One of my people — we’ll call her Jane — takes two drugs. A generic SSRI, and Nexium. While sorting through the options available to her, and running two scenarios, I discovered just how much Nexium costs her per year. More specifically, how much money she will save by switching from 40mg of Nexium to 2x20mg omeprazole capsules.
$594 per year.
I asked Jane if she’d ever taken anything before the Nexium, because it looked to me like she started it in early 2006, and she told me that she hadn’t. The doctor had given her samples, and then a prescription, and she’d been taking it ever since.
Here’s the thing: Nexium isn’t better than Prilosec. Yes, we all know it’s the isolated, active enantiomer of omeprazole, and its time to acid drop is a bit better, and “studies” (paid for by AstraZeneca) have shown that Nexium beats Prilosec in squashing acid production.
Except that it doesn’t, because if you look at the fine print, you’ll see that those glossy, purty brochures that the big-titted drug reps bring you compare 40mg Nexium to 20mg Prilosec. In fact, when AZ did studies comparing 40mg to 40mg, they discovered that the difference was inconsequential, so they didn’t include those results in their marketing materials. (My source for this is a former sales manager for AZ who used to have Nexium as a drug, and then went on to be a regional drug rep manager. He’s with Forest now.)
Pretty slick. And underhanded.
Oh, and time to acid drop isn’t a particularly important metric, by the way, because PPIs are maintenance meds, not Tums. And Nexium was only something like 2% better than Prilosec for the 8% of the study participants that even showed a difference. Whoopty-do. Clinically significant? Not especially.
Back to saving money. By changing from Nexium to Prilosec, Jane is able to pick a different Part D plan that has a lower premium, not to mention that when she comes to the pharmacy, her copayment will be lower, too. So Jane will be switching. And she could probably eke out a few more dollars in savings if she tried just 20mg omeprazole daily, but I thought I’d be generous by allowing for a non-standard dose in my calculations so her doctor would feel better about switching.
There is a tiny, tiny percentage of people — less than 1 in 100 — that do not respond to omeprazole that do respond to esomeprazole. No one knows why this is, and simply changing from one to the other results in marked improvement. That is no excuse for reaching right for the Nexium over the omeprazole, because sometimes the reverse is true: omeprazole works when esomeprazole does not. Sometimes neither of them work and you need to pick a different drug altogether. This phenomenon is true across all drug classes, and is another reason that having an inflexible, national formulary is a BAD idea.
[tags]healthcare, inefficiency[/tags]
At a time in which I had no prescription drug coverage, my family doc spent about 20 minutes going over options with me… older formulations that were now generic and had similar effect to the trade marked formulations I’d been taking.
He saved me roughly $95 per month. I suspect that people don’t question these things because their co-pays don’t differ that much between the higher priced drugs and the lower.
Maybe I’m mistaken, but it seems you have your figures wrong. If she takes 2x20mg omeprazole, she’s getting 20mg of the active S-enantiomer, because it is a 1:1 mixture of the R and S. If she takes 40mg Nexium, she’s getting 40mg of the S-enantiomer. She’ll have to take 80mg of omeprazole to get 40mg of the S-enantiomer. That not only changes your calculation, it has very significant consequences for the health of your friend if she follows your advice.
But both S- and R-forms of omeprazole have active PPI activity once metabolized within the parietal cell. The R-form does not work as well, but it does work.
Thanks, I didn’t know that. After reading a little deeper, I can see why Nexium is so widely disdained. I wonder when the people at AZ realized they had a dog on their hands, and what kind of internal politics pushed the product onto the market. A single isomer isn’t a bad idea if you have good evidence that one isomer is bad and the other good, but if it’s something like this–well, it’s too obvious to point out, isn’t it?
And yet Nexium was the second most successful drug of 2006 in terms of dollars spent.
http://www.drugs.com/top200.html
Ah, the power of marketing.
I created http://www.medsane.com with that whole idea in mind. It’s not just Nexium. Dozens of generics out there are just as good at a much lower cost.
Here is some info for Jane. Maybe you don’t care for her to know this but it is a fact. I switched this year to AARP for my medicare part D. Then I did something I had never done before. I used their mail order option. I pay one month co-pay of 48.00 and I get my nexium for 6 months. 180 nexium for 48.00. I could not believe this. I take 2-40mg daily becuase of Barretts. This has saved me a “ton” of money. Also, I dont have the hassle getting nexium through AARP, as what I had with the old ins. who always wanted to deny the dbl dose and only cover a single daily dose.
