Healthy Skepticism Library item: 16014

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Goozner M.
When Rx Cos. Use Assistance Programs As Marketing Tools
GoozNews 2009 Jul 20
http://www.gooznews.com/node/3014

Full text:

The Wall Street Journal’s Jon Rockoff has an insightful story this morning describing how drug companies that help financially struggling patients pay their co-pays are using the programs as disguised marketing tools. The mechanism is simple. If an insurance company pays for the drug, but sets up a two-tier or three-tier co-pay to encourage patients to switch to a less costly alternative, the drug company steps in and offers “help” with the co-pay, thus wiping out the incentive to switch.

My favorite quote in the story comes from one Ann Runfola, a 63-year-old secretary from Buffalo, N.Y. who swears by Nexium, the second most prescribed drug in the U.S. It’s used for acid indigestion. Her insurance slapped a $40 co-pay on a month’s supply, which she could sure use “to buy groceries.” Alas, when her AstraZeneca-supplied discount card that covered the co-pay ran out, she had to switch to OTC Prilosec. But, program to the rescue, AstraZeneca sent her another card, and she switched back to Nexium, thus running the tab to about $1,000 a year for her insurance company instead of nothing. She says Nexium works better, the story asserted.

It is frustrating to see this otherwise excellent story not correct Ms. Runfola’s description of Nexium as a better drug. Prilosec and Nexium are the same. Or to be more precise, half of a Prilosec pill is Nexium, since it is a mixture of the two mirror-image crystals that the molecule forms when synthesized. When Prilosec’s patent ran out, AstraZeneca simply separated out half the mixture to get 20 more years of patent (and marketing) life, and called it Nexium. Since most scientists believe both halves are equally active as proton pump inhibitors (the mechanism of action for inhibiting acid formation in the stomach) and half of Prilosec is Nexium anyway, it is physically impossible for Ms. Runfola’s belief that Nexium works better to be true (except in a psychological sense, which of course, is what the drug companies depend on).

That this drug is now the second-most prescribed drug in the U.S. — in an era when the daily headlines bemoan the high cost of health care — boggles the imagination. If Medicare stopped paying for Nexium entirely — and required people switch to a generic — it would save billions of dollars annually, and be a significant Congressional Budget Office-scorable contribution to paying for health care reform. Massachusetts, the story informs us, has a law prohibiting firms from using rebate programs to encourage patients to switch to pricier but no more effective drugs. There’s no reason why the health care reform bills now moving through the House and Senate couldn’t do the same.