Abilify®—Is It Worth It?

My doctor recently gave me a prescription for Abilify, a fast-acting antidepressant for patients with major depressive disorder. I couldn’t shake a depression that had kept me in bed for most of a month. Although I’d been taking a maintenance dose of Zoloft for years, it wasn’t potent enough to prevent this episode. I needed a drug that would supplement the Zoloft.

Abilify was developed by Bristol-Myers Squibb for patients with major clinical depression resistant to treatment with standard antidepressants. (It’s used for other psychiatric indications, too.) Abilify is intended to serve as an add-on treatment.

After 5 days of 10 mg of Abilify nightly, I felt my depression start to lift. I was regaining my motivation to move around and get things done. By day 7, I was pretty much back to normal, working on writing projects, talking with friends, and running errands. My enthusiasm for life was returning

By day 8, I was a bit too enthusiastic. My mood was slightly manic. My speech was pressured. At the same time, my body felt clumsy and my balance shaky. I took two falls in a week. Also, I was becoming surprisingly forgetful. In the middle of a conversation, I’d lose track of the topic. When going to another room to get something, I’d forget what it was by the time I got there. According to clinical studies, impaired memory is sometimes reported by Abilify users. My other symptoms weren’t listed among adverse events associated with taking the medication, but they felt like side effects.

Since my mood was lightening, the doctor suggested lowering the dose to 5 mg by splitting the pills in half. Then, if the improvement continued after several days, I could take one quarter of a pill. After that, I could stop altogether.

While the effects of Abilify were gratifying, the cost of the drug was daunting. My pharmacist told me a 30-day supply would cost $834.00. When he saw my shock, he asked whether I had insurance. I said no. He suggested that I apply to Bristol-Myers Squibb online for a discount coupon. I did that and found that the application could take up to two weeks to process—too long for me. I bought a 7-day supply of Abilify for $199 from my pharmacist and ordered the rest from a Canadian pharmacy, where the cost was only $165 for a 30-day supply. It would arrive by the time my initial supply was used up.

Abilify comes in six dosage strengths, ranging from 2 mg to 30 mg. In the U.S., a one-month supply of any of the four lower doses is the same—about $800. The two higher doses sell for about $1200. In Canada, the same branded product costs 80% less.

Why Canadian Prices Are Lower

The reason Canadian prices for Abilify are so much lower is that Canada, like many other countries, imposes price controls on retail medications. In the U.S., the sky’s the limit. Pharmaceutical lobbies in Washington have persuaded Congress that the high prices are justified by the cost of research and development. While this is true, the profits are often many times the amount needed to reach this goal. It’s true, too, that drug companies need to be compensated for their risk in developing new drugs that never come to market because FDA approval can’t be obtained. When this happens, they rely on the profits from other branded drugs to make up for their losses.

After Abilify sales had been tallied for the last 10 months in 2013, Bristol-Myers Squibb was found to net $16.4 billion. Only $3.7 billion of this was needed to recoup research costs. The company is undoubtedly currently maximizing profits before generic products are introduced in the U.S. in mid-2015.

Why Are Abilify Tablets So Tiny?

The tiny size of Abilify tablets may have been a measure of Bristol-Myers Squibb to deter users from sectioning high-dose tablets into pieces; pill-splitting is a money-saving exercise. A doctor may prescribe 5 mg of an expensive drug per day, but write a 15-mg prescription so the patient can score the tablets in thirds and cut costs. Sectioning is difficult with the tiny Abilify tablets. Using a pill crusher is an option, but even this is tricky for a patient trying to divide a 30-mg pill into sixths to achieve separate 5-mg doses.

Bristol-Myers Squibb warns consumers to “take tablets whole.” There’s no pharmacological need for this, as the density and composition of each tablet are uniform throughout. The Discmelt formulation of Abilify is the exception.

Is Abilify Worth It?

Who wouldn’t pay a lot of money to recover from a severe clinical depression? It’s like death to many of us. We’re convinced that it’s permanent. Knowing that a rescue drug is available is priceless.

If I need the Abilify again in the future, I’ll buy ten 10-mg tablets from Canada ($55.00) and take one pill a day for six days. I’ll cut two pills in half and take the half-pills for four nights. I’ll quarter one and take the quarters for four nights. (This will leave one pill just in case.) Abilify will then most certainly be worth it.