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“Talk to Your Doctor” and Save?

By controlling the conversation we have in the doctor’s office, Big Pharma is able to sell us drugs we don’t need at prices we can’t afford.

Prilosec, introduced to consumers as “The Purple Pill,” once drove profit of over $6 billion per year in the United States. When the patent expired, drug maker Astra Zeneca quickly rolled out Nexium, marketing it as “The New Purple Pill” in an effort to preserve market share.

It worked… and according to a new analysis published in the Annals of Internal Medicine, the ploy cost taxpayers billions.

You, your employees, and most medicare and medicaid patients have been programmed to ask for generic drugs. Doctors are usually aware when generics become available and most prescribe them whenever possible. Pharmacies substitute aggressively. Generic Prilosec should have been a no-brainer, yet as the authors of the study note, the switch to Nexium likely cost taxpayers $12.7 billion, even after factoring in rebates of as much as 26%.

So what happened?

The key, of course, is awareness — and for drug makers, controlling the conversation is now a $30 billion industry.


Omeprazole (Prilosec) and esomeprazole (Nexium) are protein pump inhibitors. They are nearly – though not exactly – identical at the molecular level. Both are considered effective in reducing stomach acid. The only demonstrable difference is price.*

A medicare patient would have paid $263 more per fill for the Nexium.

That adds up over the course of a year… during a lifetime of managing a chronic condition like GERD… and unfortunately, one analysis, published in 2014 in The American Journal of Managed Care, concluded that newer drugs like Nexium showed, “no evidence of superior efficacy over the older precursors in the pivotal trials leading to their approval, and in a majority of cases, they were not directly compared.”

In sum, Big Pharma produces a drug that is just different enough to patent, then studies it just enough to win FDA approval. In pharmacological circles, this particular tactic is known as a “chiral switch,” but it’s a good bet that your doctor hasn’t heard the term.

Since you probably don’t have time for a chemistry lesson, let’s call it what it is – a well-conceived, expertly-concealed bait and switch.


Once the “new” drug is approved, the marketing team goes to work.

You’ve seen the television commercials and glossy magazine ads, recommending a conversation with “your own trusted doctor” to see if a new drug really is right for you. Seems innocent enough. But by controlling that conversation – right there in the examining room – Big Pharma is able to sell us drugs we don’t need at prices we can’t afford.

According to a new analysis from the Journal of the American Medical Association, health care companies spend as much as $6 billion annually on direct-to-consumer marketing.

The balance of the marketing budget – as much as $20 billion annually (!) – goes into lobbying doctors, persuading them of the benefits of new drugs like Nexium.

Doctors are busy, their work grounded in science and method, and for the most part you will find that they are wary of silver-bullet remedies. With that said, doctors and other health care providers are people too, susceptible to relentless marketing and the promise of those early, pivotal studies that lead to FDA approval of new purple pills.

As we have said time and time again, prescribing caregivers don’t generally know how much a given drug will cost any one patient. That’s why we believe that in the current market environment, “talk to your doctor” or “tell your doctor,” should be seen as an opportunity for benefits managers and others hoping to get pharmacy costs under control.



It’s not just Nexium, of course, and “chiral switching” is just one arrow in Big Pharma’s quiver.

That same analysis in the Annals of Internal Medicine suggested that medicare and its beneficiaries could have saved an estimated $17.7 billion earlier this decade on generic versions of older medicines instead of paying for newer, chemically similar but more expensive brand-name drugs.

Dr. Joseph Ross, a professor of medicine and public health at Yale University (and one of the researchers) told Stat News that, “The formularies run by the pharmacy benefit managers should be taking into account when brands are so much more expensive and consider therapeutically generic alternatives, unless there is a really good reason to pay for the brand-name drug.”

That is the first step.

Step two involves a recognition that your employees are THE most important partners in any pharmacy cost containment initiative.

Wresting back control of the conversation is all about giving patients and their doctors the tools they need to make cost-conscious decisions that lead to sustainable care.


Sourcing and additional reading:


*Despite earlier studies indicating that Nexium might deliver faster results and, perhaps, better control of GERD (gastroesophageal reflux disease), Alimentary Pharmacology & Therapeutics in 2003 published a meta-analysis of 41 comparative studies of protein pump inhibitors. The authors concluded that any differences in effectiveness could be dose dependent, and not protein pump inhibitor specific. In layman’s terms: by the time it was too late to affect approval, the only thing that studies had proved regarding control of GERD was that Nexium 40mg delivered better results than Prilosec 20mg. Equivalent dosage had not been studied at the time of the analysis. Back to top.


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