Saturday, March 7, 2009

New Drugs, Old Drugs and Borrowed Drugs

I usually try to be nice to drug reps, unless they are really obnoxious, condescending, or try to tie me up when I'm obviously really busy. They're just people trying to do a job (one that I would not want). Some of them are nice and even thank me for my time, and jeez, how often does someone do that? I guess I'm just a sucker for anyone who even fakes respect for me.

I got a visit from the Kapidex rep last week. I mean, I felt bad for the guy even having to TRY and sell this stuff. This is the new R-isomer of Prevacid -- another example of the many 'new' drugs which take an existing drug and tweak it a little to make it sound brand new and different.
You take that existing drug and you market the isomer, prodrug or active metabolite and promote it as the next best thing, especially when the original drug is soon to go generic. And the company offers a discount card for $55 off on Kapidex -- so you know if they are knocking $55 OFF it already costs too much. You look at all the glossy literature and you think, this is an especially unfortunate waste of resources in these tough times. I mean, seriously? I can't wait to see the TV commercials.

The other one out there in the TV commercials now is Oracea, a "unique" formulation (ie. lower dose) of doxycyline, another drug that's been around since the Stone Age. They were even running an ad on my TIVO service. I don't see too much hope for a market share for either of these drugs -- insurances will give them the cold shoulder --- but we'll be forced to stock some eventually and then allow it to expire.

Speaking of old drugs, I'm interested to see if the FDA will pull Darvon and Darvocet-N products. I remember being told in pharmacy school that propoxyphene was a pretty mediocre analgesic with more risks than benefits and I've never been real excited to dispense it to anyone. We've already had a customer panicking on this one.....


Anonymous said...

What is your definition of expensive? Omeprazole is not on the $4 drug list at Wal-Mart and Prilosec OTC runs around $30 where I live. Granted, most plans have Omeprazole on Tier 1 of their formulary, but I would say if a company is offering $55 off for a drug that has a WAC price of $110.00 then I would say that would equal the cash price of an Omeprazole prescription with much better efficacy as well. My two cents.

Anonymous said...

I rarely see a copay for generic omeprazole greater than $10. We also have generic Prilosec OTC for about 17.99/mo. These Kapidex savings cards expire after a year and can't be used if you have Medicare Part D, even in the coverage gap. It may be an attractive way to get people to try it, but sooner or later they are stuck with the bill. I know there are always people who swear by only one proton-pump inhibitor, it just seems to me we've got enough of these and the drug co. resources could be directed elsehere.

Anonymous said...

Find it hard to believe 'much better efficacy' (first posted response) of any PPI as the function is pretty standard.

The drug either works or it doesn't as a PPI--I mean, that's why the drug is prescribed (not multiple indications among various agents, nor any other site to inhibit production of digestive juices).

As for WAC and first tier, dinking around with specific insurance programs...what's the cash price, since Prilosec and some of the others are OTC?

I remember from pharmacy school in the late 70's how we'd get our (individual) panties in wads over FDA recognizing a 'new drug' and 'updating package inserts' and 'new indication'. Then, when I graduated and worked in a hospital that filled employee scripts (not on a special insurance--straight hospital drug price cost 'discount'), the physician for one of the retired laundryworker (and, we all know laundryworkers are highly paid in hospitals!) would write 'no substitute' for brand Lasix. It used to burn me up...her schizophrenic son--used to collect pop cans to sell the the aluminum company dutifully picked up her scripts every month. Well, the doc had his day when his daughter was 'retrieved' across straight lines for city office embezzlement on a grand scale.

Hopefully, 'two cents' is a pharmacist and is honest enough to be telling patients 'same diff'.

haidee said...

Question: I am not a pharmacist, but I have Rosacea and was recently prescribed Oracea. My insurance reimburses part of this so @ Target Pharmacy it's 209.88, and I get about 150 back -- what can I get my doctor to prescribe instead? It's a hefty bill monthly for us & times are tough....

Frantic Pharmacist said...

Oracea is a slow-release, low dose form of a tetracycline antibiotic called doxycycline. Doxycycline has been around for a long time and is available as a generic. There is no evidence right now that Oracea is any better. If you have never tried any medication for this condition before, ask your doctor if you can try a low dose of generic doxycycline -- you can break the tablets in half, and you might have to take it twice a day instead of once. There are also topical products to try like Metronidazole cream or gel, or Azelex cream. With your insurance, you may pay less for these. Oracea is an example of an old drug which has been formulated in a new way, and as such is very expensive because the company has a patent on this formula.