27 December 2012

Money and medicine: the Nexium swindle

If you live in the United States, you have almost certainly encountered advertisements for Nexium (esomeprazole), a prescription medication for heartburn relief. Its ad slogan is "the purple pill." (If you live in any other developed country, your government will have forbidden advertising a prescription medication over the television.)

Nexium is a drug that shouldn't exist. It contains the exact same active ingredient*, in the exact same amount, as an older drug, Prilosec. Prilosec (omeprazole) is currently available over-the-counter as a relatively inexpensive generic drug. But Nexium is currently the third-highest-selling prescription medication in the U.S., with sales of over $6 billion a year.

How could this have happened?

The abbreviated version of the story is that years ago, AstraZeneca, which originally manufactured Prilosec, recognized that it would lose billions of dollars in sales once Prilosec lost its patent protection. And so, it developed Nexium and set in motion an enormous advertising campaign. It gave incentives to doctors and patients who switched their prescriptions from Prilosec to Nexium. The plan worked beautifully. This "Nexium swindle" is just one of many unethical but legal practices in the pharmaceutical industry that each year net tens of billions (possibly hundreds of billions) of extra revenue.

Many issues in health care (doctor shortages, expensive health insurance, steep medical school tuition, difficulty in getting a primary care physician, burnout amongst medical providers) really could be solved with more money. And yet Congress, under pressure from the pharmaceutical lobby, has mandated that Medicare pay full price for prescription medications. Congress also forbade Medicare from keeping a formulary of preferred drugs. It amounts to a massive ongoing handout to the pharmaceutical industry.

We ought to stop paying for useless drugs like Nexium, which have excellent and dramatically less expensive alternatives. If every patient on Nexium were switched to Prilosec (which is virtually the same drug), there would be enough money to pay for every current medical student's tuition, with billions of dollars to spare. And that's just one drug of many.

America is being scammed, and very few people realize it.
 *The key difference between the two drugs is that omeprazole contains an inactive ingredient that is absent in esomeprazole. For those who know a bit of organic chemistry, omeprazole contains a racemic mixture while esomeprazole has only the active enantiomer. Unsurprisingly, the manufacturer has had a difficult time showing any difference in effectiveness between drugs.