The team for the project was composed of lawyers, marketers, and scientists, and its focus was a prescription drug known as Prilosec, a heartburn medication that, in one five-year stretch of its extraordinary history, earned AstraZeneca twenty-six billion dollars.
The patent on the drug was due to expire in April of The Shark Fin team drew up a list of fifty options. One idea was to devise a Prilosec 2. Another idea was to combine it with a different heartburn remedy, or to change the formulation, so that it came in a liquid gel or in an extended-release form.
In some cases, removing one of the isomers can reduce side effects or make a drug work a little bit better, and in all cases the Patent Office recognizes something with one isomer as a separate invention from something with two. So AstraZeneca cut Prilosec in half. AstraZeneca then had to prove that the single-isomer version of the drug was better than regular Prilosec. It chose as its target something called erosive esophagitis, a condition in which stomach acid begins to bubble up and harm the lining of the esophagus.
In one study, half the patients took Prilosec, and half took Son of Prilosec. After one month, the two drugs were dead even. The new drug was called Nexium. A patent was filed, the F. To keep cheaper generics at bay, and persuade patients and doctors to think of Nexium as state of the art, AstraZeneca spent half a billion dollars in marketing and advertising in the year following the launch.
It is now one of the half-dozen top-selling drugs in America. In the political uproar over prescription-drug costs, Nexium has become a symbol of everything that is wrong with the pharmaceutical industry. The big drug companies justify the high prices they charge—and the extraordinary profits they enjoy—by arguing that the search for innovative, life-saving medicines is risky and expensive. But Nexium is little more than a repackaged version of an old medicine.
Angell used to be the editor-in-chief of The New England Journal of Medicine , which is among the most powerful positions in American medicine, and in her view drug companies are troubled and corrupt. She thinks that they charge too much, engage in deceptive research, produce inferior products, borrow their best ideas from government-funded scientists, and buy the affections of physicians with trips and gifts. Of course, it is also the case that Nexium is a prescription drug: every person who takes Nexium was given the drug with the approval of a doctor—and doctors are professionals who ought to know that there are many cheaper ways to treat heartburn.
It could have picked up the tab for Nexium only if the patient had first tried generic Tagamet. Or it could have discouraged Nexium use, by requiring anyone who wanted the drug to pay the difference between it and generic omeprazole. Both the physician and the insurance company, meanwhile, could have sent the patient to any drugstore in America, where he or she would have found, next to the Maalox and the Pepcid, a package of over-the-counter Prilosec.
Prilosec is identical to prescription Prilosec and effectively equivalent to prescription Nexium, and it costs only twenty dollars a month. Throughout the current debate over prescription-drug costs—as seniors have gone on drug-buying bus trips to Canada, as state Medicaid programs and employers have become increasingly angry over rising health-care costs, and as John Kerry has made reining in the pharmaceutical industry a central theme of his Presidential campaign—the common assumption has been that the rise of drugs like Nexium is entirely the fault of the pharmaceutical industry.
Is it? If doctors routinely prescribe drugs like Nexium and insurers routinely pay for them, after all, there is surely more than one culprit in the prescription-drug mess. A leukemia drug here was nearly twice as expensive as anywhere else The US pays four times as much as New Zealand for the exact same multiple sclerosis drug For the price of one American bypass surgery, you could buy two new cars.
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An investigation. Sign up for the newsletter Sign up for The Weeds Get our essential policy newsletter delivered Fridays. Thanks for signing up! Check your inbox for a welcome email. Email required. By signing up, you agree to our Privacy Notice and European users agree to the data transfer policy. They do this in part by creating lists of drugs that will or won't be paid for and then use their scale to negotiate lower costs.
But they also get paid by the drugmakers, who want their product on the list of approved drugs. And, because some of their fees are pegged to the drug's price, the PBMs can actually profit from higher prices too. To the pharmacists, these conflicts are made worse by the PBM's secretive contracts. This, Mitchell alleges, is what is going on with Nexium, a drug that has been off-patent for almost two years.
You can't talk to the patients. You can't talk to the payers. You can't talk to anyone. Well, I'll tell you what, I don't care. I'm tired of them scamming Americans," Mitchell told Business Insider. They're driving drug costs. To be clear: The reason pharmacists have an ax to grind with PBMs is that they feel the PBMs are squeezing profits out of every part of the industry — the insurers, the drugmakers, and the pharmacists — while providing little value.
They believe that the slices that the PBMs are taking only inflate the ultimate cost of prescriptions drugs. Sometimes the PBMs even claw back profits from pharmacies. Either way, the pharmacy owners can barely say a word about their relationships with PBMs because of restrictions in their pharmacy provider agreements.
They aren't the only ones concerned about the growing power of PBMs either. PBMs are being sued by some customers for double dealing, and they're now also starting to draw the attention of Congress. Perhaps the biggest threat of all: They're facing a backlash from America's largest employers, a group of which is working on a way to rewire the system.
The reason I'm talking about Nexium is that I take the drug. In , I had an invasive surgery to re-angle my stomach. I was born with it tilted the wrong way, so stomach acid was moving up through my esophagus and over time it wore away the lining to the point that my esophagus collapsed in three places.
For a while the surgery was enough to keep me comfortable, but as I've gotten older I've had to take Nexium every day. I take the over-the-counter Nexium 24HR, which is a 20 mg dose rather than the 40 mg prescription.
Nexium at Wal-Mart. Last year U. The problem, though, is that Nexium is no better at treating heartburn or gastroesophageal reflux disease GERD than cheaper generics or similar drugs available without a prescription, according to a new Consumer Reports Best Buy Drugs report.
More than 15 million Americans suffer from heartburn every day. If you have occasional heartburn and have not been diagnosed with GERD, your first and best bet is to try an inexpensive over-the-counter antacid like Maalox, Mylanta, Rolaids, Tums, or their generic equivalent or drugs like Pepcid AC or Zantac or their generic equivalent known as H2 blockers.
But if you suffer from heartburn twice a week or more for weeks or months on end, you may have GERD, often known as acid reflux. GERD is serious and can inflame or erode the lining of the esophagus. If you find that you need treatment, first ask your doctor for a generic or an over-the-counter drug.
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