007.

Appendix A: International Price Comparisons at Purchasing Power Parities

This appendix reproduces the tables in Section 3 using purchasing power parities to perform currency conversions rather than market exchange rates. Tables A.1a and A.1b correspond to Tables 3.1a and 3.1b; Tables A.2a and A.2b correspond to Tables 3.2a and 3.2b; and Tables A.3a and A.3b correspond to Tables 3.3a and 3.3b.

Table A.1a. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by number of Canadian suppliers, bilateral comparators, 2007
Range: Number of Canadian suppliers AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
1–2 suppliers Price ratio 1.82 0.58 0.51 0.96 0.46 0.12 0.27 0.59 0.75 0.53 0.80
Number of drug products 7 10 21 14 16 5 12 16 13 18 40
3–4 suppliers Price ratio 0.87 0.59 0.44 0.61 0.73 0.35 0.77 0.30 0.53 0.59 0.86
Number of drug products 19 31 48 22 42 10 31 22 13 45 69
5 or more suppliers Price ratio 0.85 0.56 0.59 0.65 0.75 0.19 0.63 0.35 0.57 0.54 0.40
Number of drug products 51 69 90 56 82 21 58 63 40 78 99
Table A.1b. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by number of Canadian suppliers, multilateral comparators, 2007
PMPRB comparator countries All countries
Range: Number of Canadian suppliers Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
1–2 suppliers Price ratio 0.53 1.30 0.85 0.75 0.79 0.48 1.36 0.83 0.72 0.80
Number of drug products 48 48 48 48 48 49 49 49 49 49
3–4 suppliers Price ratio 0.38 0.91 0.60 0.50 0.56 0.36 1.16 0.70 0.52 0.70
Number of drug products 89 89 89 89 89 90 90 90 90 90
5 or more suppliers Price ratio 0.28 0.90 0.55 0.48 0.53 0.28 1.00 0.59 0.51 0.57
Number of drug products 125 125 125 125 125 129 129 129 129 129
Table A.2a. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by range of two-firm concentration ratio, bilateral comparators, 2007
Range: Two-firm concentration ratio (CR2) in Canada AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
CR2 < 50% Price ratio 1.13 1.28 2.40 1.05 1.48 0.86 0.80 1.34 1.39
Number of drug products 4 2 5 3 4 1 3 3 4
50% ≤ CR2 < 75% Price ratio 0.72 0.51 0.42 0.52 0.59 0.12 0.52 0.25 0.54 0.40 0.40
Number of drug products 26 43 54 32 46 12 32 37 28 48 61
75% ≤ CR2 Price ratio 1.04 0.62 0.57 0.89 0.78 0.20 0.70 0.47 0.69 0.66 0.67
Number of drug products 47 65 100 57 90 23 66 61 38 89 147
Table A.2b. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by range of two-firm concentration ratio, multilateral comparators, 2007
PMPRB comparator countries All countries
Range: Two-firm concentration ratio (CR2) in Canada Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
CR2 < 50% Price ratio 1.21 2.40 1.67 1.84 1.57 0.96 2.40 1.47 1.66 1.40
Number of drug products 5 5 5 5 5 5 5 5 5 5
50% ≤ CR2 < 75% Price ratio 0.21 0.75 0.45 0.39 0.44 0.23 0.82 0.49 0.42 0.47
Number of drug products 74 74 74 74 74 78 78 78 78 78
75% ≤ CR2 Price ratio 0.41 1.08 0.69 0.58 0.64 0.38 1.26 0.75 0.60 0.73
Number of drug products 183 183 183 183 183 185 185 185 185 185
Table A3a. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by market size, bilateral comparators, 2007
Range: Market size in Canada AUS FRA GER ITA NLD NZL ESP SWE SWI UK USA
$25 million ≤ sales Price ratio 0.84 0.58 0.42 0.66 0.61 0.09 0.61 0.23 0.58 0.26 0.34
Number of drug products 7 14 15 13 14 2 12 11 9 15 12
$10 million ≤ sales < $25 million Price ratio 1.06 0.52 0.65 0.69 0.86 0.32 0.66 0.50 0.64 0.69 0.76
Number of drug products 17 25 28 19 28 7 20 24 17 29 35
$5 million ≤ sales < $10 million Price ratio 0.69 0.57 0.69 0.70 0.75 0.15 0.59 0.43 0.53 0.99 0.46
Number of drug products 20 24 35 22 31 7 24 21 8 29 37
Sales < $5 million Price ratio 1.03 0.66 0.69 0.89 0.81 0.35 0.63 0.74 0.67 1.01 0.63
Number of drug products 33 47 81 38 67 20 45 45 32 68 124
Table A3b. Average foreign-to-Canadian price ratios, generic drug products, at purchasing power parities, by market size, multilateral comparators, 2007
PMPRB comparator countries All countries
Range:Market size in Canada Min Max Mean Weighted mean Median Min Max Mean Weighted mean Median
$25 million ≤ sales Price ratio 0.18 0.75 0.43 0.37 0.41 0.17 0.89 0.49 0.38 0.52
Number of drug products 17 17 17 17 17 17 17 17 17 17
$10 million ≤ sales < $25 million Price ratio 0.40 1.05 0.67 0.63 0.64 0.38 1.20 0.72 0.66 0.68
Number of drug products 45 45 45 45 45 47 47 47 47 47
$5 million ≤ sales < $10 million Price ratio 0.40 1.03 0.66 0.56 0.60 0.40 1.09 0.66 0.57 0.61
Number of drug products 49 49 49 49 49 51 51 51 51 51
Sales < $5 million Price ratio 0.53 1.21 0.84 0.66 0.80 0.51 1.32 0.85 0.67 0.81
Number of drug products 151 151 151 151 151 153 153 153 153 153

