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Medically reviewed by, Russell Braun RPH
Vimovo is a prescription only medication that contains two active ingredients. One is naproxen also sold under the brand names Aleve or Anaprox. The other is esomeprazole, also know by the brand name Nexium. Unlike Vimovo both components can be obtained via prescription or over the counter.
The primary uses for Vimovo is osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.
Vimovo is available in two strengths either 375mg naproxen + 20mg esomeprazole or 500mg naproxen + 20mg esomeprazole.
Why combine the two drugs in one pill?
The naproxen component is in a class of drug called NSAID’s (nonsteriodal anti-inflammatory drug). NSAID’s are one of the most common drugs used to treat pain that comes from inflammation, which is what is normally seen in a patient with arthritis.
The problem with NSAID drugs is, if used for long periods they can lead to stomach problems. In particular stomach ulcers that can lead to stomach bleeding.
Which is why taking a drug that can help to prevent stomach bleeding with the naproxen can be beneficial. That is where the esomeprazole comes in.
Esomeprazole is called a PPI (proton pump inhibitor), which is a class of drugs that suppress the output of acid by the stomach. The less acid that is produced the less likely that the naproxen will damage the stomach and cause an ulcer that leads to bleeding.
Your doctor may call this a gastroprotective effect
It has been widely studied and is reported that nearly 15% of patients treated long term with NSAIDS are at risk of a stomach bleed. Certain patients are at higher risk than others based on medications they take or other disease states they have.
Most patients will not realize they have a stomach ulcer until it has progressed. They can become very serious.
Easier to take the combination Pill?
One reason for the high cost of Vimovo is the manufacturer has taken two pills and made it into one easy to take option. So yes, it is easier to take until you look at the bill. According to GoodRx, Vimovo costs $2466 for a one month supply!
Reasons the High Cost is Not Worth the Price
#1 Two Drugs Separately are so Much Cheaper.
The cost of the two ingredients (naproxen and esomeprazole) separately are very low, see the table below. All examples are for one tablet to be taken twice a day, the same way Vimovo is prescribed. This comes out to 60 tables for a thirty day supply of the medication.
Cost of Vimovo
| Strength | Quantity | Cost |
|---|---|---|
| 375mg/20mg | 60 | $2,466 |
| 500mg/20mg | 60 | $2,466 |
Cost of Vimovo components
You can’t buy 375mg or 500mg Naproxen over the counter. Instead you can use two or three of the 220mg strength.
| Strength | Quantity | Cost |
|---|---|---|
| Naproxen 220mg | 120 | $4.08 |
| Esomeprazole 20mg | 60 | $20.85 |
| Total | $24.93 |
Cost of commonest of Vimovo 500mg/20mg
| Strength | Quantity | Cost |
|---|---|---|
| Naproxen 220mg | 180 | $6.12 |
| Esomeprazole 20mg | 60 | $20.85 |
| Total | $26.97 |
As you can see the cost difference is significant at $2441 per MONTH! If you paid cash for Vimovo you would spend $29,172 per year over the cost of the individual drugs. If you are not using insurance you will most certainly be looking for an alternative to such high prices.
Prices sources: GoodRx & Amazon.com
#2 The Pharmacist Can’t Switch You to Generic
Vimovo is a brand name drug and is currently still protected by a patent. That means generic drug makers can’t make a generic version of Vimovo until the patent expires. That is supposed to occur in 2022, but those dates are subject to change.
In the meantime if your doctor prescribes you Vimovo, what can you do? Are the over the counter drugs that make up Vimovo the same as getting a generic?
Technically no they are not, but your pharmacist might tell you that is an option. However, they can’t just automatically switch you to generic like they do for other drugs that have a generic version available.
If the pharmacist tells you to take the two drugs you can buy over the counter then you will be paying out of pocket for them. The insurance is likely not going to pay any of the near $34 price.
