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    Reformulate, remonetize — and let the patient beware

    David StanleyDavid StaneyThe medical assistant was waiting on the line. I had never heard of the drug she was phoning in, and I wanted to make sure it was something I could order. Unfortunately, it was.

    “Why would anyone write for that?” The words slipped out of my mouth when I realized that Cambia, the mystery med, was simply powdered diclofenac — and that a drug selling for less than $20 in tablet form would bring its manufacturer more than $400 when left as a powder.

    I had momentarily forgotten the medical assistant was still there.

    “It’s what the doctor prescribed,” she said coldly. To which I replied, “I hope the patient has good insurance,” and let her go.

    “Or stupid insurance,” I thought to myself.

    Simple vs. $$$

    Setting aside the fact that diclofenac is what Pharmacist’s Letter calls a “three-strikes” NSAID, more toxic to the liver, cardiovascular, and gastrointestinal systems than other meds in its class, why would a doctor think the theoretical benefit of a few minutes’ faster absorption worth several hundred dollars, when the simple alternative of liquid ibuprofen is available?

    Most of us would come up with a similar answer to that question: Because those hundreds of dollars are someone else’s money, and “simple” is not a word that’s in fashion in today’s medical world.

    At first I felt bad about my slip of the tongue, but the more I thought about it, the less remorseful I felt.

    An entire ecosystem

    We all know there exists an entire sub-industry of incredibly overpriced pharmaceutical products that contribute nothing to the advancement of medicine.

    There’s Duexis — nothing but ibuprofen combined with famotidine. Or Solodyn — a strength of minocycline just different enough that it can’t be substituted for the generic that costs hundreds of dollars less. Or Treximet — simply sumatriptan and naproxen.

    The list goes on and on, and there seems to be a new addition every week. It’s an entire economic ecosystem that depends on pulling the wool over the eyes of prescribers.

    Well it’s time their eyes were opened, and stereotypical pharmacists — those polite, quiet, sheepish professionals who hold their tongues unless spoken to — are not going to get that job done.

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]

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