Beware of “Evergreening”: The Pharmaceutical Scam That Could Cost Your Family Thousands

Posted by – July 18, 2009

Last Friday, I was on the Medicare Part D(rugs) web site (which itself is possibly a conspiracy to break the spirit of the elderly and disabled, and make us give up on life) tabulating my medications and their costs. While crunching the numbers, I found that (as Mom had faced when I was living at home) the antidepressant Lexapro was the biggest expense, totaling over half the monthly Nick prescription costs!! Lexapro is $134.92 and, because it’s a brand name antidepressant, Medicare Part D will always make you pay 50%, or $67.46, per month!

I did some research on how this burden can be alleviated. Here’s what I learned: no generic Lexapros are available because Forest Laboratories, Inc. got a judge to extend their patent (I wonder how they’d defend that). No generic versions will be able to compete on the market until March 14, 2012.

Further, I learned the single enantiomer or enantiopure drug game is (often) one ploy out of many to “evergreen” drugs A HUGE SCAM.

A Picture of Lexapro tablets

In the case of Lexapro, they had a drug, Celexa (citalopram), and its patent ran out in 2003, opening it to generic competition. So they stripped out only the active molecule in Celexa, creating the enantiopure drug escitalopram, and then marketed it as A NEW DRUG, Lexapro! Lexapro is simply the active ingredient in Celaxa! It’s essentially the same drug! IT’S THE SAME ACTIVE INGREDIENT! Forest Laboratories has always CLAIMED that the new Lexapro with only the single active molecule is more effective than Celexa, and their marketing convinced many doctors of this (and then doctors convinced credulous patients). This, despite the fact that most independent studies show Celexa is just as effective as Lexapro in most cases (source.

Celexa’s patent expired in ’03, but they’ve been able to keep the profits rolling in by slightly modifying it and selling it as a new drug. Within the industry this is one way of “evergreening” drugs.
This video from Doctors Without Borders gives a quick rundown of the evergreening problem in light of India v. Novartis, a court battle over the manufacture of generic chemotherapy meds.
The FDA, the gov’t agency that regulates medications and their marketing (including the nonstop TV ads; “ask your doctor about Ultron!”), decided to open the floodgates to enantiopure drugs, merited and questionable medicines alike. That the regulators allow single enantiomers and other derivative medicines to be marketed as a wholly new drug, not Celexa Plus or something, means the government is an active accomplice in misleading billions (the U.S. pharma industry supplying world markets).  It is a serious travesty.

This scam works so well, and has pulled thousands from countless families, because, like the very best marketing ploys, it’s got that kernel of truth, that nucleus of realness at the center of the electron cloud of B.S.. The “rawer” compound, or racemic mixture, may be a-okay if we’re talking albuterol (also called Salbutamol in international markets) vs. the enantiopure drug Xopenex, especially if you’re accustomed to the side effects of the “whole enchilada” compound, albuterol (brand name Ventolin®).
But do you want to roll the dice on the double-barreled racemic mixture when it’s something uber-delicate like SSRI meds and you don’t know how the right-barrel (“inactive” right-enantiomer) will sit with ya? Feelin’ lucky?

Obviously there have to be tests and clinical trials on the single enantiomer vs. racemic mixture, not an inexpensive undertaking, since in some cases separating the stereoisomers is effectively impossible (Thalidomide is racemic: the enantiomers convert into each other in the body, so its adverse effects can’t be separated out), essential (Naproxen is an effective anti-inflammatory medicine, once its super poisonous enantiomer is removed) or counterproductive (Penicillin only acts against bacteria with both enantiomers intact; it is “stereodependent”).
Not all medicines are as simple as stereoisomers either. A lot of overhead is needed to test drugs. But increasingly, Big Pharma is selling S-enantiomer meds when the enantiopure drug, while more potent, does not strip out real adverse effects or confer other meaningful benefits. The antacid Nexium is probably the most infamous example, a new brand with no clinical benefits, pressed forth with skewed research that (admittedly in the fine print) compared the benefits of 20mg and 40mg Nexium against 20mg capsules of its racemic predecessor Prilosec, just for “evergreening” purposes.

PROTECT YOUR FAMILY from these ploys!

Here is a list of “new” meds that are just the active ingredient (single enantiomer) of older meds! Whenever possible (and safe) to do so, don’t buy the “new” version, get an older generic with the same ingredient, and save your money!

Racemic Mixture Single Enantiomer
Amphetamine (Benzedrine) Dextroamphetamine (Dexedrine)
Ritalin Focalin
Celexa Lexapro
Provigil Nuvigil
Floxin Levaquin
Prilosec Nexium
Albuterol Xopenex
Imovane Lunesta

Source: Single-enantiomer drugs

Talk to your doctor about switching to lower-cost generics. You could be receiving the same clinical benefits at a fraction of the cost!

