Updated Aug 13, 2018

Combining common drugs with a high price tag

Some drugs combine common meds into one high-priced capsule. Photo: Karen Bleier/AFP via Getty Images

Common medications like ibuprofen or naproxen don't cost a lot on their own. But in several instances, drug manufacturers blend those kinds of medicines into one tablet and then sell the combined drug for hundreds or even thousands of dollars.

Why it matters: Patients and the public are paying huge sums of money for cocktails of old medications that are cheaper when bought separately. Experts say the system is loaded with perverse incentives, and that pharmaceutical companies and intermediaries like pharmacy benefit managers have worked in tandem.

The details: Here are four combination drugs that industry experts have highlighted as notably pricey examples. List prices come from Elsevier's Gold Standard Drug Database.

  • Duexis, made by Horizon Pharma: $2,482 for a 90-pill bottle
  • Vimovo, made by Horizon Pharma: $2,482 for a 60-pill bottle
  • Treximet, made by Pernix Therapeutics: $880 for a 9-pill bottle
  • Caduet, made by Pfizer: $580 for a 30-pill bottle

The intrigue: Each of these drugs is made up of two different medications that can be bought in pharmacies as over-the-counter pills or as generics for a total of $20 or less. Vimovo, for example, is a mixture of Aleve and Nexium.

Clinicians and researchers largely agree the prices of many combo drugs do not match the value of the separate alternatives that cost far less.

"It's certainly not worth $580. I'd gladly swallow twice," Michael Rea, a pharmacist who started Rx Savings Solutions to help employers with drug spending, said of Caduet, which treats high blood pressure.

By the numbers: These are the aggregate sales of each drug.

  • Duexis: $674 million from 2013 through the first six months of 2018.
  • Vimovo: $540 million from 2013 through the first six months of 2018.
  • Treximet: $693 million since the drug was launched by GlaxoSmithKline in 2008 (Pernix bought the drug in 2014).
  • Caduet: more than $4 billion since the drug came out in 2004 until Pfizer stopped reporting individual sales in 2014.
  • It's worth noting that Treximet and Caduet have generic competitors on the market — meaning they are generic combinations of drugs that are still cheaper separately.

The big picture: Drug companies and middlemen like pharmacy benefit managers have been enemies as of late, each side pointing to the other as the root cause of high drug prices. But people still pay for these kinds of combination drugs because pharmaceutical companies cut deals, in the form of rebates, to PBMs as a way to keep their drugs on lists covered by insurance.

All four of the drugs above are "non-preferred" on Express Scripts' national formulary for 2019, an Express Scripts spokesperson said. They are not excluded from coverage, but they are not preferred drugs in the class and often come with higher copays.

  • Be smart: Drug makers and PBMs had been tight partners before they needed someone to blame.

The other side: Drug companies have argued their combination pills offer convenience and ensure people take both medicines they need.

  • Pfizer said in a statement: "This is a question of patient choice. Comparing the price of a branded combination medicine to individual generics is apples to oranges." The company added that Caduet is cheaper per pill than its brand-name components (Lipitor and Norvasc, both of which are also Pfizer products).
  • Horizon Pharma submitted a statement that said its drugs had "no approved generic, over-the-counter or clinically equivalent medicines" and that taking the component drugs separately "will not work in the same way."
  • Pernix Therapeutics did not respond.

Go deeper: ProPublica and Bloomberg have worthwhile pieces on the combination drugs made by Horizon Pharma.

Go deeper

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 9 a.m. ET: 1,216,422 — Total deaths: 65,711 — Total recoveries: 252,478Map.
  2. U.S.: Total confirmed cases as of 9 a.m. ET: 312,245 — Total deaths: 8,503 — Total recoveries: 15,021Map.
  3. Public health latest: CDC launches national trackers and recommends face coverings in public. Federal government will cover costs of COVID-19 treatment for uninsured. The virus is hitting poor, minority communities harder and upending childbirth.
  4. 2020 latest: "We have no contingency plan," Trump said on the 2020 Republican National Convention. "We're having the convention at the end of August."
  5. Business updates: Restaurants step up for health care workers. Employees are pressuring companies to provide protections during coronavirus.
  6. Oil latest: Monday meeting among oil-producing countries to discuss supply curbs is reportedly being delayed amid tensions between Saudi Arabia and Russia.
  7. Education update: Many college-age students won't get coronavirus relief checks.
  8. What should I do? Pets, moving and personal health. Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk.
  9. Other resources: CDC on how to avoid the virus, what to do if you get it.

Subscribe to Mike Allen's Axios AM to follow our coronavirus coverage each morning from your inbox.

Trump sees "sooner rather than later" return of pro sports

Photo: Sarah Silbiger/Getty Images

President Trump predicted yesterday that the Republican National Convention will open as scheduled in Charlotte on Aug. 24 — "We have no contingency plan" — setting a new bar for a phased return to business in America.

The big picture: With the virus peak for New York projected as Thursday, and for the nation as April 15 (a week from Wednesday), Trump continued trying to leaven dire warnings with a sunny streak.

Go deeperArrow29 mins ago - Sports

Pope Francis delivers Palm Sunday sermon to empty St. Peter’s Basilica

Photo: Alberto Pizzoli/POOL/AFP via Getty Images

Pope Francis called on listeners in his Palm Sunday sermon — on the first day of Holy Week — to "reach out to those who are suffering and those most in need" during the coronavirus pandemic, Reuters reports.

Why it matters: Francis delivered his message inside an empty St. Peter’s Basilica, broadcasting it over the internet to churches around the world.

Go deeperArrow1 hour ago - World