Nexium – Brand, generic, prescription or OTC

nexiumWhich is cheapest?

As I did my grocery shopping the other day, I ran into a large cardboard brochure holder at the end of one aisle. Literally ran into it. Why do store managers place these displays where they block cart traffic? Oh, right, to get our attention.

Well, it worked. But the bright purple brochures would have attracted my eye anyway. They touted the recent release of Nexium (“The Purple Pill”®) as an over-the-counter (OTC) medication; that is, you no longer need a prescription to buy it.

The brochure tells us that Nexium is the “#1 doctor prescribed acid blocker brand”. (Hmm, that’s not the same as saying it’s the #1 acid blocker, is it?)

But Nexium is the #2 selling drug in the US, with sales last year approaching $6 billion. Six billion dollars. Just for an antacid. (FYI, the #1 selling drug in the US is Abilify, the antipsychotic that is widely prescribed for depression and anxiety “when regular antidepressants just aren’t enough.”)

A combined $13 billion spent last year to treat heartburn and depression? Now I’m depressed.

But I digress. Now that Nexium (esomeprazole) is available at the drugstore, is it really cheaper to buy it there, rather than have your doctor write a prescription? And what about when a generic version is finally released later this year?

What’s the best deal? You’ll have to do the math.

And if you’re really looking for the best savings to treat your GERD (gastroesophogeal reflux disease), you might want to reconsider Nexium altogether.

Prescription vs OTC

Prescription prices for Nexium will vary considerably based on location and insurance. I looked on GoodRx to get an idea of the cash price for a 30-day supply of Nexium 20mg. The cheapest I found was $258, or about $8 per pill.

If you don’t have insurance, you pay the cash price. Obamacare plans must have some kind of prescription coverage, but that could work two ways.

  1. You get a discounted price (maybe as much as half price) and pay down your deductible; or
  2. You pay a co-pay—$40 or $50 for a brand name or 30% of the cost ($77 in this case).

OTC Nexium comes in bottles of 14 capsules, a two-week course of treatment. The cheapest price is to buy the package of 3 bottles for a total of 42 capsules (yes, the wasted packaging is ridiculous). These sell for about $26, or roughly $.60 per capsule.

So it’s definitely cheaper to buy Nexium OTC.

Brand vs generic

At this time, Nexium (esomeprazole) is not available in generic, but it should be by the end of the year. I assume it be will in both prescription and OTC forms.

But Nexium is not the only PPI or proton pump inhibitor drug on the market. There are two others, Prilosec (omeprazole) and Prevacid (lansoprazole), that are both available OTC and generic.

Related stories: 

They haven’t benefited from the marketing success of The Purple Pill, but they are just as effective—and a little cheaper. In fact, Nexium is really just a molecular hack of Prilosec, and some believe it should not have been approved by the FDA as it did not provide any improvment over what was already on the market.

Buying the brand names with a prescription is as expensive or more than the Nexium. On GoodRX Prilosec costs $223 and Prevacid costs $299.

The OTC brand names are also close in price to Nexium: Prilosec OTC costs about $25 for 42 capsules; Prevacid $27.

Prices for generic drugs overall are increasing, and the generic versions of Prilosec and Prevacid available in the drugstores aren’t that much cheaper than brand name. I couldn’t find 42 capsules of either generic for less than $15. Still, you could save about 20% or more by shopping around.

Perhaps the least expensive option for a PPI is to get a prescription for generic Prilosec (omeprazole) or Prevacid (lansoprazole). A 30-day supply of either generic costs as little as $12. Depending on your insurance plan, you might get a generic with no co-pay or a minimal co-pay of $10.

Either way, that price is less than the average OTC price.

With any drug it can really pay to take time and do the math. Remember, OTC is not always cheaper than prescription, and generic is not always cheaper than brand name.


Frugal Nurse




Nexium – Brand, generic, prescription or OTC — 10 Comments

  1. There are coupons every month for Nexium. When you combine a store sale and a digital coupon, you can get Nexium at a fraction of the costs quoted above. Stores run sales on it all the time and there are always coupons available to print from sites like or from the Sunday paper. This week I got the 14 ct bottle for $5.00 and the 42 count bottle for $16.00.

  2. my wife has been on Nexium 40mg 2xdaily, for several years. after trying some other meds – Nexium 40mg x2 daily was the only medication that gave her relief. Now the Obamacare Insurance she is on says they will not cover it any longer. I have shopped and the best price I can find is $365.00 per month from Nexium Direct. That is still out of our budget. The thought of experimenting with some other drugs really scares my wife due to the pain she has been through in the past while on other medications. She also had a prior authorization denied. -(she had the doctor ask the insurance company to allow this specialty medication).

    • Hi Sam, thanks for your comment, although I’m sorry to hear that you are faced with this emotional and financial distress. Be assured you are not alone!
      Nexium is much more expensive than its competition, so many PBMs (pharmacy benefits managers) are dropping it from their formularies. Plus, there have been no compelling studies that Nexium is any better than other PPIs.
      But I understand that if it has been working for your wife, she would be anxious about changing. Would she consider generic Nexium, esomeprazole? It’s cheaper and might be on your formulary. However, even the generic is about 10X more expensive than generic Prilosec, omeprazole. Over-the-counter Nexium is only sold in 20mg capsules, but at roughly $.60/capsule (Amazon) rather than $6, might also be an option. But she should talk to her doctor first, of course. If she were to try the generic Prilosec for a month or two and it didn’t work, it would give her doctor more ammunition to try the prior authorization again. Good luck with whatever you try! Best, FN

    • See my comments below. Check out websites like krazy coupon lady or living rich with coupons or coupon cabin. They will show you how to print coupons from the internet and when to match those coupons with sales at CVS, RiteAid, ShopRite, etc. When they are on sale and you combine the sale price with the coupon, you save a bundle.

  3. I can’t afford prescription Nexium 40mg which has really worked for me in the past. Is there a generic or cheaper equivalent? Thanks, love your website it’s very informative.

    • Hi Gilbert, thanks for your comment and I’m so sorry for the delayed reply to your question. Somehow, I missed this comment until now. Prescription Nexium is crazy expensive, and honestly the generic version (esomeprazole) that was released last year is not much cheaper! The website GoodRx is a great resource to check out the prices in your area of brand name and generic drugs, as well as cost-saving equivalents. According to them, the most popular alternative to Nexium is generic Prilosec, omeprazole. Cheers, FN

  4. I have been on Nexium 40mg for years. It works great. I am on a Medicare Prescription Drug Plan and get my medications through the mail. I have been researching the 2015 drug plans and find that the total drug cost of my 90 day mail order supply of prescription Nexium will cost $950.00, putting me right at the “GAP”. I have done the math and find that I could take 2 OTC pills a day at about 1/2 the cost of my co-pay for the prescription. My question is, “Is 2 20mg OTC the same as 1 40mg prescription?

    • In theory, yes, but talk to your physician before changing your medication. Generic Nexium should be available in 2015. If you’re really interested in saving money, talk to your physician about switching to prescription generic Prilosec, or omeprazole, which is believed to be just as effective as Nexium. Best, FN

      • Thanks for the rapid response. I have tried the replacements and they don’t seem to work for me. Everyone with whom I speak cannot understand why, but after a couple glasses of red wine and I know immediately. LOL I have spoken with 3 different pharmacists and they all say it would be OK. I see the doctor next month to renew our prescriptions and then comes the hours of research on Medicare Plan D providers. Again, thanks for the reply.

    • 2 nexium otc I’ve not had much success with even though the pharmacy recommended it to save money