Appendix B: Notes on Methodology

The results described in this report have been calculated from a large set of data on drug sales and prices in Canada and other countries. This section describes the data, sources, concepts and methods applied in performing these calculations.

1 Terminology

In this report, the term “drug” refers to any unique combination of active ingredient, strength and form. Except where manufacturer detail is required, all statistical results are calculated at the level of individual drug products and then aggregated.

The term “product” refers to a version of a drug sold by a particular supplier.

Results are sometimes reported by “major therapeutic class”. This refers to the Level 1 classes of the World Health Organization's Anatomical, Therapeutic, Chemical (ATC) drug classification system. Level 1 codes normally refer to the anatomical system on which the drug acts.

A “branded” product is one sold under a particular trade name. A “generic” product is sold under the name of its principal ingredient(s).

The term "supplier" refers to the economic entity (usually a corporation) that controls the manufacturer of a given drug product.6

2 Price and Sales Data

IMS Health's MIDAS database is the source of all price and sales data used in this analysis. MIDAS is a summary of data obtained from IMS Health's detailed audits of pharmaceutical purchases made by retailers (in 70 countries) and hospitals (in 45 countries). MIDAS contains information on sales of individual products, measured in both currency and physical units, as well as information on the product manufacturer, active ingredient, brand, form, strength, pack size, and therapeutic class.

The data used in this report cover prescription drug sales to the retail pharmacy sector. Sales data include direct sales by suppliers to pharmacies and indirect sales via wholesalers. The retail pharmacy sector accounts for most sales in all of the countries considered in the analysis.7

2.1 Sales

MIDAS includes a field representing IMS Health's estimate of the sales revenue in local currency received by the supplier selling the product in question. This measure of sales is used throughout the analysis. IMS's estimates are based directly on the purchase information obtained in its pharmacy and hospital audits.

To estimate the value of a supplier's sales of a particular product, IMS removes its estimate of wholesalers' mark-ups from the acquisition costs reported by pharmacies and hospitals.

It is important to understand that the acquisition costs used by IMS are based on invoiced prices. Off-invoice discounts, free goods and other forms of price reduction, such as rebates, are therefore not represented in the MIDAS data.

