There was a time when most medications came in immediate-release formulations. People often had to take their pills two or three times a day. Examples include amoxicillin, bupropion (Wellbutrin), lorazepam (Ativan), metformin (Glucophage), penicillin and venlafaxine (Effexor). Doctors and drug companies thought that this made it harder for people to follow through on their prescribed regimens. As a result, extended-release pills became far more popular.
The Increase in Extended-Release Pills:
There are a couple of reasons drug companies love long-acting medications. First, they can charge more for these extended-release pills. Second, these formulations sometimes extend the patent. When instant-release tablets lose their exclusivity, generic competition usually drives the price of the medicine into the basement.
If a drug company comes up with sustained-release (SR), long acting (LA) or extended-release pills (ER, XL, XR), they can often jack up the price. They may also have extra time to sell it before the generic manufacturers are given a green light to offer the long-acting version.
Finally, the sales reps for pharmaceutical companies can promote the extended-release pills to doctors as more convenient for patients. The argument goes that people are more likely to take their medicine if they only have to swallow one pill per day rather than two or three pills.
The Extra Cost of Extended-Release Pills:
A team of researchers examined the extra cost of these longer-acting formulations (JAMA Network Open, online, Feb. 28, 2020). They reviewed prescription drug data from Medicare Part D and Medicaid between 2012 and 2017.
When the investigators focused on 20 drugs in 37 formulations, half brand and half generic, they found that Medicare spent more than $2 billion on extended release versions in 2017. Medicaid spent $952 million for the same drugs that year. Had doctors prescribed the twice daily formulations instead, the government would have saved $2.6 billion in 2017.
During the whole five years of the study, having less costly twice-a-day prescriptions would have saved $13.7 billion. The investigators suggest that Medicare and Medicaid refuse to pay more than the cost of the immediate formulation drugs.
What Do You Think?
If you could save a lot of money by switching from once-daily extended-release pills to twice-day formulations would you do it? How much is convenience worth?
Let’s consider an example. The antidepressant bupropion XL costs nearly $100 for a month’s supply. Bupropion instant release that you might have to take three times a day costs about $50 to 64 for a month’s supply.
The brand name version of this drug, Wellbutrin, could cost around $300 for the instant release with a coupon from GoodRx. The same brand name medicine in an extended-release XL formulation could cost around $2,000 with a GoodRx coupon. Without the coupon it could be as much as $2,350. Is the XL formulation worth that kind of premium?
Share your thoughts about instant release vs. extended-release pills in the comment section below. We would love to get your opinion.
