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67% price cut available as generic for medication Duexis® arrives to market

September 16, 2021 · Medicare Insights Team

Approved by the FDA in August 2021, the first generic of Duexis, ibuprofen-famotidine, is now available and is included in the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) as of September 2021. The average wholesale price (AWP) of the new generic is a 67% price decrease compared to the brand-name formulation.

The combination product Duexis is only FDA-approved to relieve rheumatoid arthritis and osteoarthritis symptoms, and for NSAID-induced ulcer prophylaxis, though it has been used off-label for other pain conditions. Duexis is not recommended as a first-line agent, as its active ingredients are both available in multiple prescription and over-the-counter (OTC) strengths that, when used concurrently, are more cost-effective than the Duexis combination product. For comparison purposes, generic ibuprofen and generic famotidine are available as single-ingredient products, and their prices are also included in the table below. 

Price impact for conversion from brand-name Duexis to generic ibuprofen-famotidine or its individual generic components for WCMSAs, using September 2021 WCMSAP pricing .

Product with strength and formulation National Drug Code (NDC) AWP unit price
Duexis 800-26.6 mg tablet 75987-0010-03 $33.09
Ibuprofen-Famotidine 800-26.6 mg tablet 67877-0626-90 $11.08
Ibuprofen 800 mg tablet* 00904-5855-60 $0.14
Famotidine 20 mg tablet 72606-0509-02 $0.14
Famotidine 40 mg tablet 72606-0510-02 $0.28

*Ibuprofen is also available in generic 200 mg (OTC), 400 mg, and 600 mg strengths. The recommended dosing of famotidine for prevention of NSAID-induced ulcers is 40 mg twice daily. Please note that RED BOOK® AWP is subject to change.

Price comparison example

New generic Therapeutic alternative Savings
3 x per day dose of the new generic ibuprofen-famotidine = $997.20 per month Ibuprofen 800 mg 3 x per day ($12.87/month) and famotidine 40 mg tablets twice daily ($16.80/month) = $29.67 per month Savings of $967.53 per month. For a person with a life expectancy of 20 years ➡ $232,207.02 cost savings applicable to a WCMSA

Please note, when claimants have a history of brand-name medication use, the Centers for Medicare and Medicaid Services (CMS) generally requires generic medication fills reflected on pharmacy invoices to allow allocation for the lower cost generic product in a WCMSA.  

What you can do

It is our recommendation that carriers, TPAs and claim handlers flag cases where brand-name Duexis has been prescribed to determine if generic ibuprofen-famotidine tablet is prescribed in the near future. It is expected that over the next several months we will see prescriptions for brand-name Duexis transitioned to the generic formulation. If not, it is recommended that a request be made to the treating physician to initiate a trial of the generic medication. Furthermore, consider pursuing single-ingredient generic alternatives for further cost savings, when appropriate.
 

More information on Duexis

Duexis is a fixed-dose combination product containing ibuprofen and famotidine. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) approved for multiple pain conditions including rheumatoid arthritis, osteoarthritis, mild to moderate pain, musculoskeletal pain and headaches. Famotidine is a histamine type 2 (H2) receptor antagonist approved for treatment of multiple gastrointestinal conditions including gastroesophageal reflux disease (GERD), esophagitis, peptic ulcers and heartburn; famotidine is used off-label for prevention of NSAID-induced ulcers. H2 receptor antagonists are one of several classes of medications used to prevent ulceration due to NSAID use. In the Duexis product, the famotidine component is intended to reduce the risk of gastrointestinal ulceration and/or other gastrointestinal side effects associated with the ibuprofen component.
 

Future updates

Optum continually monitors RED BOOK AWP for the most common medications seen in WCMSAs to identify pricing changes that may have an impact on WCMSAs and settlements, and we will continue to update the industry as applicable. 

Sources:
1.     RED BOOK - https://www.ibm.com/products/micromedex-red-book (Subscription required)
2.     Clinical Pharmacology - http://www.clinicalpharmacology.com (Subscription required)
3.     WCMSA Portal - https://www.cob.cms.hhs.gov/WCMSA/login
4.     ODG by MCG Treatment Guidelines [database online]. An MCG Health Company. Accessed on September 3, 2021.
5.     Duexis®  (ibuprofem and famotidine) [package insert]. Deerfield, IL: Horizon Medicines LLC; April 2021. Available at https://www.hzndocs.com/DUEXIS-Prescribing-Information.pdf/ Accessed on September 3, 2021.

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