2.2 Quantities

MIDAS provides a measure of physical quantity it calls standardized units (SU). This measure is used throughout the report. Standardized units represent IMS's estimate of the number of normal doses that a given volume of physical units constitutes. This is simply the “number of pills” in the case of oral solids.

2.3 Prices

A drug product's price for any given period is obtained by dividing the value of the manufacturer's sales of that product by the number of standardized units of the product MIDAS reports for that period. Note that the prices thus obtained are properly interpreted as estimated ex-factory prices (i.e., prices charged by suppliers) and not as final retail prices paid by consumers or drug reimbursement plans.

Prices obtained at the level of the drug are derived in a similar fashion, except that sales and quantities of the drug are first summed across suppliers and the resulting sums divided.8

2.4 Patent Status

For the purpose of this study, a drug is identified as patented if at least one version of the drug (either branded or generic) was subject to price review by the PMPRB at some point over the period 2003–2007. If no version of the drug was reviewed by the PMPRB over this period, it is considered non-patented.

Every year the PMPRB, as an addendum to its Annual Report, publishes a list of patented drug products that were subject to price review as of the end of the calendar year. These lists were used to determine the patent status of individual drug products.

3 Identification and Selection of Generic Drug Products

A master list of leading generic drug products was constructed for the analysis of 2007 generic sales and prices. The following steps describe the method by which this was done.

Step 1. Using MIDAS data, drugs sold in 2007 by leading Canadian generic suppliers were identified. Drugs with aggregate 2007 generic sales of less than $1 million were then deleted.

Step 2. Using information from Health Canada's Drug Product Database, any non-prescription drugs were eliminated from the list of drugs obtained in Step 1.

Step 3. A list of all products corresponding to the drugs remaining after Step 2 was obtained. Note that the resulting list of products encompasses all branded and generic versions of the drug.

Step 4. For each remaining product, the contents of the MIDAS database's Local Product Name and Molecule fields were compared.9 Provided that the contents of the two fields were reasonably similar, the product was retained as a generic.10

Step 5. For each remaining drug, the number of generic versions on the Canadian market in 2007, was determined. If there was only a single generic version available in 2007, the drug was deleted.11

4 Matching Data Across Countries

When performing international price comparisons, matching products across countries can be difficult. Prices for the same drug can vary appreciably by strength, form and pack size, even within a single market. This suggests that price comparisons should be limited to those drug products where an exact match can be made. On the other hand, not all pack sizes may be available in all markets, which raises the possibility that a large amount of information may be lost if this is included in the matching criteria. In the PMPRB's view, matching by drug (as defined above) strikes a reasonable compromise between rigour and coverage. This is the approach taken to produce the international price comparisons reported in the main text.

All foreign-to-Canadian price comparisons are based on foreign prices encompassing foreign generic products only.12 Foreign generic products were identified by comparing the Local Brand Name and Molecule fields.

5 Currency Conversion

As noted above, the MIDAS sales data used in this report are expressed in local currencies. Sales were restated in Canadian dollars to allow for meaningful international price comparisons. Currency conversions were done using (1) annual average spot-market exchange rates (as reported by the Bank of Canada)13 and (2) purchasing power parities (as reported by the OECD).

6 Specific Reporting Elements: Statistical Methodology

The following subsections briefly describe the construction of the statistics provided in the report.

6.1 Concentration Statistics

The concentration statistics presented in Section 2 measure the extent to which markets are dominated by a small number of suppliers. In keeping with the PMPRB's general approach, concentration is first measured at the level of individual drugs. Overall statistics are then obtained by aggregating the results across all drugs. Aggregation is done by taking a simple average of drug-level results.

N-firm sales concentration ratios are commonly used in economic analysis. An N-firm ratio is calculated by first identifying the N suppliers with the largest sales in a given market, adding up their sales, and then calculating the proportion of overall market sales accounted for by the N-firm total.

