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Medically reviewed by, Russell Braun RPH
Duexis is a brand only drug that was approved by the FDA for use in 2011. The drug is indicated to treat pain and other symptoms of both rheumatoid arthritis and osteoarthritis.
If you take Duexis for Rhematoid arthritis, it might help with the pain, but will not treat the cause of your disease. I will focus mainly on this being used to treat Osteoarthritis.
Osteoarthritis is a condition that affects most people over 60 to some degree. It is estimated that 27 million patients are affected, making the market very large for a pharmaceutical company looking to sell a product to patients in need of pain relief.
Osteoarthritis has typically been treated by pain medications such as ibuprofen, naproxen and aspirin. They work great for pain, but if taken regularly they can cause stomach problems leading to ulcers. Since these meds need to be taken multiple times per day to alleviate the pain, stomach ulcers become a big problem.
#1 There other treatments for Osteoarthritis pain.
The gold standard for treating arthritis which many people overlook is Acetaminophen, also known as Tylenol.
The drug is very effective but must be dosed properly. There are some risks for your liver if you take too much, but a conversation with your doctor or pharmacist about acetaminophen should have you feeling good in short order.
The really good news is that acetaminophen poses no risk of causing stomach ulcers!
However, some patients need more pain relieve than they can get with safe doses of acetaminophen.
Thus pharmaceutical manufacturers rolled up their sleeves and came up with a drugs in the late 90’s that worked on the cyclooxyrgenase 2 enzyme to relieve pain. They were called COX 2’s and you might recognize some of the names:
- Celebrex – Available generically as celecoxib
- Vioxx- Withdrawn from market
- Bextra -Withdrawn from market
These drugs were new and novel therapies. They lessened the risk of stomach ulcers with the new way they worked in the body.
One problem….
Vioxx and Bextra caused heart failure issues and were removed from the market due to the risk of heart failure being greater than the benefit of less stomach ulcer risk.
Now Celebrex is the only COX-2 option available. The really good news is the price has come WAY down since it became generically available. The problem is that the generic is still more costly than ibuprofen, naproxen or aspirin, which are all very cheap generically.
#2 Combinations of NSAIDS and acid blockers are abundant
For years researchers have speculated that taking an acid suppressing drug together with a pain reliever such as ibuprofen, naproxen or aspirin could decrease likelihood of stomach ulcers.
This research was confirmed but before drugs that block stomach acid such as proton pump inhibitors (PPI’s) or histamine blockers (H2’s) were generic this was an expensive proposition.
Fast foward to today when both classes of drugs are cheaper and available over the counter and now it makes sense to use these in combination with pain reliever drugs to prevent the risks of stomach ulcers.
Enter Horizon Pharmaceuticals who created the combination pill Duexis to allow you to have both drug components in one simple pill. This sounds like a winning proposition until you hear the cost difference!
The good news is that you can talk to your doctor or pharmacist about all of the options available to you. It doesn’t have to be limited to the ingredients that are in Duexis.
Non steroidal anti-inflammatory drugs (NSAID’s) like ibuprofen and Histamine blockers like famotidine or Proton pump inhibitors have many options your doctor could prescribe for you with similar efficacy at a fraction of the cost.
#3 What Horizon doesn’t want you to know
The big thing Horizon Pharmaceuticals hopes you don’t find out is the cost of the ingredients. Those ingredients in Duexis are Ibuprofen 800mg and Famotidine 26.6mg.
Right now you are saying to yourself………hang on…….
I have heard of Ibuprofen and Famotidine.
Ibuprofen is sold over the counter in a 200mg dosage under the brand names:
- Motrin
- Advil
- Some others when in combination with other products for cough and cold.
Famotidine is sold over the counter in a 10 & 20mg dosage as well under the brand names:
- Pepcid
- Pepcid AC
- Some others when in combination with a variety of other medications.
Duexis is supposed to be taken 800mg/26.6mg 1 tablet three times per day. For a 30 day supply of the medication which would be 90 tablets the cash cost is about $2466!!!!
