Are suffix drugs a ripoff?

The Consumerist has been pulling plums from Dr. Edward Jardini’s How to Save on Prescription Drugs — and the latest has caused a bit of a firestorm on the blog.

Specifically, the Consumerist says that “suffix drugs” — the kinds with letters like CD, CR, ER, LA, SR, XL, XR, or XT after the name — are usually just different versions of the same drug that vary only in how the drug releases in the body. The blog then says:

By coming up with different variations on old drugs, pharmaceutical companies can keep the profits rolling on drugs whose patents have expired. Best of all, if they can get the doctor to write one of these letter sequences after the drug’s name, the pharmacy can’t substitute a lower-priced generic (unless a generic of the extended release version is already on the market).

For example, Wellbutrin (bupropion) came out in 1985 requiring 3 pills a day. In 1996, 36 months before the old patent expired, they came up with Wellbutrin SR, only 2 pills a day. In 2003, 5 months before the SR patent expired, Wellbutrin XL was released, only one pill a day.

A 3 month supply of 300 mg of bupropion per day retails on average for $270. You’ll have to pay $693 and $656 for Wellbutrin SR and XL, respectively. Over the course of a year, that’s $1080 extra dollars. Is it really worth paying 2.5 times as much just for one fewer pill?

You know how we feel about Big Pharma’s slimy game-playing with patents, so you know where we stand on this issue; we agree, in principle, with the Consumerist and Dr. Jardini.

But every drug is different — as is every patient’s reaction. The Consumerist handled the issue too glibly, causing it to receive quite a bit of pushback from its commenters. In fact, we found the pushback just as valuable as the blog post itself.

Here are a few choice responses:

Wellbutrin can cause seizures if too high of a dose is given at once. The time release capsules allow a higher dose to be taken because it will be slowly released into your blood stream rather than released all at once (which is what brings on the seizures). For people not at risk for seizures, or for people taking low doses, the SR or XL probably doesn’t matter, but for some people it does…

I take Adderall XR. When I was first prescribed adderall, i was on lower doses, multiple pills per day. There were definite peaks and valleys to my day. At one point I was also on generics, which gave me a headache, so i went back to regular adderall. I then switched to the XR to try and avoid peaks and valleys and I haven’t looked back since. It’s not just as simple as fewer pills, the body chemistry is different, that’s why its a different prescription…

I prefer the Ambien CR. Because with regular Ambien I wake up in less than 5 hours. With CR I can get a full 8 hours…

Totally bad advice. I take the Wellbutrin XL, and have since its release. Prior to that, on the Twice a day SR, I would frequently forget – and suffer the consequences. Anti-depressants are less forgiving than other medications. The time release aspect of the XL really reduces the swings even normal doses of SR can cause…

When an epileptic stops taking his extended release medication because the Consumerist told him the evil pharm companies were ripping him off, don’t be surprised when he hires a lawyer. The consumerist should leave the job of dispensing medical advice to those with medical degrees…

Really, there are two separate issues here. First, choice is good for consumers; the more versions of a drug the better. And clearly from the comments above, those little suffixes can and do make a difference.

The second issue is not really a medical issue; it’s a public policy issue. Why do these different drugs have such different costs? The answer is clearly that Big Pharma is taking advantage of our current drug patenting system’s loopholes; as one commenter correctly puts it:

Remember, the drug companies could have offered all the versions at once, but by delaying releases till patent protection is near expiration helps them control the market for many times longer than traditional patent protection would provide.

This is plainly true. And we, as consumers and members of the public in a democracy, have the power to close these loopholes. We can require the FDA to be stricter in its patent requirements. By not doing so, we’ve effectively allowed pharmaceutical companies to keep new versions of a drug off the market simply in order to extend their patents and avoid generic competition.

The (understandable) mistake the Consumerist has made here is underestimating how completely the tentacles of Big Pharma control our behavior as drug consumers — and how difficult it is for us to extract ourselves from their grasp.

By the way, eDrugSearch.com’s own e-book on saving money on prescription drugs will be coming out soon. Be on the lookout.