“Me-too” drugs fuel rising costs
This isn’t surprising at all, as someone who works in the field, but these so-called “me-too” drugs which are reportedly better than their forebears is driving costs.
A “me-too” drug is a drug that has its origins in another drug. Probably the most famous example of this is Prilosec (”The Purple Pill”) and Nexium (”Today’s Purple Pill”). Prilosec’s active ingredient is omeprazole. Nexium’s active ingredient is called esomeprazole.
What’s the difference? Well, Nexium is the left-handed version of omeprazole. In chemistry, S stands for sinister, which means the molecular conformation has a left-handed orientation. (D would be right handed.) So this S-omeprazole is one half of the mixture that comprises it’s predecessor. By specifically picking only the S conformation, the drug is made more potent. This sounds great, but its efficacy is only marginally better than Prilosec — which has a generic version, and costs about a third less than Nexium.
Is this slight increase in efficacy worth 1/3 more? Well, AstraZeneca’s own research suggests that they are not. Nexium was created because AZ’s patent on Prilosec was finally running out, and they wanted to continue to making money from one of their flagship drugs so they released a new version that costs more and performed only partially better. This is the classic definition of a “me-too” drug. Often the research is sort of doctored to make the new drug seem much better than the old. In the case of Nexium, the literature put out by AstraZeneca compared 20mg of Prilosec to 40mg of Nexium. Of course Nexium performed better.
I spoke with an acquaintence who happened to be a drug rep for AstraZeneca, and one of his drugs had been Nexium. He told me that AstraZeneca had compared 40mg of Nexium to Prilosec, and the difference was so negligible that they simply suppressed it, and opted to publish the lobsided 20mg-40mg comparison. He also admitted that Nexium was only released because the patent on Prilosec was expiring.
Some other “me-too” drugs come readily to mind:
- Claritin (loratidine) and Clarinex (desloratidine)
- Celexa (citalopram) and Lexapro (escitalopram)
- Nexium (esomeprazole) and Prilosec (omeprazole)
Generally, these me-too drugs are released as a means to beat patent expiry, as I explained above. In the case of Claritin, not only was the patent expiring, but it went over-the-counter. Almost no insurance companies will pay for Clarinex because it’s so similar and doesn’t demonstrably work better.
Some of these “me-too” drugs are better in most cases without doctoring research findings. Lexapro, for instance, is more potent because only the S enantiomer has any effect in the body, so Forrest opted to remove the D component entirely — citalopram vs. escitalopram. The result is a drug with a lesser side effect profile, and a greater success rate. Nonetheless, it is also a “me-too” drug, and is more expensive than Celexa (for which a generic is now available).
Given everything I’ve said above, it should come as no surprise that these more expensive “me-too” drugs cost the medical industry money. Coupled with an effective marketing campaign — drug reps and direct-to-consumer advertising — patients clamor for the newer drugs, and doctors write for them. If I were a big pharmaceutical company, I’d probably do exactly what AstraZeneca and others have done, simply because it’s good for the bottom line, despite the fact that it contributes to the rising cost of health care in the United States.
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I’m very capitalistic about stuff like the pharm industry, so unfortunately I don’t have a huge problem with “me too” drugs. I honestly have no idea why Nexium is so popular when Prilosec is OTC and cheaper, and then people complain about how expensive Nexium is. Not that Prilosec is that cheap, but it’s cheaper at least. Is it truly misinformation by the public that they don’t know that the drug is pretty much the same? Are some possible marginal benefits of PPIs like Protonix and Prevacid worth the cost?
I understand why drugs like Claritin, Zyrtec, and Allegra became popular, but I don’t know why many people don’t at least try some classic and cheaper antihistamines like Benadryl or Chlortrimeton first instead of jumping straight to more costly drugs that may have fewer side effects, but whose overall effectiveness is really no better.
Comment by Yaz — September 4, 2005 @ 2:19 pm
Well, a couple of things…
1.) Nexium’s popular just because of the incredible marketing campaign surrounding it. But like I said, mg for mg, it’s not much better than Prilosec.
2.) Prilosec OTC isn’t the same as Prilosec. They’re both omeprazole, but the salt is different. OTC is omeprazole magnesium, whereas the prescription stuff is omprazole sodium. OTC is supposed to be for short-term use only. There was some discussion about whether OTC could be unhealthy used long-term, but I believe that it was decided that it probably wasn’t. Anyway, for patients on Prilosec long-term, it’s generally cheaper to have a prescription for it.
3.) I believe that Protonix is generally considered the “best” PPI for most people. And it’s a little bit cheaper than Nexium, IIRC, but still not as cheap as generic omeprazole. FWIW, generic omeprazole is not available in 40mg capsules (yet), and insurances generally won’t cover bid or 2qd dosing, which is extremely irritating and frustrating because it’d be cheaper than going brand Prilosec 40mg or Nexium.
4.) Patients are very misinformed, yes. Or rather, they’re victims of marketing. Most docs know that Nexium and Prilosec are basically the same, but they don’t usually know about the 40mg omeprazole vs 40mg esomeprazole study that showed that they were just about the same.
