The author contends that we all share responsibility for helping to fight waste, fraud and abuse.

A recent effort to fill a prescription was an eye-opening experience for me. I actually discovered one of the most outrageous examples of corporate greed and its effect on the health care system in America. This happened to me — a reasonably well-versed user of health care services — in the process of using insurance coverage to pay for my expenses. The outrage is Duexis, a drug made by Horizon Pharma.

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Duexis is for people with severe back pain. Its applications include treating symptoms of arthritis and disk degeneration. I don’t think many would argue with the point of the drug, which is to provide a prescription-only strength dose of ibuprofen, combined with a prescription strength dose of an antacid, to relieve pain and protect the stomach lining from some of the effects of ibuprofen on the digestive system. Sounds reasonable so far, right?

As you probably know, ibuprofen is a pain reliever and anti-inflammatory drug included in Advil, Motrin and many other drugs. It’s easily bought in generic form from thousands of companies in all different combinations.

The previously mentioned Horizon Pharma “developed” a drug that merges ibuprofen and a strong antacid in one simple pill. Duexis was born.

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The problem is simple, and grotesque in the extreme: Horizon produces this product and charges over $1,400 monthly for a 90-pill supply (three pills per day). The true cost for the same amount and supply of generic Ibuprofen, in the exact same strength (800mg), is about $11. The true cost for the comparable amount of the same antacid is about $7. 

A Horizon representative told me that I’m over-simplifying, and that the company used data from two randomized clinical studies that enrolled more than 1,500 patients to win FDA approval for Duexis. The representative said physicians have been too slow to prescribe antacids to regular users of non-steroidal anti-inflammatory drugs (NSAIDs), and that Duexis can reduce the likelihood that NSAID users will develop stomach ulcers. He said that contract manufacturing is common in the pharmaceutical, and that saying Horizon is “nothing more than a broker” is clearly erroneous.

In my opinion, however, Horizon Pharma is ripping off every consumer, and third party payer in the nation, by charging so much for Duexis.

Where does that difference in price go? Just look at Horizon Pharma’s marketing, and you’ll know.

In my case, I was visiting an orthopedic practice due to a stubborn lower back problem that wasn’t getting any better with Tylenol, heat wraps, chiropractic or massages. They shot some X-rays, and I met with the doctor, a very talented and well-regarded orthopedic physician. He told me that I have osteoarthritis and some other problems that can be managed with therapy and anti-inflammatories.

He asked if I had any allergies to anti-inflammatories, and I said no. In fact, I had been on some previously with no problems. So he said, “Well, I’m going to give you something that will protect your stomach lining from any ill effects of ibuprofen.” Fair enough, I thought. We finished up. I went out to his assistant to get my instructions.

She handed me two trial size boxes of Duexis and explained that it was a newer compound of a combination of drugs that work well. “We always recommend it now,” she told me.

The assistant also handed me a slip of paper from a company I’ll call “Outrageous Rx Pharmacy,” which, she said, would be contacting me to arrange delivery of a regular 30-day supply. Not a handwritten note, but a slick, printed piece of paper. It looked very official. It turned out that Outrageous Rx Pharmacy was a specialty pharmacy that would get me my supply of Duexis, “so I can just have it sent to my home for convenience. They’ll deal with all the insurance hassles.” No discussion of cost was ever raised, or intended to be raised. No one was going to tell me, “By the way, this drug is thousands of dollars for pennies in product,” and my insurance will cover it! Is there anything else I need to know?

When I got home, I went straight to my desk and began researching. First I went to Horizon Pharma’s website. According to Horizon Pharma’s own website and annual report, the company does nothing to even make this drug.

The company contracts with a European company to supply the ibuprofen. The company then contracts with a second company to supply the antacid.

Horizon Pharma doesn’t even have these compounds shipped to its offices in the United States, so it never even touches the product.

So, Duexis is a drug that costs $1,400 for a 30-day supply and is generally a Tier 3 drug.

Taking two pills with the exact same content costs about $18 for a 30-day supply.

So:

  • Where does the excess money go?

  • Why is any insurance plan paying for this?

  • Whose fault is this outrage?

There are many schools of thought on this. Is it “Big Pharma” taking advantage of the system while choking off the money spent on deserving support systems in health care?

Is it the patients’ fault, because the patients aren’t asking about the price? Is it the insurance companies’ fault for ever agreeing to pay for these types of drugs? Is it the government’s fault for allowing this type of entitlement mentality to permeate our society? Is it the fault of the greedy stockholders (aka everyone with a 401(k) plan)? Or is it just the result of greed across the board, including the consumers, the drug companies, and everyone else with fingers in or near the till while pennies are (supposedly) being counted carefully?

Finally, it seems the “private pharmacy,” Outrageous Rx Pharmacy, is an interesting company that, apparently, works directly for individual doctors, and groups of doctors. So, it seems as if my doctor is also involved in this.

Drop me a line and let me know if you think I can still see this doctor.

Just so you know, when challenged, his office agreed to call in the generic ibuprofen and antacid prescriptions to my pharmacy with no questions asked. Final cost? $14.73 for a 30-day supply. You can thank me now, Anthem.

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