I’ve written before about how effective drug reps are at influencing our prescribing habits. They use samples, personal relationships, free meals, and incomplete presentation of data to sell new drugs. Some of those drugs may be worthwhile: drugs that are new in class or significantly more effective or safer than standard therapies. But many are not.
Here are some you probably should not prescribe (though I have seen them all on the medicine lists of my patients).
Vimovo. This drug is a combination of Naproxen and esomeprazole. The idea is that if you co-prescribe a proton pump inhibitor along with an NSAID you will reduce the risk of gastric ulcer formation, especially for prolonged use. And that is true.
Sixty tablets of Naproxen 500mg can be had for as little as $6.60. Sixty tablets of esomeprazole 20mg (Nexium) will set you back $26.05. Thus, one month of Naproxen/esomeprazole 500mg/20mg will cost your patient $32.65. Vimovo takes these two over-the-counter drugs and combines them in one table for the convenience of your patient for just $2313 for 60 tablets of the same doses; to be fair, you can get it at Walmart with a discount card for only $864.42. That seems like a small price to pay to take one tablet instead of two…
Duexis. This medication is similar to Vimovo but instead combines ibuprofen 800mg with famotidine 26.6mg and this combo can be used three times a day instead of twice a day. Ninety tables of ibuprofen 800mg costs $4.50 while a month’s worth of famotidine (Pepcid) can be had for $3.00. So a month of treatment will cost your patient $7.50. Surely, since this is cheaper than the last combination drug, Duexis will be more reasonably priced than Vimovo? Muhahahahaha! One month of Duexis costs $2929.97 and the cheapest price with a discount card is $2450.88.
But we have samples! How did you enjoy your sandwich from Panera? All my doctors at (*insert bigger hospital or city*) are using it and just love it.
Both drugs are made by the same company and they have reported hundreds of millions of dollars in sales since they premiered.
Annovera. This is the newest wrinkle in birth control. It’s a ring that releases hormones in the same manner as the birth control pill, patch, or the current vaginal ring, Nuvaring. It actually has more daily estrogen release than Nuvaring and its generic, Eluryng. The difference though is that instead of getting a new one each month, it lasts a whole year. The company asks women to insert it into their vaginas for three weeks, take it out for a week, then put it back in and repeat this 12 times (or 13 cycles). Women who use the current ring or its generic do the same thing, they just use a new one each month rather than wash it off and store it in its little case. I’m not sure what happens if you lose it.
So, I guess this saves three trips to the pharmacy each year (assuming one prescribes a 90 day supply of Nuvaring).
Thirteen Nuvarings cost $744.25 at CVS ($57.25 a piece), which is significantly cheaper than it used to be since the generic version came to market. How about Annovera? It costs $2176.92 at CVS. Preventing those three extra trips to the pharmacy only costs $1432.67 (of course, they do have a home delivery option).
Birth control makers take advantage of current federal law which requires insurances to pay for each unique form of birth control, so formulary coverage should be quite good for Annovera since there is no other once-a-year vaginal ring. I will point out that all of the IUDs, the Nexplanon, and almost every pill is far cheaper than this. In fact, one year’s worth of equally-effective Lessina (generic of Alesse) at CVS only costs $153.72 while the Liletta IUD which is far more effective, safer, and lasts up to 6 years only costs $625 (and as little as $50 if you are uninsured).
Balcoltra. Speaking of birth control, Balcoltra is a new and heavily marketed birth control pill that I’m seeing quite a bit of recently. It contains 20 micrograms of ethinyl estradiol and 0.1mg of levonorgestrel for 21 days and 7 days of hormone-free tablets. This is actually the exact same hormones and doses found in Lessina and has been a standard formulation of many birth control pills since 1978. Remember, one year of Lessina will cost $153.72. How about a year of Balcoltra? Only $2401.44 at CVS. Hmm. So what do you get extra for $2247.72 a year? Well, they added in 36.5mg of ferrous bisglycinate per day. Yup, iron. Iron. But that makes it a unique formulation so that insurances have to pay for it by law. Clever. By the way, a year’s worth of iron costs $12.56 at CVS.
Solosec. This antibiotic (secnidazole) is a one dose treatment for bacterial vaginosis. The traditional treatment is metronidazole 500mg BID for 7 days. Solosec is sold as more convenient and simpler than the traditional treatment. It costs $337.18 while the traditional treatment costs as little as $3.00, but usually around $7.77.
It is a fair question as to whether it’s worth $330 extra to take one pill rather than 14 – the answer is no, for a few reasons. First, treatment will likely be delayed for your patient while you fight for prior authorization. Second, there is no evidence to indicate that there is a higher cure rate with Solosec versus 7 days of metronidazole – even accounting for the fact that many patients don’t take it correctly or don’t finish the course of treatment. In fact, studies show that Solosec is no more effective than 2g single-dose treatment with metronidazole. So, if you’re really wanting one dose treatment just use single-dose metronidazole at a cost of only $1.16.
There are many more examples of similar drugs. These are just some I’ve seen in the last week or so. Here are some things you can ask your next drug rep that will help you get closer to the truth:
- How much does the drug cost? How much does the traditional treatment cost? (Look the prices up for yourself on goodrx.com).
- Is there a head-to-head study of the drug versus traditional treatment? If so, who funded the study? (Many such novel drug makers show studies of their drug versus placebo and the traditional drug versus placebo and play other such games).
Those two questions should insure that you get no more free lunches.
If you don’t want to be the kind of doctor who makes these mistakes, you should really read my new book which will be available soon (click here).