Standard criticisms of N-firm ratios are that they say nothing about the extent of concentration among leading sellers, and that their construction entirely excludes the remainder of the market. The Herfindahl index represents an attempt to correct for these supposed deficiencies. To calculate the Herfindahl index one first calculates market shares for every manufacturer and then takes a sales-weighted average of these market shares. The resulting statistic is the sum of squared market shares taken across all suppliers.

6.2 International Price Comparisons

This report presents a variety of average foreign-to-Canadian price ratios, similar to those published in the PMPRB's Annual Report. These average ratios are constructed as Canadian-sales-weighted arithmetic averages of foreign-to-Canadian price ratios at the level of individual drug products. Algebraically, let

i = 1 … N, each number identifying a drug included in the calculation

p(i) = the Canadian price of drug i

pf(i) = the foreign price of drug i (restated in Canadian dollars)

w(i) = the proportion of Canadians' spending on the drugs 1 to N accounted for by drug i

Then the sales-weighted arithmetic mean of foreign-to-Canadian price ratios is given by:

RA = S w(i)[pf(i)/p(i)]

where S signifies summation over drug products 1 to N.

With currency conversion at market exchange rates, average ratios constructed this way have a simple intuitive interpretation: they indicate how much more or less Canadians would have paid for the medicines they purchased in a given period had they paid foreign prices.

Multilateral foreign-to-Canadian price comparisons are also presented using the following indicators as comparators: minimum foreign price, maximum foreign price, the simple mean of foreign prices, the weighted mean of foreign prices (with weights based on sales by country) and the median of foreign prices. Each of these indicators is an aggregate measure encompassing all countries where comparable drug prices could be calculated.

6 These controlling entities are identified in the MIDAS database's Corporation field.

7 Retail pharmacy purchases account for more than 85% of drug sales in Canada, based on 2004 results from IMS's Hospital and Pharmacy Audit./p>

8 Note that, under this approach, a drug's price can be interpreted as a sales-weighted average of the product prices it encompasses.

9 For a large majority of generic products, the ingredient name actually appears in MIDAS's brand-name field (along with a company identifier). Sometimes the brand-name field contains the ingredient name in a modified form, in which case the product was retained as a generic. Only products sold under names clearly different from that of their principal ingredient were eliminated.

10 Note that whether the product is sold by a “generic” or a “brand-name” manufacturer does not matter here. This means our list of generic products will include “pseudogenerics” sold by companies principally engaged in selling branded products.

11 Markets with a single generic supplier will be considered separately in a subsequent report.

12 Because generic versions of some drug products are not available in all markets, the number of matches will vary from comparator to comparator.