Correction to above post…I meant I get it for 3 months. Not six.
That doesn’t help you when you hit your donut hole. Which you most certainly will do.
The Fallacies Associated With The Me-Too Medications
“But corruption is neither need based nor greed based. It’s simply opportunity based.†—–
Billy Tauzin, president and C.E.O. of PhRMA, the pharmaceutical industry’s most powerful lobbying group, as Mr. Tauzin stated in Boston recently.
It has been said by others that the pharmaceutical industry should not have government regulation or interference from our government at all because that would drastically limit if not eliminate innovation as well as our health care choices and options, both from the perspective of the doctor and the patient, so the public has been told often by others. Also what has been stated by this industry that their internal controls prevent wrongdoing. So, according to some, the public’s health would be limited and possibly harmed without the copious innovation of this industry. As with other issues we face as citizens, this is another attempt by these others to apparently install fabricated fear in our minds- void of any proof or reason, and is a fallacy.
As it has turned out, the pharmaceutical industry’s lack of innovation in particular has happened and they have appeared to do this on their own, overall, those innovators and lifesavers.
Over the past several years, those few meds created and FDA approved with true therapeutic advantages happened by discovery with government involvement in over half of these meds with clear clinical advantages for certain patients. Conversely, of the new chemical entities approved lately and developed by drug companies, over 50 percent of these have microscopic therapeutic advantage for patients, so I understand upon information and belief. This inefficient drug development by the pharmaceutical industry has created what is now the dominant development strategy of drug companies, and this strategy is known as the intentional development of what are phrased, ‘me too’ drugs.
These drugs essentially are small molecular variations of the original molecule in a particular class of medications. In other words, they tweak the original molecule in order to obtain patent rights for their now new drug project. This me too objective of drug companies now accounts, I believe, for about 80 percent of the research budgets of drug companies. And because the FDA only requires a potential med to be superior to a placebo in their mandatory clinical trials, usually these me too meds are approved- regardless of their necessity for others, or the need for such drugs.
And me too drugs are selected by the drug company for their potential blockbuster status as well as the speculated growth of a particular market, which means making over 1 billion dollars a year on such a drug, at least. For example, statin drugs, for high cholesterol patients, is a multi- billion dollar market. As a result, there are several statin meds now available for use by doctors to prescribe to their patients. Yet, arguably, me too drugs are all essentially very similar in regards to safety, efficacy, and cost, regardless of the class referred to so often saturated with me too meds, with few exceptions. The differences overall are minor once again with most me too drugs, overall. As aggressive marketers, the makers of these meds are suspected of doing a bit of publication planning, it is suspected, to falsely claim superiority of their newly approved me too drug over all the other drugs in a particular class both during and after the creation of these me too meds. Also, other classes of meds with several me too drugs may include SSRI anti-depressant drugs, as well as those meds for hypertension. There may be a dozen drugs in a particular class of medications that are all essentially the same in regards to their treatment abilities for patients with such disease states that they treat.
Now, there may be cases where a patient tolerates one drug in a class over another for unknown reasons, so in these few cases, some me too drugs occasionally are beneficial for patients for some reason or another, but should absolutely not be a primary objective of the drug companies to create them as often as they do. Instead, true innovation and discovery should be the focus of pharmaceutical companies, and it does not appear to be the focus of the pharmaceutical industry, presently. It appears that, thanks to the Bayh-Dole Act of 1980, they license molecules from those in the academic world, and then proceed with development of another’s creation they claim as their own.
Further vexing is that competition in the pharmaceutical industry amazingly does not and has not been of any financial benefit for the consumer, as competition normally does create. This fact is greatly demonstrated with other industries and is the apex of business operations. This pharmaceutical industry model is an exception, and the reason for this remains an unknown, as far as the etiology of being deprived of this costly environment of drug spending, yet it can be speculated that the me too drug makers claim uniqueness of their me too drug, which is rather deceptive.
This progressive marketing paradigm of the pharmaceutical industry, such as the creation of me too meds solely for their own profit, clearly illustrates their focus on these issues over true research and science, so it seems. Innovation, along with ethics, use to define this pharmaceutical industry. Sadly, it seems this is not the case today, which ultimately and potentially deprives potential treatment methods potentially for the public health if the objectives were focused on their true purpose. Yet hopefully, such historical qualities of drug companies will return some time. With effort, in time.
Dan Abshear
Is prilosec same as prevacid