How Sanofi Prices Its MS Drug Aubagio (Teriflunomide) in the U.S. and Five Reference Countries

The U.S. Army recently rejected requests by public interest groups, Senator Bernie Sanders, and almost a dozen House Democrats to refuse to grant Sanofi an exclusive license on patents on a Zika virus vaccine, or, alternatively, to ensure that the license included terms assuring that U.S. taxpayers would not pay a higher price than other high-income countries. Specifically, KEI proposed the following terms to be included in the contract:

The [agency] will normally expect the licensee to make products available to the public in the United States at prices no higher than the median price charged in the seven countries with the largest GDP, that have per capita incomes of at least half that of the United States.

The Army responded that it does not have the "means, expertise, and authority to define, implement, and enforce 'affordable prices' or to set price controls."

To help the Army evaluate how Sanofi charges the United States more than other high income countries, we collected data on the price of Sanofi's multiple sclerosis drug Aubagio (teriflunomide).

According to shareholder disclosures, in 2016 Sanofi earned $1.3 billion in global revenues from Aubagio, and $966 million in the United States. The United States thus accounted for 72-percent of global revenues for Aubagio, while it contains only around 16-percent of the global population of MS patients.

According to the FDA label, patients take one 7 mg or one 14 mg pill daily.

We used the 14 mg price in our data.

As the table below shows, Sanofi charges U.S. patients the highest price of five other reference countries.

Of the reference prices, the lowest is the pre-tax price in France, which at €667.27 ($725.29) for a 28 day supply of 14 mg pills, is 8.38-times less expensive than the $6,074.40 price for the same dosage and supply charged at a Safeway pharmacy in the United States — with a coupon discount.

In the United States, one pill costs $217, compared to a pre-tax cost of $26 ($31 after tax) in France.

A one-year supply in the United States costs $79,237.34 ($216.94 times 365.25 days), compared to $9,461 ($11,244 after tax) per year in France.

One kilogram of the active pharmaceutical ingredient (API) from India costs $4,346, which works out to $0.004346 per mg, or $1.70 for a 28 day supply of a 14 mg dose.

Aubagio (INN teriflunomide), 28 x 14 mg dose

Source Local Currency Exchange Rate USD Ratio of GoodRx Price to Source Price
U.S., GoodRx, Safeway Pharmacy With Coupon (Apr. 28, 2017) $6,074.40 -- -- --
U.S., Medicare (2015) $5,276.60 -- -- 1.15
Australia, Pharmaceutical Benefits Scheme (PBS) (2017) AUS$1,836.73 1.34 $1,370.69 4.43
France, Ministère des Affaires sociales et de la Santé, Before Tax (2017) €667.27 0.92 $725.29 8.38
France, Ministère des Affaires sociales et de la Santé, After Tax (2017) €793.04 0.92 $862.00 7.05
United Kingdom, The National Institute for Health and Care Excellence (NICE) (2014)* £1,037.84 0.77 $1,347.84 4.51
New Zealand, PHARMAC (2017) NZ$1,582.62 1.46 $1,083.99 5.60
Ireland, National Centre for Pharmacoeconomics (NCPE), Ex-Factory Price (2014)** €1,250.41 0.92 $1,359.14 4.47