Prilosec, held by some to be the "anti-ulcer wonderdrug," is the third leading prescription drug in the world — or it was until June 20, 2003, when the FDA reclassified it as an over-the-counter medication. While still available as a prescription in larger doses, Prilosec now joins other over-the-counter anti-heartburn medications such as Zantac and Pepcid AC. As Prilosec becomes available in drugstores, Aetna, Inc. will be sending a $10 coupon for the drug to 100,000 of its members with a history of using anti-reflux medications. A $10 coupon will pay for a two-week supply of the drug for each Aetna member targeted.
The cumulative face value of the coupons is $1 million. The initiative, which will be funded by the drug’s maker, Proctor and Gamble, is intended to "educate Aetna’s members and help them maximize available benefits," according to a press release from Aetna, Inc. ("Aetna Expands Efforts to Educate Members With Information on PPIs and Coupons for Prilosec OTC," Oct. 7, 2003). But some consumers are worried that the long-term results of this new over-the-counter classification will cost them money.
As an over-the-counter drug, Prilosec will cost a mere $.70 a dose — about a third of the price it carried as a pharmaceutical drug. However, as an over-the-counter drug, Prilosec will no longer be covered by an insurance copay. While the cost of a pharmaceutical drug might have been covered by an insurance plan, the $.70 will be coming out of the consumer’s pocket. As a result, some patients may be seeking to switch their prescriptions, a trend which has some insurance providers worried.
It’s possible that the much lower cost and added convenience will offset the loss of a copay; but the outcome is uncertain for both the consumer and the health coverage provider. Rather than seeing all of their members switch to another prescription medication, Aetna has initiated a major coupon and education drive.
According to Eric Elliott, head of Aetna Pharmacy Management, "The FDA’s recent decision to move 20mg Prilosec to over-the-counter status provides consumers with an effective, convenient and more affordable option for the treatment of frequent heartburn."
The convenience and effectiveness of the new over-the-counter Prilosec (which is pink, rather than its trademark purple) cannot be contested. For those whose insurance does not cover prescriptions, or who do not have insurance, the new policy is a wonderful stroke of luck.
For those patients who are accustomed to paying for Prilosec with an insurance copay, it remains to be seen whether the much lower cost and much greater convenience will balance out the fact that the drug must be paid for out-of-pocket.