Antihistamines are just as tricky as the PPI stuff because of the drowsiness that most first generation drugs cause. This includes diphenhydramine (benadryl) and chlorpheneramine (chlortrimeton). Generally, Benadryl is the most effective antihistamine for everything from potentially-fatal allergic reactions to seasonal allergies, but it’s also the primary ingredient in every single OTC sleep aid, which might give you some idea as to why it’s not generally used unless absolutely necessary.
Second generations antihistamines like Claritin and Allegra don’t penetrate the blood-brain barrier so they don’t cause fatigue as a side effect nearly as often. The problem is that they generally aren’t as good as Benadryl, but the trade-off is usually worth it.
Zyrtec is interesting because it’s related to Atarax (hydroxyzine), which is a first generation antihistamine. Zyrtec causes drowsiness more than Allegra and Claritin, but much less than Benadryl. Zyrtec seems to work the best for most people, (second only to benadryl) but it’s also the drug that most insurance companies seem the least enthusiastic about paying for. (I cannot remember if it’s more expensive than something like Allegra 180 dosed bid.)
Comment by Rian — September 4, 2005 @ 9:39 pm
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The FDA approves drugs only after the drug companies proove moderate and widely unknown safety results which really take another 15 years to find out they are truly safe. Additionally, they allow the drug companies to produce these fake “me too” drugs in order to trick consumers and get the insurance companies to pay the big bucks out. The FDA and the DEA are joke acting as if they are protecting consumers when they are really protecting the system. The system is composed of doctors who need to be patronized in order to be paid. They are then the only ones who can prescribe these poisons to everyone and the drug companies and pharmacies reep the benefits paid by the insurance companies. BIG SCAM. In reality, 90% of physicians are idiots and a ton of these guys became doctors at the Univ of Bagdad and were passed through as MDs here since we had a shortage. They are licensed drug dealers doing nothing but prescribing what there payoff buddies from the drug companies tell them too. Meanwhile, the DEA watches out for everyone’s interest while they too are involved in offshore drug deals to pay for rebel forces and spying all over the world. The consumer snd employers get screwed by this whole process. Granted, some medications are wonderful and quite useful but most are not. God provided us with herbs to fix almost every ailment but there is no money in researching natural and safer medications. Instead, we gotta send the DEA in after the people smoking and growing weed for cancer. The real threat is that these people arent paying their money into the system for unnatural chemical poisons that the governement would rather have them using. Its amazing how cynical I am and I’m not even a pot smoker. I just see the crap through the smoke screen of the USA. God bless freedom and government by the people!!!
Comment by Jeff — October 11, 2005 @ 1:39 pm
[...] The article goes on to talk about Levitra and Cialis: me-too drugs in their own right without a doubt. It should be noted that the drug that these meds are modelled after was an accidental find — sildenafil citrate, the active ingredient in Viagra, was originally developed for pulmonary arterial hypertension (PAH), not erectile dysfunction. It just so happened that just about every male suffered from prolonged erections not related to sexual excitement during drug trials, so the emphasis was shifted to ED because the severity of such a side effect would render it unmarketable. And it certainly has been a success in this regard. [...]
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Comment by Ray Guest — March 14, 2008 @ 8:59 pm
I have just been informed by my Health Care Company-Harvard Pilgrim that they are switching me from Nexium to Omeprazole.
I suffered for 20 years with stomach problems & even had to take a medical leave of absence because of mu uncontrolled diarrhea problems-supposedly IBS. Finally after a colonoscopy & endoscopy, a doctor prescribed nexium. I had tried every other PPI available with no success. Nexium has been a miracle drug for me; I can now function without the worry of stomach pain and uncontrollable bouts of diarrhea.
Why are “healthcare” providers making decsions for our doctors?
Comment by Linda Coffey — March 7, 2009 @ 4:08 pm
As a pharmacist, I just want you to know that these drugs are not “me-too’s”. Prilosec was the 1st in the PPI class. Prilosec, Aciphex and Protonix are all me toos…they are PPI’s with slightly different chemical structures. Prilosec and Nexium are the same drug…simply different stereoisomers. All the other info you present is absolutely correct…the only reason they do it is to hold on to a patent. Oh, except the price difference…today a Nexium 40mg is approximately $5 and the generic Prilosec 20mg is less than 10 cents (take 2 to equal 20 cents). You can do the math. Great article. Bob
Comment by Bob Hall — March 16, 2009 @ 7:44 pm
Linda’s comment exemplifies one of the critical problems with the insurance industry. They do make decisions that should be left to doctors and their patients. My doctor once wrote a prescription for me for a generic allergy medication. Since their was an OTC option, the insurance would not cover it. Further, the OTC option was more than double what the generic cost would have been for the prescription option that my doctor preferred. These cost saving measures on behalf of the insurance industry become problematic when patients may not tolerate certain medications. This is clearly the case for both cholesterol lowering drugs as well as anti-depressants. For example, my insurance company has increased the cost of Lipitor because there are generic alternatives. However not everyone can tolerate these alternatives. So long as the insurance industry is profit driven, Americans will always receive inadequate coverage.
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