13 This is the Bank of Canada's annual average of the daily noon rates.

Appendix C: Drug Products Included in the Analysis

Ingredient Form Strength
Acebutolol Film-coated tablet 100 mg
Acebutolol Film-coated tablet 200 mg
Acebutolol Film-coated tablet 400 mg
Aciclovir Tablet 200 mg
Aciclovir Tablet 400 mg
Aciclovir Tablet 800 mg
Alendronic acid Tablet 10 mg
Alendronic acid Tablet 70 mg
Allopurinol Tablet 100 mg
Allopurinol Tablet 200 mg
Allopurinol Tablet 300 mg
Alprazolam Tablet 0.25 mg
Alprazolam Tablet 0.5 mg
Amoxicillin Capsule 250 mg
Amoxicillin Suspension 250 mg
Amoxicillin Capsule 500 mg
Anagrelide Capsule 0.5 mg
Atenolol Film-coated tablet 25 mg
Atenolol Tablet 50 mg
Atenolol Film-coated tablet 50 mg
Atenolol Tablet 100 mg
Atenolol Film-coated tablet 100 mg
Azathioprine Tablet 50 mg
Azithromycin Film-coated tablet 250 mg
Baclofen Tablet 10 mg
Baclofen Tablet 20 mg
Beclometasone N.top M-D 50 mcg
Bicalutamide Film-coated tablet 50 mg
Bisoprolol Film-coated tablet 5 mg
Bisoprolol Film-coated tablet 10 mg
Brimonidine Eye drops 0.2%
Bromazepam Tablet 3 mg
Bromazepam Tablet 6 mg
Bupropion Film-coated tablet 150 mg
Buspirone Tablet 10 mg
Captopril Tablet 50 mg
Carbamazepine Tablet 200 mg
Carbamazepine Delayed-action tablet 200 mg
Carbamazepine Delayed-action tablet 400 mg
Carvedilol Tablet 25 mg
Carvedilol Film-coated tablet 25 mg
Carvedilol Tablet 12.5 mg
Carvedilol Film-coated tablet 12.5 mg
Carvedilol Film-coated tablet 3.12 mg
Carvedilol Tablet 6.25 mg
Carvedilol Film-coated tablet 6.25 mg
Cefaclor Capsule 500 mg
Cefalexin Film-coated tablet 250 mg
Cefalexin Film-coated tablet 500 mg
Cefprozil Film-coated tablet 250 mg
Cefprozil Dry syrup 250 mg
Cefprozil Film-coated tablet 500 mg
Cilazapril Tablet 5 mg
Cilazapril Tablet 2.5 mg
Ciprofloxacin Tablet 250 mg
Ciprofloxacin Film-coated tablet 250 mg
Ciprofloxacin Tablet 500 mg
Ciprofloxacin Film-coated tablet 500 mg
Citalopram Tablet 20 mg
Citalopram Film-coated tablet 20 mg
Citalopram Tablet 40 mg
Citalopram Film-coated tablet 40 mg
Clarithromycin Film-coated tablet 250 mg
Clarithromycin Film-coated tablet 500 mg
Clindamycin Capsule 150 mg
Clindamycin Capsule 300 mg
Clobetasol Ointment 0.05%
Clobetasol Cream 0.05%
Clomipramine Film-coated tablet 50 mg
Clonazepam Tablet 0.5 mg
Clonazepam Tablet 1 mg
Clonazepam Tablet 2 mg
Clonidine Tablet 0.1 mg
Clonidine Tablet 0.2 mg
Clonidine Tablet 25 mg
Clonidine Tablet 100 mg
Codeine Tablet 30 mg
Cyclobenzaprine Tablet 10 mg
Cyclobenzaprine Film-coated tablet 10 mg
Cyproterone Tablet 50 mg
Desmopressin N sys M-D 10 mcg
Dexamethasone Tablet 4 mg
Diazepam Tablet 5 mg
Diazepam Tablet 10 mg
Diclofenac Enteric-coated tablet 50 mg
Diclofenac Film-coated tablet 75 mg
Diclofenac Film-coated tablet 100 mg
Digoxin Tablet 0.12 mg
Digoxin Tablet 0.25 mg
Diltiazem Delayed-action capsule 120 mg
Diltiazem Delayed-action capsule 180 mg
Diltiazem Delayed-action capsule 240 mg
Diltiazem Delayed-action capsule 300 mg
Diltiazem Delayed-action capsule 360 mg
