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

VS

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

VS

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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