Which 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.
- You get a discounted price (maybe as much as half price) and pay down your deductible; or
- 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.
- Consumer Reports “Overprescribed and overpriced:Just say ‘No’ to Nexium”
- Consumer Reports “Best drugs to treat heartburn and GERD”
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.