Drug companies often combine two cheap generic medications that have been around for decades, sometimes slightly altering their doses, and then market them as a “new” expensive brand name medication. Most often, there is little evidence that these combination medications work any better than the two individual agents. However, what is evident is that these products are expensive, with some costing up to 80 percent more for a one month supply and costing patients thousands of dollars.
According to Carrie Schanen, KHP’s Managed Care Pharmacist, “It may seem advantageous to prescribe a combination product to minimize daily pill burden or to help patients avoid paying one additional copay, but these combination products can have a significant negative financial impact for both patients and our health system.”
Below are a just a few examples of expensive combination agents which are highly utilized among our patient population. Providers are encouraged to take into consideration if the clinical benefit of these products outweighs the hefty price tag, and if not, consider prescribing lower cost individual agents instead.
- Duexis: This arthritis pain medication is a combination of ibuprofen (Advil) and famotidine (Pepcid) at a dose of 800mg and 26.6mg. Patients can buy ibuprofen over-the-counter (OTC) or get a prescription for the 800mg tablets, both of which are very inexpensive. Famotidine 20mg is also an inexpensive product that is available over the counter or by prescription to help prevent the ibuprofen from causing stomach irritation. Compare the cost: One month of ibuprofen and famotidine averages $30, compared to Duexis at $2,500.
- Vimovo: This is another arthritis pain medication containing naproxen (Aleve) and esomeprazole (Nexium) at a dose of 500mg and 20mg. Lower dose naproxen is available OTC or patients can get the higher strengths available by prescription. Esomeprazole is now available OTC or by prescription and is relatively inexpensive as well. Compare the cost: One month of naproxen and esomeprazole averages $35, compared to Vimovo at $2,500.
- Omeprazole-bicarbonate: This antacid is an immediate-release product combining omeprazole (Prilosec) with sodium bicarbonate to prevent premature degradation at a dose of either 20mg-1,100mg or 40mg-1,100mg. While this product may provide a slightly earlier onset of action, its efficacy and duration is quite similar to standard omeprazole. Omeprazole can be purchased in multiple strengths over the counter or by prescription and is one of the most affordable proton pump inhibitors available. Compare the cost: One month of OTC omeprazole-bicarbonate 20mg-1,100mg is available for around $25, compared to prescription omeprazole-bicarbonate (all strengths) at $2,000.
Contact Carrie Schanen at KentuckyOne Health Partners, 1.877.543.5768 or by email at CarrieSchanen@KentuckyOneHealth.org, for help with increasing your patient’s medication adherence and reduce pharmacy costs.