April 05, 2016

What are Combination Drugs?

, Cost Containment
, Network Solutions


The topic of combination drugs is growing within the industry. Combination drugs are created when a manufacturer combines two or more active medications to create a new FDA-approved drug. The appeal of combination drugs is that they offers patients the convenience of taking a single-dosage pill, which can potentially improve compliance. Initially developed to target individual diseases, such as antivirals used against AIDS, combination drugs are on the rise as they are increasingly developed to target multiple related diseases and conditions.

However, cost and compliance drivers in workers’ compensation and auto/PIP claims must also be considered. A combination drug can be far more expensive than the underlying medications.

To better manage combination drugs, CorVel flags them for prospective management in our formulary. Combination drugs trigger a prior authorization at the pharmacy and the Pharmacy Solutions team uses this opportunity to request a substitution to the single, active ingredients. Most often the prescribing physician approves our request and a substitution is made.

An example we see often is the common combination drug Duexis®, which consists of two generic ingredients – ibuprofen and famotidine. The generic pills are inexpensive with both pills costing $2.50 total. Conversely, Duexis® costs $16 per pill, more than six times more expensive. Similarly, another combination drug, Vimovo®, can easily be converted to its much more cost-effective ingredients naproxen and esomeprazole (generic Nexium). When possible, we also convert the new migraine combination drug, Treximet®, to its separate generic drugs, naproxen and sumatriptan.

Flagging combination drugs helps CorVel’s clients better manage pharmacy exposure. By prospectively managing combination drugs, CorVel is committed to providing prospective and clinically appropriate management to manage our clients’ pharmacy costs.

The below graphic shows the potential for dramatic savings realized due to prospective management of just two of the popular combination products, Duexis® and Vimovo®.  

 Prospective Management