Medical Treatments

Combination Drugs: Expensive Marketing Scams?

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Yesterday I heard about Vimovo, a new product marketed by AstraZeneca for the treatment of osteoarthritis.  It’s another in the latest rage in drugs, a combination product.  The drug is really just a naproxen pill wrapped in a layer of Nexium. I have to say the artist’s rendition is pretty enticing. Naproxen is a typical non-steroidal anti-inflammatory medication sold as an inexpensive generic over the counter and prescription medication.  By prescription it’s available at the 500 mg twice daily dosing at the discount pharmacies for $4./ month.  Nexium is a marketing miracle that I wrote about earlier, the second grossing sales drug in America.  It is the L-isomer of omeprazole, dosed at twice the typical dose of omeprazole.  Not surprisingly, since this makes Nexium 40 mg roughly equal to omeprazole (branded Prilosec) 80 mg it may work slightly faster than the typical omeprazole 20 mg.  Still since generic  omeprazole at 40 mg dosing costs $39.61/ 90 pills at Costco, and Nexium costs $565.97/ 90 pills at Costco or about 14.2x as much per dose, it’s incredible that so many physicians prescribe Nexium and that so many patients use Nexium.  It’s  a byproduct of our system of third party payment and marketing by big pharma.

Now AstraZeneca has come out with Vimovo, which is available in 3 doses, either 375 or 500 mg of naproxen wrapped in 20 mg of Nexium.  This works by allowing the Nexium to be dissolved and absorbed first, neutralizing the stomach acid and thereby reducing the chances of getting an ulcer from the naproxen.  It seems to work pretty well, and the studies compared Viomvo to naproxen alone.  This should come as no surprise to physicians who have been using PPIs to reduce the GI upset of NSAIDs for years.

Not surprisingly there was no study comparing taking a generic inexpensive drug like omeprazole 40 mg a half hour before eating, and taking the naproxen with the meal twice daily.  There is little doubt in my mind that this would be equally effective, and it certainly would cost about 7% as much.

When talking to the drug reps, or looking at the AstraZenica web site it looks like Vimovo only costs $10./ month.  This is another of the drug discount coupons tricks of pharma.  They guarantee that Vimovo will not cost you more than $10 total out of pocket cost per month.  They can do this knowing that most patients will have health insurance which will cover the medication except for a top tier copay of maybe $50./ month.  In this scenario the insurance pays the bulk of the cost of the Vimovo, the company reimburses the pharmacy for the remainder of the copay, and the patient pays $10.  AstraZenica knows that physicians are not going to have time or energy to prescribe the Vimovo only to the uninsured patients and make them essentially give the medication out at a real cost of $10./ month.   The effect of this drug is going to be to add one more expensive drug to the market and to drive up health care costs if physicians actually prescribe Vimovo.

The best thing about this medication is that it has such an obscure name that I’ll never even remember it exists, although I will try so I can prescribe it to the few uninsured patients I have and give them the coupons to reduce the profits of this bogus marketing effort.  I say reduce, because I have little doubt that the company actually makes a profit at $10./ 30 pills.  The cost is of marketing and sales of this product that adds very little to our treatment ability.