92017May

Leaving Expensive Generics Behind

With more than 53 million people in the US affected by gastroesophageal reflux disease (GERD), KHP providers likely prescribe treatment for this common condition every day. Proton pump inhibitors (PPIs) have become the mainstay of therapy for long term management of GERD, particularly for patients with erosive disease. Costs for this treatment – even generic options – can be very expensive for the patient. As a result, patients often do not fill prescriptions, leading to long term problems. You can find a more affordable alternative drug on the KHP suggested generics list on our website.

For patients presenting with intermittent symptoms of heartburn or for those with uncomplicated non-erosive disease, considering over the counter (OTC) products as a starting point can help to minimize costs and prevent overtreatment. There are several cost effective options including antacids, H2 receptor antagonists (H2RAs) and PPIs that may be beneficial in this specific patient population.

Antacids
Calcium, aluminum, and magnesium based products are available OTC in a wide variety of formulations and are very affordable. These neutralizing agents help to raise intragastric pH resulting in increased lower esophageal sphincter (LES) pressure. Although these agents have a rapid onset of action, they do have a short duration which necessitates frequent daily dosing. Antacids can be used as first-line therapy for intermittent (less than twice weekly) symptoms or for breakthrough therapy for patients already on PPI/H2RA therapy.

H2 Receptor Antagonists
All H2RA products are available as prescription or OTC and come in a variety of formulations. H2RA products may be used for on-demand therapy for intermittent mild to moderate GERD symptoms or for preventive dosing before meals or exercise. Higher prescription doses are often necessary for more severe symptoms or for maintenance dosing. Generics exist for all prescription products which helps minimize out of pocket costs. Most of the H2RA products are well tolerated with minimal adverse effects; however cimetidine (Tagamet) inhibits multiple cytochrome P450 enzymes which could cause significant drug interactions. In particular, patients currently taking warfarin should consider other H2RA alternatives.

Proton Pump Inhibitors
PPIs provide a greater degree of acid suppression and typically have a longer duration of action compared to H2RAs. They are the most effective agents for short and long term management of GERD but they are also the most costly agents. There are several generic prescription and OTC products available. Generic omeprazole, lansoprazole and pantoprazole offer patients an affordable treatment option and are covered by most all insurance plans. Other options include esomeprazole and omeprazole/sodium bicarbonate; however although generic, they are still quite costly with retail prices reaching $2,700 for a one month supply of omeprazole/sodium bicarbonate. For patients experiencing typical heartburn symptoms that may require intermittent short term therapy, OTC Prevacid, Prilosec, or Zegerid are inexpensive options to consider.