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Good morning ... Start your week wth B.C. Manjunath. He can do a Fibonacci sequence in konnakol, which NPR describes as "the Carnatic, or South Indian, art of speaking percussive syllables in rapid-fire, intricate patterns."

1 big thing: Big money from cheap drugs

Photo Illustration: Mario Tama/Getty Images

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

The details: Here are four combination drugs that industry experts have highlighted as notably pricey examples.

  • 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.

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.

The other side: "This is a question of patient choice," Pfizer said in a statement. "Comparing the price of a branded combination medicine to individual generics is apples to oranges."

Go deeper.

2. Where the opioids are
Expand chart
Data: Opioid Prescribing Rates by Congressional District, United States, 2016; Note: The prescription rates are from 2016, but the map reflects the current representatives of the district. Map: Kerrie Vila/Axios

The areas most flooded with prescription opioids are mostly represented by Republicans. The opioid crisis has taken a steep toll nationwide, but the South and Appalachia are particularly inundated with highly addictive prescription painkillers.

Between the lines: This is an association, not necessarily a cause-and-effect relationship. The abuse of prescription painkillers is worst in the South and Appalachia, which are predominantly represented by Republicans.

  • And it's often worse in rural areas than in major cities — note how much the Atlanta area stands out from the rest of the Deep South for its comparatively low levels of opioids per capita.

What's next: The House passed roughly 60 opioid-related bills in June; a timeline for getting a full package all the way to President Trump's desk is not yet clear.

  • Experts say Congress' efforts are a worthwhile start, but that the main thing Washington needs to do is come up with a lot more money for addiction treatment programs.
  • Public health experts have praised the FDA for embracing medication-assisted therapy — products like methadone that help reduce the symptoms of withdrawal so people are less likely to return to more dangerous and addictive illicit drugs.
3. Dems personalize health care attacks

As Democrats put health care front and center ahead of the midterms, their national message is mainly about threats to the Affordable Care Act, including its protections for pre-existing conditions.

But my colleague Caitlin Owens runs through some more personalized health care attacks in some of the most hotly contested Senate races this year.

What Democrats are saying:

  • In Missouri and West Virginia, Democrats are attacking the GOP candidates — Attorneys General Josh Hawley and Patrick Morrisey — for signing onto a lawsuit against the ACA.
  • In Florida, they're hitting Gov. Rick Scott for not expanding Medicaid and for his tenure as CEO of hospital chain Columbia/HCA when it was fined $1.7 billion for Medicare fraud.
  • Montana Senate candidate Matt Rosendale is the state insurance commissioner and is getting hit for approving premium hikes.
  • And in New Jersey, GOP candidate and former Celgene CEO Bob Hugin is getting hammered for the company's drug price hikes. (Sen. Bob Menendez has his own problems, though: corruption charges against him that ended in a mistrial were related to Medicare fraud.)

The other side: Republicans are happy to remind voters that Democratic incumbents, especially in red states, belong to a party that is quickly moving towards embracing single-payer health care.

4. Eshoo responds to anti-pharma ad

I reported on Friday that Patients for Affordable Drugs Action was, for the first time, spending money against a Democrat: California Rep. Anna Eshoo. I reached out to her campaign for a response. They said, in part:

  • "Congresswoman Eshoo continues to work for reforms in the current drug pricing system. She has called for hearings on the cost of prescription drugs, supports price negotiations in Medicare Part D to drive down costs and is the lead Democrat on a bill to lift restrictions so pharmacists can tell patients about less expensive drugs. "
5. While you were weekending ...
  • The health care industry is banding together to fight "Medicare for All," The Hill reports.
  • STAT News notices that Johnson & Johnson CEO Alex Gorsky has gotten a lot nicer to/about Trump over the past year (subscription required).
  • The improv group Upright Citizens Brigade apparently has a whole show about "pharma bro" Martin Shkreli.

What's on your agenda this week? Let me know: baker@axios.com.