Dimenhydrinate Tablet 50 mg
Domperidone Tablet 10 mg
Domperidone Film-coated tablet 10 mg
Doxazosin Tablet 2 mg
Doxazosin Tablet 4 mg
Doxepin Capsule 25 mg
Doxepin Capsule 50 mg
Doxycycline Film-coated tablet 100 mg
Doxycycline Capsule 100 mg
Enalapril Tablet 5 mg
Enalapril Tablet 10 mg
Enalapril Tablet 20 mg
Famciclovir Film-coated tablet 125 mg
Famciclovir Film-coated tablet 250 mg
Famciclovir Film-coated tablet 500 mg
Famotidine Film-coated tablet 20 mg
Famotidine Film-coated tablet 40 mg
Fenofibrate Film-coated tablet 100 mg
Fenofibrate Film-coated tablet 160 mg
Fenofibrate Capsule 200 mg
Fentanyl Transdermal patch 50 mcg
Fentanyl Transdermal patch 100 mcg
Fluconazole Tablet 100 mg
Fluconazole Capsule 150 mg
Fluoxetine Capsule 10 mg
Fluoxetine Capsule 20 mg
Fluticasone N.top M-D 50 mcg
Fluvoxamine Film-coated tablet 50 mg
Fluvoxamine Film-coated tablet 100 mg
Fosinopril Tablet 10 mg
Fosinopril Tablet 20 mg
Furosemide Tablet 20 mg
Furosemide Tablet 40 mg
Furosemide Tablet 80 mg
Gabapentin Capsule 100 mg
Gabapentin Capsule 300 mg
Gabapentin Capsule 400 mg
Gabapentin Tablet 600 mg
Gabapentin Tablet 800 mg
Gemfibrozil Capsule 300 mg
Gemfibrozil Tablet 600 mg
Gemfibrozil Film-coated tablet 600 mg
Glibenclamide Tablet 5 mg
Glibenclamide Tablet 2.5 mg
Gliclazide Tablet 80 mg
Hydrochlorothiaz Tablet 25 mg
Hydrochlorothiaz Tablet 50 mg
Hydrocortisone Ointment 0.5%
Hydroxyzine Capsule 25 mg
Ibuprofen Film-coated tablet 600 mg
Indapamide Coated tablet 2.5 mg
Indapamide Coated tablet 2.5 mg
Indapamide Coated tablet 1.25 mg
Indometacin Capsule 50 mg
Ipratropium bromide N.top M-D 0.03%
Ipratropium bromide Liq/inh l 250 mcg
Ipratropium bromide Rgn lung U-D 250 mcg
Ketoconazole Tablet 200 mg
Ketorolac Eye drops 0.5%
Ketorolac Film-coated tablet 10 mg
Lamotrigine Tablet 25 mg
Lamotrigine Tablet 100 mg
Lamotrigine Tablet 150 mg
Leflunomide Tablet 10 mg
Leflunomide Tablet 20 mg
Leflunomide Film-coated tablet 20 mg
Levetiracetam Film-coated tablet 500 mg
Lisinopril Tablet 5 mg
Lisinopril Tablet 10 mg
Lisinopril Tablet 20 mg
Lorazepam Tablet 0.5 mg
Lorazepam Tablet 1 mg
Lorazepam Tablet 2 mg
Lovastatin Tablet 20 mg
Lovastatin Tablet 40 mg
Medroxyprogester Tablet 2.5 mg
Meloxicam Tablet 15 mg
Meloxicam Tablet 7.5 mg
Metformin Tablet 500 mg
Metformin Film-coated tablet 500 mg
Metformin Tablet 850 mg
Metformin Film-coated tablet 850 mg
Methotrexate Tablet 2.5 mg
Methylphenidate Tablet 10 mg
Methylphenidate Tablet 20 mg
Metoprolol Tablet 50 mg
Metoprolol Film-coated tablet 50 mg
Metoprolol Tablet 100 mg
Metoprolol Film-coated tablet 100 mg
Metronidazole Capsule 500 mg
Minocycline Capsule 50 mg
Minocycline Capsule 100 mg
Mirtazapine Tablet 30 mg
Mirtazapine Film-coated tablet 30 mg
Misoprostol Tablet 200 mcg
Mometasone Ointment 0.1%
Nabumetone Film-coated tablet 500 mg
Nadolol Tablet 40 mg
Nadolol Tablet 80 mg
Naproxen Tablet 250 mg
Naproxen Film-coated tablet 275 mg
Naproxen Tablet 375 mg
Naproxen Enteric-coated tablet 375 mg
Naproxen Tablet 500 mg
