The Curious Case of Duexis

Duexis represents the genius of the pharmaceutical industry in turning lead into gold. A recent article in January 2017 issue of the JAMA Internal Medicine, a respected publication,  pointed out how you may be spending an unnecessary $2000 each month for every member taking this medication.

It’s a combination pill that combines the ingredients in 3 prescription-strength ibuprofen pills (generic Advil) and about 4 over-the-counter famotidine pills (general Pepcid). Purchased individually, the cost for both would be about $16 per month. An enterprising person can actually purchase the same ingredients in different strengths per pill without a prescription for about the same amount.  (For the technically-minded, Duexis is 800mg ibuprofen and 26.6 mg famotidine. A generic ibuprofen is 200 mg and costs about 2¢; a generic famotidine is 20 mg and costs about 8¢.)

The cash price for Duexis at large Tulsa pharmacies is about $2330.00. No, that is not a misprint. The cash price for the prescription is over 144 times the cost of the ingredients separately. When Duexis was first marketed a few years ago, the average wholesale price was about $160. Now the average wholesale price is over $2000. 

The manufacturer encourages usage of the drug by allowing patients to avoid copayments through coupons and other methods. An employer may be paying thousands of dollars each year because an employee can get a drug for free instead of $16 per month.

Why would a pharmacy benefit manager even permit this drug on a formulary? That’s because the PBM may get a rebate from the manufacturer each time the drug is prescribed. Think about this: if your PBM is covering Duexis, you may be paying over $2000 a month you don’t need to and your PBM may be sharing part of that excessive payment while they are “managing” your pharmacy benefits.

There are other ways pharmaceutical manufacturers may circumvent controls that some PBMs put on this medication. The bottom line is the same: the patient may save a few dollars and you waste thousands.

To be fair, Duexis is a combination drug that is intended to assure that people taking a high dose of ibuprofen gets a medicine at the same time that helps protect the stomach and intestinal lining. The vast majority of people can do quite well taking the medications separately.

So does your PBM have Duexis on the formulary?