Combination Brand Name Drugs Cost Medicare Millions More Than Separate Generic Pills Interview with:

Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital

Dr. Sacks

Chana A. Sacks, MD, MPH
Program On Regulation, Therapeutics, And Law (PORTAL)
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital What is the background for this study? What are the main findings?

Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications.

Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products.

For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen.

The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. What should readers take away from your report?

Response: Our study shows that promoting generic substitution and therapeutic interchange offer important opportunities to achieve substantial savings in the Medicare drug benefit program. As patients, doctors, payors, and economists look to understand why the US spends far more per capita on prescription drugs than other countries, these data are important to consider. We need to optimize generic substitution since all available evidence shows that FDA-approved generic drugs and their brand-name versions are clinically interchangeable. What recommendations do you have for future research as a result of this work?

Response: The theoretical benefit of combination pills is that they improve convenience for patients and therefore may improve adherence. Further research is important to understand the impact of these combination products on clinical outcomes, recognizing that the impact may be different for different patients. For example, if someone is taking 4 pills every morning, adding a 5th may not impact adherence very much, whereas high co-pays that often come with expensive medications are known to reduce adherence.

In addition, in many cases doctors often do not have good information in real time about how much a medication costs, so in some cases, the substantial price difference between the combination pill and the individual pills may not be known. Understanding how to educate prescribers and improve substitution policies are important areas of study. 

Disclosures: I have no relevant financial disclosures.


Sacks CA, Lee CC, Kesselheim AS, Avorn J. Medicare Spending on Brand-name Combination Medications vs Their Generic Constituents. JAMA. 2018;320(7):650–656. doi:10.1001/jama.2018.11439


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