Why Take Propecia Rather than Cut Proscar Into Pieces?

I had a visit last week from a Merck executive and while talking with him, I realized that I could ask some sensitive questions about why they hold the price for Propecia (1mg finasteride) much higher than Proscar (5mg finasteride). It is not uncommon for a Merck representative to visit various physicians’ offices, and because of my position in creating this website I had an executive pay a visit so he could meet me face to face. His focus as an executive of the manufacturer of Propecia is clearly focused on maximizing the value to the company (as it should, of course). These are their arguments for taking Propecia, rather than cutting Proscar into quarters:

1. Propecia gives you a certainty on the dose. 1mg is 1mg, but if you cut a Proscar into quarters, you are never completely sure of what the dose that you are taking might be.
2. Some people try to put Proscar through their insurance. This is not only illegal (if hair loss is not a covered benefit), but the insurance company can come back on you for the money they laid out for Proscar if they wish to enforce their rule that hair loss is not a covered benefit.
3. If you get a prescription and process it through your insurance, you may be deemed to have a pre-existing condition (Prostatic Hypertrophy is usually the reason that a Proscar prescription is written by the doctor). If your insurance company puts that in your medical record, this pre-existing condition may impact your ability to get insurance if you switch your employment. Once you get a ‘pre-existing condition’ label, it is often near-impossible to get the diagnosis reversed in the insurance company database records. I don’t know if this is a real concern, but it is something that people who process Proscar through their insurance should be aware of.
4. The FDA has only authorized Propecia for treating hair loss, not Proscar.
5. The cost of Propecia is subsidized by Merck at $25/3 month supply, which means that there is a $100 rebate per year. They feel that these incentives make the drug more affordable.
6. There is a one year full money back guarantee if you feel that you did not get a benefit from Propecia. See their website for details.

I asked about the problem with women handling Proscar and cutting it in quarters for their husbands. I was given the example that if a woman who handled finasteride, then gave birth to a male child with a genitalia defect (e.g. hypospadias), Merck could be held accountable for the birth defect if they did not take a legal position on this subject beforehand. I probed them one more time about doing a study on touching the pill, cutting a 5mg pill into quarters and seeing what level of absorption of the drug would occur through the fingers. Essentially though, there is no reason for them to do this. The 1mg dose pill is already available on the market and all this would do is undermine the sales of Propecia.

With all this being said, Proscar and Propecia are still the same drug — finasteride. They are just in different dosages, obviously. If you want to ignore Merck’s perspective and stick to Proscar (or the generic Proscar) for treating your hair loss, and your doctor will prescribe it to you, that is your prerogative. I’m just showing both sides of the coin — the benefits of taking cut Proscar tablets (price) vs the benefits of sticking to the actual Propecia (as outlined above). I’m all for a drug if it is proven to work… and finasteride works.