Pick yourself back up off the floor and realize that is over $27 per tablet!
Now what will really shock you is the cost of the components. Remember I said that ibuprofen over the counter comes in 200mg tablets.
So, to get the same dosage you need to take four 200mg tablets. The famotidine doesn’t come in 26.6mg (something I will discuss below) but 26.6mg x 3 times per day = 79.8mg or round it to 80mg per day. Therefore you would need four 20mg tablets of famotidine to net the same dose.
Ibuprofen 200mg – 4 tablets x 30 days = 120 tabs Cost = $3.90
Famotidine 20mg – 4 tablets x 30 days= 120 tabs Cost = $6.00
Total cost for the over the counter components, drumroll……….$9.90
Total cost savings is $2456…. and that is for one month!
The annual savings is $29,473!
Do you have to take 8 pills per dose, yes and that is not ideal but for 30 grand per year I think I could make the concession. Also, the tablets are small and easy to swallow, not large horse pills. They do have other options as well like caplets.
#4 Still ask your doctor to substitute
Horizon pharmaceuticals took it a step further in their marketing of their product than most drug companies do.
The package insert is often used by doctors and pharmacists as the source of truth for prescribing information especially when a drug first comes to market. It contains the information that was looked at in clinical studies that lead to the drugs approval.
For Duexis the package insert contains a statement under the dosage that states “do not substitute Duexis with single ingredient products ibuprofen and famotidine”
Why did the FDA allow them to put that statement in the package insert if most clinicians view it to not be true?
Well the comparison that lead to the statement was not apples to apples. They conducted a study that looked at Duexis vs. ibuprofen only. They then noted that the incidence of stomach ulcers was higher in the ibuprofen only group.
To date, no study has been done with both ibuprofen and famotidine to compare them both to Duexis. That is the problem with the FDA approval process that I noted in my book Prescription for Maximum Savings. The FDA approval process looks at safety and efficacy and does not take cost into account when approving drugs for use.
Make sure to confirm with your doctor that they feel you can substitute with ibuprofen and famotidine. If they say no, you might want to ask why not, but of course listen openly to your doctor.
#5 Don’t take the copay coupon offer!
To make patients feel more comfortable with the drug a copay coupon is available for Duexis. In cases when drug prices are very high and treatment options are limited, manufacturer copay coupons step up to help meet the need and help patients afford needed medications.
That is not the case I am describing here. There are numerous other drugs available to treat arthritis that you do not need a mortgage to obtain.
The Duexis coupon offers a savings of $1200 for each prescription of 90 pills for a 30 day supply. Above I told you that the cost for a 30 day supply of Duexis was $2466.
Therefore, if your insurance pays $1266 and you have a coupon for $1200 then the cost to you is $0, sounds great. Right?
Well not exactly here are a few reasons why:
- Your insurance will want a Prior Authorization to be completed before they would approve this drug.
- Many insurers consider it not covered thus even with a Prior Authorization they won’t pay for it.
- If you have Medicare or other government insurance, you can’t use the coupon.
- If your insurance has a copay accumulator program the the coupon will not count toward your deductible. That means when the coupon runs out, and IT WILL RUN OUT. You could be on the hook for the full price of the drug and none of the money paid by the coupon in the past would apply toward your deductible. If you have a high deductible plan, that could mean the next fill costs thousands of dollars.
A Track Record of Expensive Meds
In addition to Duexis, Horizon manufactuers another high cost combination drug Vimovo for arthritis pain. 9 Reasons Arthritis Drug Vimovo Price is Such a High Cost explains how to save money if your doctor recommends that medication.
What else can you do for arthritis?
Healing Arthritis is a great resource to explain other ways besides medication to stop arthritis pain. Doctor Blum explains many different approaches that have data behind them.
Your thoughts?
I am interested in your feedback on Duexis. Do you have anything to spur discussion? My goal is to see patients achieve the most effective treatments at the most reasonable price that ensures safety and efficacy. I would love to hear your thoughts.
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Share your story!
Have you used Duexis? How well did it work for you? Please chime in below with your comments and thoughts below
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