PROTECT YOURSELF!! It seems the government is in the pocket of moneyed interests and won’t protect us from these scams.



Related Bloggery:
Scott’s Web Log: Evergreening Does Not Refer to Trees

  • One of my transplant drugs is about to go generic and the maker has a huge campaign to convince patients that the brand name is better or even essential, I made the mistake of signing up on their site because they promised non-existent gifts and have been inundated ever since with propaganda. My part B. pays for all my transplant drugs so it doesn't cost me but I will request the generic as soon as it is out because my transplant center probably won't, UVA prescribes the most expensive drugs as a rule unless you tell them money matters. How I paid over 700 dollars for Prilosec in a prescription last year…… I buy OTC generic and save money even though I pay for it myself without coverage….

  • The Prilosec / Nexium scam really is incredible. How'd they ever get away with it? If they wanted to market the active ingredient only, why wait until Nexium? They could've formulated Prilosec that way from the beginning! But no, they wanted to wait and use that as an evergreening ploy.

  • I take Lexapro. I think that will change.

    Also, talked to Aloha about all of the problems you're dealing with. I noted that firearms always work in solving problems quickly, so I will be getting on a bus soon to solve it all!

  • Just because I went to med school and tend to write with a free drug company pen (those fat padded ones are so gentle on my knobbly fingers) doesn't mean that I automatically give evil big Pharma advice. I do feel compelled to spout a few party line caveats.

    In general, the generic substitution works, but not always. Some people do react to the inactive isomer in a rather unpleasant way. In other words, some people do every well on Lexapro but react in a very poopy fashion to citalopram/Celexa. I'm a big fan of boring old methylphenidate ER (generic, extended release Ritalin), but those stimulant salts can be weird, especially in kids, who react to them in different ways, with some unpredictable side effects. The branded medication isn't ALWAYS necessarily bad, although in my experience, 98 times out of 100 generics are just fine. And cheap.

    Just sayin', talk to your physician about it. I'm always willing to give a generic a whirl, recognizing that cheap doesn't ALWAYS mean better when it comes to medication. Although I recognize that cheap can often be the difference between taking a medication and not taking a medication.

  • I hear what you're saying, and agree that not everything will work for everyone. But I still believe it's a blatant scam, and that the FDA should not allow companies to market the active ingredient only, and claim it is a new product. That is a very deceptive practice. They should only be able to market Lexapro as Celexa Plus, for example, and that will give patients and doctors an opportunity to HONESTLY evaluate if trying this new version of Celexa would be of clinical benefit.

  • icedlatte

    I LOVE it! Celexa PLUS. I'm actually cracking up at the thought of a marketing meeting at a drug company about that.

    Pharmacists usually know all this too, and can be terrific sources of information regarding identical, or therapeutically similar substitutions.

  • dansadler

    If you all are interested in how the scams work, just buy or check out from the library like I did;
    Overdo$ed America
    The broken promise of American medicine by John Abramson, M.D.
    ISBN 0-06-056852-6
    Dewey Decimal # 310.973 Published 2004
    It is a great read, especially for anybody interested it how the pharmacutical industry works.
    I highly recommend this book!

  • dansadler

    If you all are interested in how the scams work, just buy or check out from the library like I did;
    Overdo$ed America
    The broken promise of American medicine by John Abramson, M.D.
    ISBN 0-06-056852-6
    Dewey Decimal # 310.973 Published 2004
    It is a great read, especially for anybody interested it how the pharmacutical industry works.
    I highly recommend this book!

  • Heathermmize1

    they did it because they can only hold a patent for so long. so they do this knowing that when the patent runs out, they’ll develop a new product. Prilosec OTC can cost on average $20. Nexium, if covered at all under insurance (many carriers have dropped it because of high cost and over utilization) is a brand drug and wil cost the highest copay. If you’re on a CDHP- consumer driven health plan then you’re paying the full cost. $280 on average per prescription. That’s true dollars! That’s after discounts, etc. So, it costs either you, or your health plan $3,360 per year. You could be spending $240 on Prilosec and would not need to go and get a prescription costing more due to doctor visit costs. THis is a HUGE problem that can be solved!!!!

  • Heathermmize1

    agreed……the issue is that people don’t even try generics.

  • Common sense and an aversion to Big pharma gaming the system is all that is necessary to end Nexium-type fiascos…

  • Bill Santer

    There is actually a difference between Xopenex and albuterol. Studies have shown that Xopenex has fewer cardiac side effects than albuterol. From personal experience, I find that Xopenex is less likely to keep me up at night or give me heart palpitations.