The manufacturer of Vimovo has come out and stated that taking the two drugs over the counter is not appropriate. Saying they are not clinically equivalent. You should ask your doctor about this and let them know the cost difference. They will likely tell you switching seems appropriate to them.
#3 Your Insurance May Have Made a Deal
If Vimovo is on your formulary for your insurance you should be weary. Insurers will categorize drugs as:
- On formulary preferred (Best price for you)
- On formulary non-preferred (Middle price for you)
- Non formulary (Worst price for you)
On formulary preferred means the drug is the one they want you to use. I don’t think any major insurer also known as a pharmacy benefits manager (PBM) will have Vimovo as on formulary preferred due to such a high cost.
On formulary non preferred means they drug can be filled and insurance will pay, but it is not the best option. With such a high cost, why would the insurer just make it non formulary?
Drug manufacturers and PBM’s work together to negotiate prices and formulary status. When a PBM puts a drug on formulary, it means the drug has the potential for a lot more use than if it is non formualry. The drug manufacturer will give the PBM a rebate on the price of the drug to get it listed on the formulary.
That rebate is often not past on to your insurer or rarely ever to you.
This is when your PBM made a deal!
This is what you need to understand that you might have to pay a high copay of $50, $75, $100 or more to get a drug that is on formulary but not preferred. If that is the case, it would be a better option for you to pay cash and buy the separate drugs over the counter.
Other PBM’s will make the drug non formulary. Meaning they will not pay for it and they don’t think it is the best option for you to use. In this case the PBM is actually acting on your behalf and has your best interest in mind if they list Vimovo as non formulary.
#4 Doesn’t Work as Good as They Make it Sound
The manufacturer of Vimovo, Horizon pharmaceuticals gained FDA approval for the drug to treat arthritis pain and have a lower occurence of stomach problems.
They claim that the risk of developing ulcers is 70% lower with Vimovo. What you have to keep in mind is how the study they did came to this conclusion.
Vimovo was compared to Naproxen by itself. They never studied Vimovo against Naproxen and Esomeprazole separately. Thus the huge increase in price over regular Naproxen is being justified by a 70% lower risk of stomach ulcers.
If they did a study with Vimovo in one group and Naproxen plus Esomeprazole in the other group would they find a 70% lower risk? My feeling is they would not and it would not justify the huge price they ask for Vimovo. You should talk to your doctor and see if they were aware that Vimovo was never compared to both drugs in any studies.
#5 Too high a dose of Esomeprazole?
AstraZeneca the manufacturer of Nexium (Esomeprazole) have also studied Esomeprazole for prevention of NSAID induced stomach ulcers.
Based on these studies they created their package insert. The package insert is the document the FDA requires a manufacturer to put together about their drug when it is approved for use.
AstraZeneca found that the 20mg and 40mg per day dose of Esomeprazole had the same benefits in preventing NSAID induced stomach ulcers.
That means if you take 40mg per day you don’t get any additional benefits.
However, you do open yourself up for higher risk of side effects from any drug you take, if you take it in a higher dose. If you take Vimovo, you dont have the option of taking only 20mg per day of Esomeprazole. Each tablet contains 20mg, and you take it twice a day, so you are always taking 40mg.
If you were to buy the individual drugs yourself you could take 20mg of Esomeprazole in the morning and only naproxen with the second daily dose. Thus eliminating the risk of more side effects and saving yourself even more money because now you would need only 30 Esomeprazole capsules per month instead of 60.
#6 Long Term Acid Blockers May Have Risks
Proton pump inhibitor (PPI) drugs like Esomeprazole the PPI in Vimovo are not FDA indicated for long term treatment. In fact they are only recommended for a short treatments when being used for ulcer prevention with NSAID’s like naproxen.
The dose for Nexium taken directly from the package insert of reads:
- Prevention of NSAID-induced stomach ulcers: 20mg to 40mg once daily for up to 6 months
The 6 month period is very often forgotten by doctors and patients stay on these drugs for years. Long term suppression of stomach acid can lead to some adverse effects that may outweigh the benefits.