Naproxen Enteric-coated tablet 500 mg
Naproxen Film-coated tablet 550 mg
Nizatidine Capsule 150 mg
Norfloxacin Film-coated tablet 400 mg
Nortriptyline Capsule 10 mg
Nortriptyline Capsule 25 mg
Omeprazole Capsule 20 mg
Ondansetron Film-coated tablet 4 mg
Ondansetron Film-coated tablet 8 mg
Oxazepam Tablet 15 mg
Oxazepam Tablet 30 mg
Oxybutynin Tablet 5 mg
Paroxetine Tablet 10 mg
Paroxetine Film-coated tablet 10 mg
Paroxetine Tablet 20 mg
Paroxetine Film-coated tablet 20 mg
Paroxetine Tablet 30 mg
Paroxetine Film-coated tablet 30 mg
Pindolol Tablet 10 mg
Pioglitazone Tablet 30 mg
Pioglitazone Tablet 45 mg
Pramipexole Tablet 0.25 mg
Pramipexole Tablet 1 mg
Pravastatin Tablet 10 mg
Pravastatin Tablet 20 mg
Pravastatin Tablet 40 mg
Prednisone Tablet 5 mg
Propafenone Film-coated tablet 150 mg
Propafenone Film-coated tablet 300 mg
Quinine Capsule 200 mg
Quinine Capsule 300 mg
Rabeprazole Enteric-coated tablet 20 mg
Ramipril Capsule 5 mg
Ramipril Capsule 10 mg
Ramipril Capsule 2.5 mg
Ramipril Capsule 1.25 mg
Ranitidine Oral liquid 15 mg
Ranitidine Film-coated tablet 150 mg
Ranitidine Film-coated tablet 300 mg
Risperidone Film-coated tablet 0.25 mg
Risperidone Film-coated tablet 0.5 mg
Risperidone Film-coated tablet 1 mg
Risperidone Film-coated tablet 2 mg
Risperidone Film-coated tablet 3 mg
Risperidone Film-coated tablet 4 mg
Sertraline Capsule 25 mg
Sertraline Capsule 50 mg
Sertraline Capsule 100 mg
Simvastatin Film-coated tablet 5 mg
Simvastatin Tablet 10 mg
Simvastatin Film-coated tablet 10 mg
Simvastatin Tablet 20 mg
Simvastatin Film-coated tablet 20 mg
Simvastatin Tablet 40 mg
Simvastatin Film-coated tablet 40 mg
Simvastatin Film-coated tablet 80 mg
Sotalol Tablet 80 mg
Sotalol Tablet 160 mg
Sumatriptan Tablet 50 mg
Sumatriptan Tablet 100 mg
Tamoxifen Tablet 20 mg
Tamsulosin Delayed-action capsule 0.4 mg
Temazepam Capsule 15 mg
Temazepam Capsule 30 mg
Terazosin Tablet 1 mg
Terazosin Tablet 2 mg
Terazosin Tablet 5 mg
Terazosin Tablet 10 mg
Terbinafine Tablet 250 mg
Ticlopidine Film-coated tablet 250 mg
Timolol Eye drops 0.5%
Topiramate Film-coated tablet 25 mg
Topiramate Film-coated tablet 100 mg
Topiramate Film-coated tablet 200 mg
Trazodone Tablet 50 mg
Trazodone Film-coated tablet 50 mg
Trazodone Tablet 100 mg
Trazodone Film-coated tablet 100 mg
Trazodone Tablet 150 mg
Trazodone Film-coated tablet 150 mg
Tryptophan Film-coated tablet 1 g
Valproic acid Capsule 250 mg
Valproic acid Syrup 250 mg
Valproic acid Enteric-coated tablet 500 mg
Vancomycin Vial dry 1 g
Venlafaxine Delayed-action capsule 75 mg
Venlafaxine Delayed-action capsule 150 mg
Venlafaxine Delayed-action capsule 37.5 mg
Verapamil Film-coated tablet 120 mg
Verapamil Film-coated tablet 180 mg
Verapamil Film-coated tablet 240 mg
Warfarin Tablet 1 mg
Warfarin Tablet 2 mg
Warfarin Tablet 3 mg
Warfarin Tablet 4 mg
Warfarin Tablet 5 mg
Warfarin Tablet 2.5 mg
Zopiclone Film-coated tablet 5 mg
Zopiclone Tablet 7.5 mg
Zopiclone Film-coated tablet 7.5 mg
Date modified: