Combo pills: Convenience vs. cost

Chicago Tribune (MCT) - Popping so many pills that you sometimes forget to take a medication?

The drug companies think they have the answer: combination pills, which aim to treat several ailments in one medication. Indeed, dozens of combo pills are in the works to combat a range of ailments, from asthma and heart disease to arthritis and severe heartburn, by merging at least two medications into one.

Pfizer Inc's Caduet, a prescription pill that combines the blood pressure pill Norvasc and cholesterol drug Lipitor, may be the most high-profile example of pharmaceutical companies' efforts to drum up new patents.

But buyer beware: Analysts say the all-in-one movement generally comes with a higher price.

"It is actually cheaper for both our (health plan) members and our plans if two generics are taken instead of the combination Caduet," said Dr. Scott Sarran, chief medical officer of Blue Cross Blue Shield of Illinois. Because Caduet is often not on a health plan's preferred list of drugs, pharmacies and health plans say, consumers can save more than $100 a year with a two-pill generic regimen.

In fact, insurers, pharmacies and employers are stepping up efforts to encourage generics because prices are up to 50 percent cheaper for a similar treatment that involves taking multiple pills.

Critics say the fast-growing combo-pill industry is more about resurrecting sales of old drugs by winning new patent protections, particularly as cheaper, generic forms hit the market. In addition, compared to the decade or longer it takes to research and develop a new drug, combo pills can take just a few years because the ingredients are on the market.

North Chicago-based Abbott Laboratories recently launched its combination pill known as Simcor, a pairing of Niaspan, a pill that raises HDL, the so-called good cholesterol, and generic Zocor, a drug in a class known as statins that lower LDL, the bad cholesterol.

Skokie-based Horizon Therapeutics Inc. is working on an experimental pain-relief pill that reduces the risk of stomach ulcers by combining the pain-relief drug ibuprofen with a high dose of famotidine, the active ingredient in the antacid Pepcid.

"The fixed-dose combos are huge in the (pharmaceutical industry's) pipeline," said Mary Lynn Miller, principal and global therapy leader for IMS Health. "You want to reduce the pill burden. Some patients might be taking 15 pills a day, particularly senior citizens."

Advocates say combo pills can help consumers better manage their medications. A study last year by the National Council on Patient Information and Education found half of people, particularly elderly patients, with chronic ailments forget or skip their dosages.

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"If they look at taking a combination of a couple medicines, they look at it as a relief, psychologically," said Dr. Parag Patel, a cardiologist and chairman of Advocate Medical Group in Park Ridge, Ill. "All of the compliance data that's out there to look at shows the fewer pills a patient has, the more likely they are to take them. (The pills) are only as good as what gets in their mouth."

This month, 89-year-old Josephine DiPrima of Des Plaines, Ill., began taking Caduet, happy to be reducing her regimen of medications she pulls from her plastic pill box.

"I set my pills up once a week in each compartment for seven days, so taking the combination will make it easier to keep track of," said DiPrima, who was able to rattle off a half-dozen medications she takes. "I'd rather have combinations if I could."

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WHAT YOU SHOULD KNOW

Q: What are combination pills?

A: Meant to treat several ailments in one product, combination pills merge at least two medications into one.

Q: How do drug companies benefit from combination pills?

A: It offers drugmakers a new patent and, therefore, a new way to make money on brand-name prescriptions that in many cases have cheaper generic equivalents. For example, in the cholesterol market in the U.S., brand-name prescriptions account for nearly $20 billion in annual sales, but cheaper generics are eroding those sales.

It also takes just a few years to research and develop a combination product because its ingredients have been on the market, compared to the originals that took a decade or longer.

Q: What should consumers know?

A: Insurers, pharmacies and employers are stepping up efforts to encourage generics because they can be up to 50 percent cheaper, even if you have to take more than one pill. Talk to your doctor about your options.

SOURCES: Blue Cross Blue Shield of Illinois; Midwest Business Group on Health; IMS Health; and National Council on Patient Information and Education

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© 2008, Chicago Tribune.