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Only Kim Kardashian can afford Diclegis, the Birkin Bag of morning sickness medication | Dr. Jen Gunter

2015-09-29

Here is another example of pharmaceutical company price-gouging and opportunism: a drug company has patented a delayed-release preparation of doxylamine and vitamin B6, previously marketed under another name at  much lower price in an immediate-release preparation.  It is possible to obtain the exact same ingredients over the counter, and the price differences impressive: the OTC combination costs a little over  $20 a month, while Decligis costs between $350 and $700 a month, depending on the needed dose.  This is a price differential of twenty times in order to get a delayed-release  preparation which has never been tested head to head against the OTC combination.

Who in his right mind would pay twenty times the price for an unproven “improvement” which makes it possible to take the drug twice a day as needed instead of four times a day as needed?  Patients with mild-moderate nausea could probably get by with the OTC preparation two or three times a day.  The funny thing about delayed-release preparations is that they are not reliably time-released.  Sometimes the contents are all dumped into the blood stream at once; at other times, sometimes depending on food content in the stomach, the preparation will not fully dissolve by the time it exits the body in the fecal stream.

Insurance companies should refuse to authorize payment for prescriptions of this drug– it takes money away from higher health priorities (not that morning sickness is not a dreadfully unpleasant, and rarely, a life threatening illness).  At the very least, the insurance companies should include the OTC preparation in the formulary that they WILL cover; and the Diclegis should only be available to patients who have failed the OTC version.

The fact that Kim Kardashian is pushing this drug indicates the market for which it was intended: the top 0.1% on the income ladder.

Here is a quote from an excellent blog post by Dr. Jen Gunter describing the outrages committed by this drug company (who will remain nameless for the moment):

 

Yes, while you can buy Diclegis as a prescription it is just a combination of two readily over-the counter (OTC) medications –vitamin B6 and doxylamine (an antihistamine) with slightly different dosing. When taken together doxylamine and vitamin B6 are mildly to moderately effective for nausea and vomiting in pregnancy. The difference between the prescription and the OTC is a minor variation in dose and the prescription is delayed-release so it is only taken once a day. However, there has been no head to head comparison between the OTC and prescription so we have no idea if the delayed-release offers any advantage beyond the convenience of one-daily dosing.The big difference between the OTC option and Diclegis is price. You can buy 100 doxylamine 25 mg tablets for $12.79 and 100 vitamin B6 tablets 25 mg for $7.29 (see below) and you can bet the manufacturers are still making a profit. Diclegis, if you have a coupon, is $345 for 60 tablets. The dose is two tablets a day, but some women need four tablets so the cost for could be $690 a month (with discount coupon!). Some may get it covered by insurance, but even then co payments are likely to be $20 or more. You will pay at most $25.20 a month for OTC (less if you don’t need four pills a day and/or take advantage of the buy one get the other 50% off at Walgreens). The other advantage of the OTC route is you can start with vitamin B6 and if that doesn’t work then add in the doxylamine. After all, we recommend a step wise approach to nausea and vomiting.Let’s compare OTC doxylamine/vitamin B6 with Diclegis. The OTC dosing is not identical but close enough and before 2013 (when Diclegis wasn’t available) we managed just fine using these slightly different doses. Check out this table:

Source: Only Kim Kardashian can afford Diclegis, the Birkin Bag of morning sickness medication | Dr. Jen Gunter

Diclegis– if you have to ask the price you can’t afford it.

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