An Irish-domiciled pharmaceutical company has put a price tag of almost $3,000 (€2,400) on a bottle of two-in-one painkillers that can be bought separately for $36, in another instance of price gouging in the United States, the world’s largest healthcare market.

Horizon Pharma has continually raised the price of Vimovo, a common painkiller combined with a drug that prevents stomach irritation, since it acquired the US rights to the medicine in November 2013 from AstraZeneca.

The Dublin-based company raised the average wholesale price again earlier this month by 9.9 per cent, according to data reported by the Financial Times, taking the cost of a bottle of 60 pills to $2,979.

When AstraZeneca was selling the drug in the US, the price was $138 per bottle. But since Horizon has owned the rights, it has raised the price on 11 occasions by an aggregate of more than 2,000 per cent.

Soaring drug costs have been at the forefront of public debate in the US ever since biotech entrepreneur Martin Shkreli raised the price of a cancer and Aids medicine by 5,000 per cent.

US president Donald Trump addressed the issue in his State of the Union address last month, saying the administration would “make fixing the injustice of high drug prices one of our top priorities” and pledging “prices will come down”.

Vimovo is a mixture of two medicines: naproxen, an anti-inflammatory that treats pain but can also cause gastrointestinal problems such as ulcers and bleeding; and esomeprazole, a medicine known as a proton-pump inhibitor, which lessens the risk of stomach problems.

If purchased individually, the drugs can cost as little as $36 and both are available in over-the-counter forms: naproxen is sold under the brand name Aleve, made by Bayer, while AstraZeneca sells esomeprazole as Nexium.

Painful experience

“Companies often try to come up with equations where one plus one equals three. In this case, it appears one plus one ends up costing 83 times more,” said Michael Rea, chief executive of Rx Savings, which makes software to help patients reduce their drug bills.

He added: “It’s a painful experience for unsuspecting patients and insurers.”

Horizon also markets another two-in-one painkiller, Duexis, which is a mixture of ibuprofen, an anti-inflammatory drug, and famotidine, an antacid. A bottle of 90 tablets is priced at $2,979, while buying the pills separately can cost as little as $15.

The company generated $134 million in sales from both products in the first nine months of last year.

“Based on the mechanism of action of these drugs, I see no reason why these products can’t be taken individually,” said Mr Rea.

Express Scripts, a pharmacy benefits manager that negotiates with drugmakers on behalf of its employer and health insurer clients, said it included Vimovo and Duexis on the list of medicines it will reimburse but that they did not have “preferred” status.

To discourage people from picking more expensive “non-preferred” medicines, Express Scripts clients can ask patients to pay out of their own pocket.

But like other pharma groups Horizon tries to counter this by offering patients a savings card that can reduce their personal outlay to zero while continuing to bill the insurer for their full share.

Express Scripts said: “The constituent parts of these medications are available separately as generics for much less.”

It added that some of the PBM’s clients require patients try the individual drugs first before they will reimburse Horizon’s two-in-one medicines.

Step therapy

Horizon said this practice, known as “step therapy”, was in “direct conflict” with prescribing information from the US Food and Drug Administration, which says patients should not substitute the combination pills for individual tablets.

A company spokesman added: “There are no FDA-approved generic, over-the-counter or clinically equivalent medicines to Duexis and Vimovo, and any assertion otherwise is completely inaccurate.”

He also said Horizon operated patient assistance programmes that meant the majority of people pay less than $10 out of their own pocket.

However, patients still end up paying more for expensive drugs such as Vimovo and Duexis in the form of higher insurance premiums. – Copyright The Financial Times Limited 2018