Combination Drugs: At What Price?

Today’s Managing Health Care Costs Indicator is $167.40

I’m a devoted reader of the Medical Letter – a nonpartisan, nonprofit biweekly newsletter on drugs that is not supported by pharmaceutical advertising.

This week’s issue highlights a new medicine, Duexis, which is a combination of a high dose of ibuprofen (800 mg, Advil or Motrin) and a high dose of famotidine (26.6mg, Pepsid).  These medicines make sense together – ibuprofen causes a substantial amount of GI upset and some ulcers, and famotidine can prevent these complications. 

All the elements of this medicine are available over the counter – and they’re all available from multiple different generic manufacturers.  The cost of a month of this therapy – using generic OTCs, would be well under $30, and would allow more dosing flexibility. (Many patients experience relief from ibuprofen 600mg, and famotidine is generally not prescribed as more than 40mg a day). 

The cost of the combined pill?  $167.40 per month.

There are compelling reasons to put medicines together – and a single “superpill” to address cardiovascular risk (combining aspirin, angiotensin converting enzyme inhibitor, and statin cholesterol medication) would be an enormous boon. 

There are good reasons not to prescribe Duexis, though:
1)     It’s far too expensive
2)     The fixed doses are convenient but not clinically optimal

The manufacturer has priced this medication with reference to the cost of brand name antiinflammatories and antiulcer medications – but it makes better sense to value this medication with reference to generic/OTC medications.

I’m hopeful that health plans and pharmacy benefit managers will choose not to increase the cost of health care by providing coverage for this medicine.