Alright, folks, time for a bit of an old school "Check Your Reality"-type tirade, because I'm pissed off about something that will probably just slip under the radar. I'm someone who (unfortunately) lives with chronic neck and shoulder pain, and has navigated the orthopedic/pain-management maze to the tune of one shoulder surgery, three epidurals, two EMG/NCV's, and failure on Advil, Aleve, Mobic, Diclofenac, and Celebrex, so let's get that out of the way. I'm not a doctor, but I've done a lot of mandatory reading of my own. I welcome nurses and doctors, as well as insurance specialists to correct me where I am wrong. I am the kind of person that needs better non-narcotic pain medication, the exact type of person who the Opioid Crisis is focused around.
Each bottle is 60 pills; each bottle's cost when Horizon Pharma acquired it was $138 (so a little more than $2/pill). It now costs almost $3,000; such a big increase that, frankly, I feel okay just rounding it to 3K. That means each pill now costs roughly fifty bucks a piece. That's right, $50/pill.
Now, you might be thinking to yourself, "Oh! This is a powerful opioid, right?!" Well, it's a combination of Naproxen and Esomeprazol. Now, if you're like me and you try to learn generic medicine names because you've had to talk to a lot of doctors for yourself and others, well, you probably recognize Naproxen as the key ingredient of "Aleve." This is an anti-inflammatory medication used similarly with Ibuprofen, the contents of "Advil" and "Motrin." This is an extremely common pain killer, non-narcotic, and extremely inexpensive.
So what's Esomeprazol? Something stronger than Dilaudid? It's gotta at least be as powerful as a Percocet (Which, BTW, is Oxycodone mixed with Acetaminophen (AKA Tylenol)), right? Well...Actually, it's not an opium-based pain-killer, at all! And that's gotta be great, because it must really knock out pain without the risk of addiction, yeah?
Actually, Esomeprazol is a stomach pain medication, used to counter the side-effects of the Naproxen which tears at the stomach lining a bit when used long-term to control disorders like arthritis.
So...Wait a minute. This pain medication is, functionally, just a dose of Naproxen?! People who take stronger meds take those stronger meds because Naproxen has utterly failed to control their pain. Trust me - I know. I know because when I had a calcium deposit the size of a golf ball in my left shoulder, one the doctor delineated in his post-surgical report as the largest he had ever seen, it was pretty much the ceiling of what I took. Maybe I just respond poorly to the stuff, but if the pain weren't so bad I might not have needed the surgery, you know? And for many pain patients, intervention really helps (Unfortunately, for me, it hasn't been so helpful), and they can stage down to non-narcotic meds, which is always a good thing.
But let's put the "how strong is this medication" argument on hold, here, because these jackasses at Horizon are cranking the price up on this drug and they're doing it hard-core. If we know Naproxen is a common, cheap, first-line-intervention, and they aren't doing anything super-special like reducing the need for opioids, then what's the magic of this stomach medicine?
Here's the core of the article: It turns out that according to this article, "Those ingredients can be purchased by patients very cheaply separately." Horizon's response? "However, Horizon said that Vimovo is a special formulation that's not the same as simply combining the two main ingredients."
So you're telling me this special formulation justifies the $3,000-price tag? Remember, Horizon BOUGHT this drug in 2013, and it stands to reason that they bought it from whoever paid for the actual FDA clearance of the drug, meaning it isn't like they're trying to pay off the FDA expenses (unless, stupidly, they agreed to pay a price for the medication as well as take on the FDA expenses, in which case they had still accounted for how much it would cost and they are therefore passing those costs on to the pill buyer).
Now, here's where things get interesting - and I do mean interesting. According to Egan, “Horizon estimates that 98% of all insured Vimovo patients pay $10 or less out of pocket.” Waiiiiiit-a-minute. You’re telling me insurance will cover $2,990 of the $3,000 price-tag, or thereabouts? No. I don’t think so. I think insurance companies, seeing as they are probably buying in bulk, actually pay the company a far lower price; I think that only those of us who can’t afford insurance have to pay the full price. Unless they get one of those free pharmacy discount cards that the fiscally-realistic doctors give out, maybe? I know this is the case because this is what happens with doctor office billing. My mother spent many years as a doctor’s secretary (this is the kind of doctor that we trust with our family; when my mother died and my father was sick, he was there), and she made sure I understood that insurers rarely pay the asking price that those without insurance have to pay. In fact, now that I think about it, responsible doctors probably wouldn’t prescribe this medication when they can just prescribe the two component meds, together, even if it’s not exactly as effective. After all, it’s widely known that reasonable costs lead to better results with patient compliance on taking their meds (This is especially important with psychiatric meds).
Alright; it’s tired, and I’m annoyed. The point: What magic, exactly, is Horizon possibly charging $50/pill for that couldn’t be accomplished by just taking the two drugs separately? What social good does a company like this serve? Why would a doctor prescribe this to their patient? Why would this not be considered a medicine of last resort with respect to side-effects like nausea, in the case that it did have a significant improvement on taking the drugs desperately?
Again, I’m not a doctor, but I’m also not a dummy and while I’d love to be better informed, I have a feeling I’m not wrong with my questions, here.