prescribing the two ingredients in a single pill and that the single pill protected patients by making it more likely they would take their medication as directed.
Horizon also primed the medical community by giving donations totaling $101,000 to the American Gastroenterology Association, a specialty nonprofit for physicians. Some doctors refuse drug-industry money, if only to at least avoid the appearance of a conflict of interest. ProPublica has done loads of stories showing why doctors taking money is indeed problematic, including one about drug makers’ influence on physician specialty groups. When I went on the American Gastroenterology Association’s website, the first thing I saw was a pop-up ad from a drug company. Several of the association’s board members have received drug-company money, too. Horizon has made clear in its annual reports that donations to the group “help physicians and patients better understand and manage” the risks of pain relievers causing gastric problems.
Horizon also zeroed in on patients’ worries about drug costs. To encourage them to fill their prescriptions, Horizon covered all or most of their out-ofpocket costs. That’s why my doctor’s office could promise me I wouldn’t spend too much for my Vimovo. The program, Horizon told investors in reports, addressed the impact of pharmacies switching to less expensive alternatives and could “mitigate” the effect of payers searching for cheaper alternatives.
The strategy worked on me. I didn’t even know why I was getting the prescription, but when they told me it wouldn’t cost more than I would spend on lunch with a friend, I gave it the OK. A pharmacy I’d never heard of sent me a bottle of Vimovo for $10, even though my insurance company rejected the claim.
Turns out paying the patient’s costs motivated my doctor, too. I waited until the end of my next visit to bring up Vimovo, and then we had a follow-up conversation on the phone. Ramani didn’t know the price of the drug and found it “disturbing” when I told him. That was a surprise to me, but not to him. He said he leaves billing to his staff and doesn’t even know how much he gets paid for a lot of the procedures he performs, let alone how much insurers are being charged for drugs. The marketing arms of companies like Horizon must count on this sort of blindness.
Ramani doesn’t receive money or gifts from Horizon. (I confirmed this on ProPublica’s Dollars for Docs website, which lists drug-company payments.) He said he likes Vimovo because Horizon covers the patient’s out-of-pocket costs, entirely in many cases. Prescribing the generics or over-thecounter medications separately would actually cost more, he said. Which of course is exactly the company’s plan. But Ramani agreed that the high cost of the drug to insurers ultimately raises overall health care costs for all Americans.
Knowing Vimovo’s price, I asked him if he would continue to prescribe it. “It changes my thought process,” he said. “But at the end of the day, I have to think about the patient and whether the patient will be able to pay out of pocket or not.”
Ramani said the Horizon drug rep told him Vimovo prescriptions had to go through a particular pharmacy for the patient to receive financial assistance. In its 2016 annual report, Horizon wrote that prescriptions for its drugs might not be filled by certain pharmacies because of insurance-company exclusions, co-payment requirements, or incentives to use lowerpriced alternatives. So that’s why they didn’t give me the option of picking up my pills at my neighborhood drugstore.
Instead, my Vimovo was mailed to me from White Oak Pharmacy in Nutley, New Jersey, which is about 45 minutes from my house. I drove there to find out why. The neighborhood pharmacy is on the bottom floor of a twostory brick building on a street corner, next to a hair salon.
Vishal Chhabria, the pharmacist who owns White Oak, told me the drug company sets the price of Vimovo. He insisted his pharmacy has no special relationship or contract with Horizon. Maybe the drug company steers prescriptions his way, he said, because his pharmacy will process the coupons that reduce or eliminate the patient costs, which some pharmacies don’t.
Chhabria said there is no approved generic alternative to Vimovo, so he can’t suggest one to patients. And while other drugs, like over-the-counter medications, would be cheaper for the health system overall, they are more expensive for the individual patient, he said.
In poring through Horizon’s financial filings, it appears the drug’s run may be ending. Horizon said in its report for the first quarter of 2017 that fewer insurance companies have been willing to cover Vimovo and many that do have demanded larger rebates. As a result, Horizon has been eating more of the costs of providing the drug to patients, as they must have in my case. The prescriptions have still been coming in, but net sales were just under $5 million in the first quarter of this year, down 81 percent from the first quarter of 2016.
Critics of Vimovo say that’s still more than patients should be spending on the drug. “That number should be zero,” said Linda Cahn, an attorney who advises corporations, unions and other payers to help reduce their costs. “If you want to talk about waste, that’s waste.”
Herrick, the health care economist, said Horizon cashed in by eliminating many of the barriers in the system that are meant to control costs. The company got patients on board by covering their out-of-pocket costs. It appealed to doctors by promoting the benefits to patients. And it did an end-run around chain pharmacies, which typically might suggest a lowerpriced alternative, by steering prescriptions to pharmacists who would participate in their patient-assistance program.
“Somebody brainstormed: ‘How can we nullify any consumer check and balance in this supply chain? What can we do to keep the customer from asking questions?’” Herrick said.
The scheme that played out with Vimovo is bound to happen again, Herrick said. Maybe it already is. Drug companies are always on the lookout to deploy similar strategies.
I dutifully took my Vimovo for several days, until I noticed it kept me awake until 3 in the morning — a rare side effect. (Perhaps they need to add a third drug to the combo.) I probably have more than 50 pills left in the bottle on my bedside table. Maybe I could sell it back to Horizon for $1,500.
Marshall Allen is a reporter at ProPublica investigating the cost and quality of our health care.