Medications that increase health care costs without improving care are silly, and doctors love to hate ‘em. “PharManure” is the brilliant term used to describe these medications. Here is a list my colleagues and I love to hate:
1. Intravenous acetaminophen (Ofermiv). This intravenous Tylenol (acetaminophen) was just approved. Acetaminophen is already available as a suppository in the event you can’t swallow a pill. Acetaminophen through the IV is really expensive . . . and silly.
2. The new spray form of the sleep medication zolpidem (the generic for Ambien) is Zolpimist and it’s expensive and silly. They have also come out with a dissolvable zolpidem tablet called Intermezzo which is also silly.
3. Brand name minocycline (Dynacin or Minocin). Minocycline has been around forever as a generic yet drug companies are now making brand name minocycline variations for the treatment of acne. Don’t get tricked in to paying for them.
4. New combinations of older drugs: examples are ibuprofen/famotidine (Duexis) and naproxen/esomeprazole (Vimovo). So these are anti-inflammatories mixed with generic stomach medications in to a new pill. They are so cheap on their own it makes no sense to pay for the combo.
5. Irritable bowel syndrome (IBS) medications that cost hundreds of dollars a month and don’t tend to do any better than placebo for symptoms. Amitiza is the latest example for IBS where very few patients respond to it and it’s pricey. Studies show most IBS drugs don’t work much better than placebo for IBS symptoms.
6. It’s a love-hate relationship for doctors with the erectile dysfunction meds but there is new reason for pure love. The hate comes from how expensive they are for our patients. The bright spot here is there a new indication for tadalafil (Cialis). Cialis is now FDA-approved to treat benign prostate hyperplasia (BPH). This new indication may ease the pre-authorization process for the drug so you can actually get it covered.
7. Petadolex: While I am a believer in butterbur supplements for migraine prevention this prescription form is too expensive for something available over the counter.
8. Ella (ulipristal acetate) is uber expensive at 44 dollars a pill. Ella is used as an emergency contraceptive where you have other cheaper options like Plan B. What is promising, though I can’t even imagine the cost, is that Ella will soon be tested and marketed as Esmya to control bleeding in women with fibroids.
For an example in the potential difference in cost: generic minocycline will likely be covered by most insurance plans as a Tier 1 medication, meaning you’ll pay only your lowest copay, and can cost as little as around $75 for thirty tablets. Dynacin, in contrast, is considered Tier 3 by most plans, meaning you’ll pay your highest copay, and can cost upwards of $400 for the same thirty tablets.