More Chicanery from the Drug Industry: The Combo Scam

The pharmaceutical industry has come upon a new scheme to milk a gullible public. Combine two or more ordinarily cheap drugs and market it as a “new” drug. And they get away with this.

Suppose there was a prescription drug that was identical to a combination of ibuprofen and Pepcid (famotidine)—two over-the-counter medicines. The monthly over-the-counter cost of these two is around $15. If your doctor prescribed this combo drug, marketed under the name Duexis, you would have paid, when it came out in 2012, around $200 a month. Since then, according to an article in the prestigious Journal of the American Medical Association (JAMA), found here, the price has gone up a bit. To quote:

”Since 2012, Duexis has had 11 price increases. As of August 12, 2016, the monthly wholesale price was $2061, representing a 1131% aggregate increase. In 2015, nearly $200 million was spent on Duexis in the US, with estimated cumulative revenue over 5 years of more than $600 million since FDA approval.”

$2000/month WHOLESALE for $15 worth of over-the-counter drugs. How can this not be against the law? And why would any reputable physician prescribe such a predatory drug?

Horizon Pharms is the name of the pharmaceutical company behind this, should you want to keep a sharp eye out.

And how do we suppose Horizon managed to get physicians to prescribe $600 million of this drug? Three possibilities come to mind.

  1. The doctor does not know what is in Duexis.
  2. The doctor believes that the patient is too stupid to take two drugs.
  3. The doctor is getting a kickback from the drug company.

Although any of the three should trigger an immediate change-of-doctor reaction, it is item 3 that is most disconcerting. Is it ethical for a doctor to take a kickback from a drug company? Obviously not, and most docs don’t do this. The patient’s interest clearly come first. Is it legal? Unfortunately, yes. And it is not small. $5 billion a year supposedly finds its way back to the prescribing physicians. If you want to see if your doctor made the list, look here. Warning, be prepared for some surprisingly high numbers.

How did they get these numbers? Quite interesting. Although it is apparently perfectly legal for docs to take these kickbacks, the drug companies are required by law to disclose the amounts paid and to whom. (Ooh! Wouldn’t certain people like to get rid of that law!)

If your doc didn’t make the top five, you can still look him up here.

Full disclosure: Dr. Mike will immediately and forcibly eject any drug rep from his office, head first, if he or she suggests anything of this sort. He doesn’t show up in the government database, though there are ten Michael Nichols, MD that do. (N.B. The name ‘Mike Nichols’ is some kind of genetic risk for becoming an MD; there are 5 in my neighborhood!) Note: This database includes a lot of relatively innocent stuff, such as the sales rep taking the doc to lunch.

But we digress. This posts is about the combo pill scam, not how the drug companies get docs to prescribe it.

Here’s a few other combo drugs, gotten from this site.

Vimovo—a combination of Aleve and Nexium, both over-the-counter. Vimovo is $2300 for a sixty pill supply. The Aleve+Nexium combo, in generic form, costs around $50.

Vytorin—$330 for 30. A combination of simvastin ($20), and ezetimibe ($120). The former drug is useless in most cases, the latter is harmful.

Treximet—9 tablets, $750. This one is a combination Aleve, pennies a pill, and sumatriptan, a prescription drug costing $12 for 9 pills.

Acanya—an acne drug costing $500 for 50g is a combination of clindamycin ($50) and benzoyl peroxide, ($10).

And there are more and more and more.

There are also often equivalent drugs that are much cheaper. If a drug seems outrageously priced, investigate both the drug and the physician prescribing it.

Caveat emptor shouldn’t be a consideration when it comes to medicine, but this is sadly not always the case. .



  1 comment for “More Chicanery from the Drug Industry: The Combo Scam

  1. Jim Guerin
    February 12, 2017 at 6:13 am

    In these troubled political times, I have been trying to educate myself on the political-economic arena because I feel it is important to have a better understanding of the history and language being used by our politicians – need to better understand the bull and rhetoric.

    In doing this the issue of pharmaceutical company abuses is a consistent theme as a major player in what economists call “rent-seeking”. Basically the rigging of policy to favor regulations allowing entities like pharmaceuticals to gain increased market share and thus more outrageous profits for the shareholders – but little to no benefit to society at large. Truly a sad state of affairs, which under the “new” administration, I fear, will get worse.

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