Healthy Skepticism Library item: 1584

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Publication type: Journal Article

Connolly C.
Pentagon to Drop Nexium From Its List Of Covered Drugs for Military Personnel 'Purple Pill' Nexium the First to Be Cut
The Washington Post 2005 May 8;

Full text:

Beginning this summer, nearly 140,000 active and retired military personnel and their family members will find that the Pentagon has stopped picking up the tab for their Nexium, the blockbuster heartburn drug marketed as the “healing purple pill.”

It is the first time the Defense Department has decided for financial reasons to drop a licensed medication, and a harbinger of many difficult choices Pentagon officials envision as they try to rein in a $5 billion-a-year pharmaceutical budget that has exploded by 500 percent in the past four years.

Taking a cue from the corporate world and a direct order from Congress, the Pentagon is in the early stages of implementing a program that discourages use of expensive “me, too” medications that have been found to provide no major medical advantage and yet are priced significantly higher than competing drugs. This mini-rebellion against a drug that generated $4.8 billion in U.S. sales last year is part of the more aggressive tactics health care purchasers are employing in the ongoing battle over soaring medical bills.

“Nexium is not worth the money, period,” said Mike Krensavage, a pharmaceutical industry analyst at Raymond James Financial. “It’s pretty dubious to pay $4 a pill for Nexium when you can get over-the-counter Prilosec for 67 cents.”

By switching patients from Nexium to one of four cheaper medications for heartburn and ulcers, the Pentagon expects to save “many tens of millions”
of dollars a year, said William Winkenwerder Jr., assistant secretary of defense for health affairs. He also intends to tighten access to the more expensive versions of drugs that treat such illnesses as skin infections, hypertension and erectile dysfunction.

“The goal is to ensure that the best value is obtained for our beneficiaries,” he said in an interview.

For decades, private employers, insurers and some state Medicaid programs have refused to pay for some pricey medications by creating a preferred drug list, or formulary. Long ago, major insurers such as WellPoint and Kaiser Permanente refused to put a host of copycat drugs, including Nexium and the antihistamine Clarinex, on their preferred lists.

But for the military, which until now has covered virtually every legal medication, the decision to drop the “new purple pill” represents a cultural shift. After providing unlimited, gold-plated medical care for 9 million members of the armed services and their families, Pentagon leaders suddenly must contend with the same financial burdens that have prompted many small businesses to drop health insurance entirely and large corporations such as General Motors to contemplate equally drastic steps.

When patients complain of severe heartburn or acid reflux, they frequently ask for Nexium by name, said Lt. Cmdr. Robert Catania, a staff surgeon at the National Naval Medical Center in Bethesda.

“A lot of people will say, ‘I heard Nexium is the best drug, so that’s what I think I should be on,’ “ he said, noting that the comments mimic almost verbatim Nexium’s commercials. He tries to steer patients toward cheaper alternatives. But with 25 million Nexium prescriptions written in the United States last year, Catania said, it seems few doctors resist pressure from patients and drugmaker AstraZeneca.

“My mother went to her primary-care doctor with heartburn, and he gave her Nexium right away” when Tums might have sufficed, Catania said.

AstraZeneca spokesman David Albaugh disputed assertions that Nexium is effectively the same as other proton pump inhibitors.

“Nexium is more effective at controlling acid and better in healing acid-related damage,” he said in a statement. “More patients have better acid control with Nexium than with other branded medications of its type.”

Few drugs in the United States have been as widely advertised as Nexium, which was introduced in 2001 to replace Prilosec when that drug’s lucrative patent expired. (Prilosec is still available in a prescription form and a lower-dose over-the-counter version.) Nexium was the most heavily advertised drug in 2004, with $2.2 million spent, said Christine Franklin, spokeswoman for DTC Perspectives, a consulting company.

The result is “the triumph of marketing over science,” said Sharon Levine, a physician who oversees pharmacy operations for Kaiser Permanente’s Northern California group. “There’s no science behind this being a superior drug.
It’s a purely promotional and marketing success.”

She does not blame drug companies.

“This is not evil on the part of manufacturers. It’s a strategic business decision to try to preserve and extend the length of a patent,” she said.
“It’s the job of prudent prescribers and prudent purchasers to ask the
question: Is this just new, or is it new and improved?”

Nationwide, medications to treat heartburn and ulcers were second in sales, behind cholesterol-lowering drugs, in 2004, according to IMS Health, an independent research firm. As the Pentagon’s second-costliest class of drugs
— at $379 million last year — proton pump inhibitors were a prime target, said Col. James H. Young, director of the Defense Department’s pharmacy programs.

A team of doctors and pharmacists reviewed 15 studies and concluded there were “no significant differences clinically in those drugs,” he said, and “Nexium was far more costly.” Of the five heartburn medications, Nexium represented 33 percent of total retail purchases for military personnel last year — more than 528,000 prescriptions.

As of July 17, people insured by the Pentagon will be offered the four other heartburn drugs — Zegerid, Protonix, Aciphex and Prevacid — for a $9 co-payment per prescription. Patients, with the backing of their physicians, can request an exemption if the other drugs fail to bring relief and only Nexium works. Or the patient can pay the Pentagon’s negotiated price of $22, still a bargain compared with the retail price of more than $120. And the military will save money not only by dropping Nexium but also as a result of lower prices offered by AstraZeneca’s competitors, Young said.

AstraZeneca spokesman Albaugh said the company did not bid on the military contract because the Pentagon based its decision “exclusively on price.”

Some health care purchasers have grown frustrated with what they say are attempts to game the market, by introducing “me, too” drugs or clamping down on supplies of generic versions as a way to force patients to stick with the more expensive brand name.

In Arkansas, officials introduced incentives for state employees to switch from prescription medications to the over-the-counter version of Prilosec, said Jill Johnson, a consultant to the state and a professor at the College of Pharmacy at the University of Arkansas for Medical Sciences. But for a sudden and suspicious shortage of the nonprescription Prilosec OTC, the state would have saved $4 million in the first year, she said.