Would you suggest a different drug brand to a patient?

[MunoRN]

A debate came up at work regarding Vimovo and other pills that combine two generics, the combination is considered a new drug and given exclusivity. Vimovo is naproxen and esomeprazole in one pill (Aleve and Nexium), a month's supply of generic naproxen and exomeprazole in separate pills costs about $40, a month's supply of Vimovo ranges from $2,300 to $3,000.

Even though the active ingredient is the same, not all formulations have the same effect, some patients absorb warfarin more predictably with some formulations than with others, so there are times where using the brand name formulation makes a difference. The justification for Vimovo and other generic combination pills is only that it's easier to take one pill instead of two.

The debate that came up was if you were doing a med rec for instance, and a patient told you they take this drug, would you use the opportunity to point out that the same medications are available separately at 1/60th the price? Would you suggest they ask their doctor why they need the two medications in one pill instead of two? Or would you just stay out of it and not mention it at all?

[catsmeow1972, BSN, RN]

At my facility, Pharmacy routinely reviews home med lists and the doc has to check off each home med that they want to continue while in the hospital. Frequently ALL are held except for things like BP meds, and even those until pt is out of surgery. When it comes to things like Pepcid vs Zantac, we have protocols where they are interchangeable unless the doc says otherwise. i've seen where Zestoretic is split into the 2 separate drugs routinely, probably due to cost.

I once had a neurologist prescribe Horizant, which is nothing but extended release gabapentin. it was incredibly expensive and my insurance denied it. They happily paid for the regular kind. So i take 2 pills a day, whoopee. I take other stuff twice a day too.

Welcome to healthcare run by pharmaceutical companies.

[hppygr8ful, ASN, RN, EMT-I]

A debate came up at work regarding Vimovo and other pills that combine two generics, the combination is considered a new drug and given exclusivity. Vimovo is naproxen and esomeprazole in one pill (Aleve and Nexium), a month's supply of generic naproxen and exomeprazole in separate pills costs about $40, a month's supply of Vimovo ranges from $2,300 to $3,000.

Even though the active ingredient is the same, not all formulations have the same effect, some patients absorb warfarin more predictably with some formulations than with others, so there are times where using the brand name formulation makes a difference. The justification for Vimovo and other generic combination pills is only that it's easier to take one pill instead of two.

The debate that came up was if you were doing a med rec for instance, and a patient told you they take this drug, would you use the opportunity to point out that the same medications are available separately at 1/60th the price? Would you suggest they ask their doctor why they need the two medications in one pill instead of two? Or would you just stay out of it and not mention it at all?

I just heard about this new drug and think it is preposterous for what amounts to an Aleve and a Pepcid Complete to cost $2300.00 for a single prescription that treats heartburn and mild to moderate pain. Of course the consumer does not pay that. The insurance companies do and it's my understanding that this drug is not covered in most formularies so what happens is the consumer goes to get their prescription filled and then has to be admitted to a psych ward or cardiac unit once they find out how much it costs. Pharmaceutical companies are out of control and a large part of the reason that health care is as expensive as it is in this country. Our politicians would serve us better finding a way to bring these criminals to heel than do arguing over the ACA.

That being said I would without question let a consumer know that this medication was readily available over the counter for less than $40.00 for 100 or more tablets.

Hppy

[Graduatenurse14]

I agree with the poster who said tv commercials give information and then suggest that the patient talk to their doctor. I think that we can give public information and tell them to talk to their doctor with any other questions if interested in learning more about it.

If I owned stock in the company that makes it and I did the same thing I mentioned, my ethics may be able to be questioned if the situation got wonky.

[catsmeow1972, BSN, RN]

Interesting factoid: The US and New Zealand are the only countries that allow "direct to consumer" advertising for drugs. AKA "ask your doctor is such and such is right for you..."

[TriciaJ, RN]

At the clinic where I work, a doctor once prescribed a particular dose of metformin for a patient. An astute pharmacist gave us a call to tell us it was cheaper to combine 2 smaller doses to make up the correct dose. The difference in price was hundreds of dollars. We were blown away.

[Tenebrae, BSN, RN]

Not really in the sense of cost as here all meds are $5 an item + or - a part charge of an extra couple of bucks for meds that arent fully subsidized.

for an example though if a patient was on warfarin and wasnt keen on the regular INR blood tests I may say mention some of the alternatives sch as dabigatrin and suggest they discuss with their doctor if that is an viable alternative for them

[MunoRN, RN]

I would not say a word about it unless it was a family member, no good will come from recommending this to a regular patient.

I think there is some good in keeping our healthcare system viable by advocating for less waste. We have a fixed amount to spend on healthcare, when we spend $2000 a month for something that costs $40 then we're taking away care elsewhere.

I think I have a different view of the role of nurses in the world of healthcare, because to me pointing this out for what it is, an abuse of the healthcare system, is a core part of the nursing professions responsibility.

[Caffeine_IV]

Our case managers ( RNs and social workers) often ask the MD about substitutions/alternatives for meds that a patient cannot afford. As they say, discharge planning starts the day of admission. It is not out of my scope to advocate for my patient. I would encourage the patient to ask the doctor about it or I would speak on their behalf to the case manager and physician.

[ClauICURN]

I would answer questions in a general sense if it came up, or recommend they discuss it with their provider but would never suggest any specific brand to patients be it generic or proprietary.