- Combination drugs are typically new medications that are made by combining two or more generic drugs into one medication.
- Often, drug manufacturers are primarily motivated to combine these drugs in an effort to improve their bottom line.
- In a majority of cases, combination drugs don’t make any clinical difference for patients, yet pharmaceutical companies charge a significantly higher price for them.
Last year, the United States spent an estimated $3.8 trillion on healthcare.
That’s trillion, with a T.
It’s expected to grow in all areas, including prescription medications. The rise in spending for medicine, according to the Centers for Medicare and Medicaid Services, is being partially driven by the increase of new drugs being introduced to the market.
Some of those medications include new twists on old, trusted medications called combination drugs.
That’s when manufacturers take two generic drugs, smash them together, and slap a new brand name on the old-yet-new medication, even if the dosing changes don’t make any clinical difference for patients.
The process requires little scrutiny from the Food and Drug Administration because the ingredients have already been shown to be safe and effective, while bringing something — technically — new to the market.
Soon, patients are being prescribed a more expensive branded version of cheap and proven medicines, just newly available in one easy dose.
“It’s really a matter of convenience, but it doesn’t justify the cost,” said Tom Bizzaro, a registered pharmacist and vice president of health policy and industry relations at First Databank, a clearinghouse for drug information, including pricing, for retail pharmacies across the country.
Mostly, he says, drug manufacturers are primarily motivated to combine these drugs in an effort to improve their bottom line.
“I don’t think there’s a question that the reasons for these combinations are to provide an opportunity to generate revenue,” Bizzaro told Healthline.
But most people with public or private insurance rarely even see it. They’re prescribed a drug and then pay whatever copay their prescription drug insurance plan dictates to get their medicine.
The rest goes on behind the scenes, as drugmakers and insurance companies decide what to charge and pay for the newer, expensive drugs.
A recent NBC News investigation highlighted the cost of one combination medication, Zegerid. It’s an acid reflux medication that combines generic Prilosec with baking soda, made by Dr. Reddy’s Laboratories.
Suzanne Luttig in Nebraska found out a 3-month supply cost $14,000, but she only pays $24.
“Because I have health insurance with my employer, I am able to be covered for this medication,” Luttig told NBC News. “I would not be able to get it if I didn’t have insurance.”
The generics — bought separately without insurance but with a coupon — would only run $34 for those same 90 days, NBC reported.
Combination drugs do have some benefits for some patients, as taking one medication is easier than two or more. That’s an important issue for people who have difficulty taking their medication, whether it be swallowing issues to simply remembering to take it.
Dr. Robert Greenfield, a double board certified cardiologist and lipidologist and medical director of noninvasive cardiology and cardiac rehabilitation at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, says combination medications increase adherence and compliance, as there are fewer pills to take or doses to remember.
“Adherence and compliance with medications remains a large problem in healthcare today,” Greenfield told Healthline.
But one important part of adherence issues is the cost of the medication, as people simply can’t take medication if they can’t afford it. That’s the most criticized aspect of combination medications.
Joanna Lewis, a pharmacist based in Jacksonville, Florida, says one such example is common blood pressure medications that are formulated into a branded combination drug.
A person’s copay for the combination may be $45 or $50, while generic versions of the drug will go for $10.
“Over the course of a year, that can be significant,” she said.
And to lower costs, all people have to do is ask.
Lewis says she can tell customers if there are generics available when the prescription calls for a more costly combination drug, and can call the doctor to break up the medication if cost is an issue.
Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California, says combination drugs are used to treat almost everything, including high blood pressure, HIV and other infections, and diabetes.
One example is a form of birth control that combines a form of estrogen and progestin. Another is Vicodin, which combines the opioid hydrocodone with the generic form of Tylenol to manage pain.
“There is likely no difference to your health whether the medications be separate or in the same pill,” Cutler told Healthline. “Usually, taking multiple separate medications will cost less money.”
In essence, combination drugs are like buying a Cadillac when a Honda Accord will get you to the same place you want to be.
And when the government is fitting the bill, taxpayers would prefer to see fewer people driving around in Cadillacs.
Noting that the United States spends more per capita on prescription medications than any other industrialized nation — the vast majority coming from brand-name drugs — researchers at the Brigham and Women’s Hospital in Boston, Massachusetts, and Harvard Medical School wanted to know how much more was spent on combination drugs when “equally safe and effective lower-cost generic drugs” were available.
Using data from the 2016 Medicare Part D drug benefit program, they focused on 29 brand-name combination products to find out the cost difference of their generic constituents.
The researchers found the federal government could have saved $925 million in 2016 alone by sticking with generics.
Over a 5-year period, not using the 10 most costly brand-name combination drugs — which don’t clinically do anything more than the sum of their parts — the researchers say the potential savings could have been $2.1 billion or more.
“As with other medications in the United States, the prices for these combination products are not determined by the magnitude of any incremental clinical benefit or the amount invested in research, development, or clinical trials; rather, initial prices are set by the manufacturer,” the researchers said.
They pointed to one drug in particular that contributes to $189 million in potential cost savings. It’s called
Nuedexta was the only combination drug studied where its active ingredient — quinidine — wasn’t available in a similar or identical dose. It uses 10 milligrams of quinidine, while the smallest generic dose was 200 milligrams.
The researchers noted “it would be impractical to ask patients to split these tablets to achieve this dose,” but that Nuedexta is a “compelling example of the price differential between a recently introduced brand-name combination and its constituent parts.”
Bizzaro and other experts say patients need to ask their doctors whether generic versions of prescription drugs are available, even if it does mean swallowing a few more pills.
That’s what Bizzaro personally does, but he readily admits that not everyone has seen firsthand what combination drugs’ single greatest contribution to the U.S. healthcare market has been: higher costs.
“It’s very difficult for the consumer to see it,” he said.