Combo pills do not save patients money

Many prescription medicines are actually two or more medicines combined into one pill or package. True, this packaging is convenient– but you can often save money by buying your medicine as its separate components. Let’s look at some examples:

Lotrel blood pressure pills. This is actually a combination of two blood pressure medicines: amlodipine and benazapril. Lotrel, the combo pill, is available in a generic form, as are it’s two individual ingredients.

However, the pricing works out as follows (Costco prices):

Lotrel 10/20 (generic), 30 tabs: $70


Amlodipine 10 mg, 30 tabs: $6

Benazepril 20 mg, 30 tabs: $6

Total: $12

I am really not sure the reason for this price disparity but I have some inklings.

I know that Big Pharma (BP) releases their combo products long after the original medication has been released. Usually by adding a little bit of diuretic, or in this case the amlodipine, a calcium channel blocker. This enables BP to get a brand new patent for these combo pills. So they are able to keep the combo pill price high long after the individual ingredient prices go generic and become much cheaper.

In the case of Lotrel, while the combo pill is also technically generic, its makers may be enjoying the one year manufacturing exclusivity that keeps generic prices initially high. Or it may be an expensive manufacturing process– but why pay for that?

Moving on to my latest favorite outrage:

Prevpac, a treatment for H.pylori. H.pylori is the bacteria that can cause ulcers and gastritis. Prevpacs are a two week treatment course of three different medicines all prepackaged for you. For us docs they are super easy to order. However, Prevpacs are not generic, but the three components of Prevpac ARE available as generic. Let’s look at how the pricing shakes out:

Prevpac, 2 week supply: $396


amoxicillin 500 mg, 4 tabs x 2 weeks- $8

clarithromycin 500 mg, 2 tabs x 2 weeks- $17

lansoprazole 30 mg, 2 tabs x 2 weeks- $63

Total of the three components: $88

These are just two examples of how buying prescriptions “a la carte” saves you big money over medicine “combo platters”. Ask your doctor if you are on any of these combination treatments and see if there might be a cheaper alternative.

Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.

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  • GlassHospital

    Good point, especially on the PrevPac. But for Medicaid eligibles in your state, the formulary includes many combination blood pressure medicines.

    Getting someone to take two pills in one is a lot easier (and easier for them to remember and swallow) than two pills.

  • Matthew Mintz

    Agree, but I would change the title of your post to “Combo pills may not save patients money.” Your Lotrel example is true for patients who pay completely out of pocket (which can be a huge expense and why you developed However, many patients do have prescription benefits, where a generic co-pay is the same, regardless of whether the pill is a combination or not. Thus, a patient who has a prescription plan that charges $10 for generics would pay $20 for both pills and only $10 for the combination.
    Also, for some medications where part of a combo pill is a branded product where there is not a generic yet (i.e. Benicar HCT, Avandamet), Big Pharma (BP) usually throws in the generic for free, i.e. Avandia and Avandamet cost the patient who has a prescription plan (and sometimes the insurer) the same amount.

  • Edward

    In addition to the above many generic combo pills, e.g. lisinopril-hctz, generic for ziac, and others are on the budget pharmacies $4/ month lists.

  • Doc D

    I’d like to see a study (probably already exists) that looks at compliance with combo versus separate drugs, like the ARB-hctz example. I’ll bet people who are compliant at taking one will be compliant with two, as long as they know both are for the same problem and both are needed. If you go to the trouble to make sure you take a daily pill, it seems reasonable to assume you’d take the pair. I think part of the compliance problem is multiple different regimens. (2 qid, 1 q6h, 1 hs, etc). But I could be wrong.

    • JustADoc

      I have one patient who told me I can prescribe anything I think necessary up to a 3-pill maximum. Why is that his limit? I don’t know but it is. I asked which was more important: cost or the 3-pill max. The 3-pill max. He was willing to pay significantly more for ExforgeHCT than the very similar and cheap LisinoprilHCT and Norvasc.

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