For more in depth information on long term PPI use, I encourage you to read an analysis by the National Library of Medicine called Advantages and Disadvantages of Long-term Proton Pump Inhibitor use.
Certain patients should always use a PPI, such as Barretts esophagitis or other severe types of esophagitis. You should discuss this with your doctor to see if you have a condition that would require you to use PPI’s long term.
#7 Patient Assistance Program Worth it?
I always recommend that patients check into patient assistance programs (PAPs) when they are available. PAPs offer free or discounted prices on medication to patients who meet certain eligibility criteria.
- U.S. resident
- 400-500% of the federal poverty level (FPL)
Horizon the manufacturer of Vimovo does have a patient assistance program in place through their program HorizonCares. You must have health insurance and the insurer must cover the medication to receive assistance. A few other eligibility requirements include:
If you are eligible you may qualify for a $0 copay. Your doctor will have to fill out paperwork on your behalf to qualify. Additionally you will have to show various documentation to be eligible.
If you do get approved keep in mind that funding for this PAP could run out at any time leaving you stuck with the high costs mentioned above.
If you are still interested click here to review this PAP.
#8 Copay Coupon Really a Good Deal?
If you have commercial insurance and you don’t qualify for patient assistance a copay coupon is your next option. However, if you have Medicare, Medicaid or any other government insurance you will NOT be eligible for the copay coupon.
The majority of arthritis sufferers are on Medicare, so that makes a high number of patients ineligible for the copay coupon.
The Vimovo website states that patients pay $10 or less out of pocket with this coupon card. While that sounds great you have to keep in mind copay coupons do not last forever. The program states it can be used 12 times in 12 months.
What do you do after that?
Will you be able to get that same great deal after using the drug for a year?
Will you have to change your medication if they will no longer provide the coupon? You must be careful, one fill by your pharmacy without this coupon could cost you up to $2466 in one month!
#9 If You Don’t Pay the $2466, Your Insurance Is
Since Horizon offers the copay coupon, some patients will only pay a fraction of the cost. The website states $10 per month, but who pays the rest?
When the copay coupon is used, it is a form of secondary insurance. The drug manufacturer is still getting paid by your insurance for the majority of the cost of the drug. Though the insurance may get a rebate, they will still pay a large portion of this cost.
Imagine if every member who used your insurance took this drug for arthritis over the much more cost effective options? Guess what would happen to your premiums for your health insurance the next year?
They would skyrocket!
With many patients being in a small group insurance plan offered through a small, medium or even large company they overall spend from the year before ends up causing the premiums for the next year to rise or fall.
Don’t be of the mindset that you don’t care what the insurance pays because you only pay $10 out of pocket per month. That might come back to bite you when the next open enrollment comes around.
A Track Record of Expensive Meds
In addition to Vimovo, Horizon manufactuers another high cost combination drug Duexis for arthritis pain. 5 Tips to Avoid High Duexis 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.
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
We want to hear from you!
Have you used Vimovo? How well did it work for you? Please chime in below with your comments and thoughts below
Related Posts:
- 5 Tips to Avoid High Duexis Cost
- 15 Important Things to Know About Patient Assistance Programs
- 7 Easy Ways How to Save Money on Drugs
- 5 Proven Methods to Get Cheap Rx Drugs With Health Insurance
It has actually caused me severe stomach bloating with extreme gas and pain.
I am sorry to hear that. If taken on an empty stomach, many NSAID medications can cause stomach upset. Did you try eating a small snack prior to use?
The Vimovo directions tell you to take 30 minutes before you eat, so you are supposed to take it on an empty stomach! If I take it once a day, it seems to help, but twice a day causes terrible bloating and diarrhea!
Sorry to hear about the issues with taking this twice a day. The reason Vimovo recommends to take 30 minutes prior to eating is to give the esomeprazole (Nexium) component, which is the acid reducer to get a head start to help with the heartburn symptoms. It is just fine to take this with your food. Hope you are seeing relief from your arthritis pain.