It’s been a tried-and-true tactic for drugmakers for years: Take an aging drug and combine it with another aging drug, and voila! Brand-new, patent-protected product. It might face generics earlier than newly developed drugs, but unlocking sales from older meds for whatever length of time can be a bonus.
But the selling power of convenience--one pill rather than two--started dwindling a couple of years ago as payers cracked down on combos that married two now-off-patent drugs. And now, with drug pricing an enormous election-year issue, pricey off-patent meds--including these two-in-one drugs--are getting even more scrutiny.
Take Horizon Pharma’s Vimovo and Duexis which were kicked off Express Scripts’ formulary in 2015 and failed to win a slot again this year. They’re called out in a Wall Street Journal survey of pricey combo meds, for list prices of $2,061--without discounts, of course. The price of their two separate meds are a tiny fraction of that. The OTC pain reliever ibuprofen and the OTC stomach acid fighter Pepcid (famotidine), in Duexis' case, run about $20 in generic form, the WSJ says, citing GoodRX data.
CVS Health continues to cover Duexis and Vimovo, which combines the OTC pain med naproxen with another stomach drug, Nexium (esomeprazole), which went generic last year. Horizon has told FiercePharma that it’s working on a “partnership” with Express Scripts to make the meds available to its patients next year. It’s in talks with other payers as well.
Horizon’s not the only company trying to reap sales off painkiller-acid reducer combos, however; the two-in-one pill that puts the two together is quite common. Aspirin, for instance, is often taken daily for heart attack prevention, but it can upset patients’ stomachs. Aralez Pharmaceuticals recently won FDA approval for Yosprala, which puts aspirin (salicylic acid) with the generic stomach remedy omeprazole, better known as Prilosec. Its list price is about $1,200 per year, before rebates and discounts, for two meds that might cost patients $1 per day or so.
Credit Aralez; it’s working on copay programs that will keep patients’ costs down to that $1-per-day level. That’s not going to help payers on the hook for the brand-name price--actually, it may not help Aralez win payer coverage for the new brand, because pharmacy benefits managers are particularly annoyed with brands that use copay assistance to circumvent their own attempts to steer patients to generic meds.
And then there’s Valeant, whose acne drug also got the WSJ spotlight for its $444 list price and $41 cost for individual generics. It combines the old remedy benzoyl peroxide (introduced in 1966) and clindamycin, a generic antibiotic commonly prescribed for acne. The drugmaker also markets Zegerid, which puts omeprazole (Nexium) with that pantry staple sodium bicarbonate, a.k.a. baking soda. CVS pushed the latter off its formulary for 2017--not only because its constituent parts are cheap, but because it had seen price increases that CVS considered “hyperinflationary.”
To a degree, these combo drugs are catching flak for similar reasons as Mylan’s EpiPen. Big deductibles on insurance plans are burdening patients with retail prices for brand-name meds. Some Medicaid and exchange plans don’t cover branded drugs at all until $5,000-plus deductibles are met. Sticker shock at the pharmacy is an increasingly common occurrence.
So, combo drugs are likely to remain in an uncomfortable spot--unaffordable at retail prices, pressured by payers, and criticized for charging brand-name stickers on generic meds.
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