Sunday, April 25, 2021
Alex Papp MD
Millions of lives have been saved by the products of pharmaceutical companies, but let’s face it, they are not primarily in the business of saving lives. They are in the business of making money. As long as we remain able to live our lives and maybe have a little fun doing it, we seem to accept that part of the price of our well-being is the yacht of the Pharma Company CEO.
Every time a new medication comes on the market, it is priced high. To a degree it is understandable – it takes hundreds of millions of dollars to develop a new drug and the company not only needs to recoup the cost, it also needs funds to be able to start working on a new drug – or else some other company will. When eventually the patent runs out, yesterday’s expensive brand medication becomes today’s cheap generic drug.
But don’t feel sorry for the pharmaceutical companies, they have a few tricks up their sleeves, with which they can squeeze a few more cents out of a drug that is about to stop being a cash cow.
The following is an incomplete list of these tricks, called “evergreening”, that these companies utilize in order to get some additional patent from a molecule that had it patent already expired.
Silenor. Silenor is simply Doxepin at an unusually low dose. Doxepin is an old antidepressant that can be used for sleep in low doses. The lowest dose in the original patent, long expired, was 10 mg. This company simply patented 3 and 6 mg Doxepin as “new” medication. It costs over $400 per a month’s worth of 6 mg tablets, while a month’s supply, using 10 mg Doxepin pills cut in half to make 5 mg, costs $9.
Symbyax. Symbyax is the combination of Fluoxetine (generic Prozac) and Olanzapine (generic Zyprexa), in doses the individual drugs do not come in. Prozac/fluoxetine is marketed in 10, 20 and 40 mg capsules, Zyprexa/olanzapine in 2.5, 5, 7.5, 10, 15 and 20 mg. Symbyax combines 3, 6 and 12 mg Olanzapine with 25 or 50 mg Fluoxetine. If you think that the drug company decided upon these dosages in order to discourage combining generics, you are right. Symbyax is itself generic now, but even as generic, it costs 10 times more than if you buy, let’s say, 7.5 mg Olanzapine and 20 mg Fluoxetine and take them together. That combination would work just as well as a 6/25 mg single Symbyax capsule.
Pristiq, Invega. These two medications are the active metabolites of Effexor and Risperdal, respectively. A metabolite is a molecule the body changes the drug into, during the course of its breakdown and elimination. An active metabolite is a breakdown product that retains the activity of the original drug. The advantage of active metabolites is that they don’t have to be invented, the body creates them for the benefit of the drug companies, they just have to declare it to be a new molecule, run a few more studies, and get a new patent. Truth to be told, sometimes there is some minor advantage to the active metabolite over the original drug, but isn’t it surprising that they appear just when the patent for the original drug expired?
When you get prescribed a new and expensive branded medication, think about asking your doctor, how it is different from a cheap generic. It may save you much needed money – the CEO can wait a few more weeks for his or her new toy.
