Out-of-pocket and total costs of fixed-dose combination antihypertensives and their components

Background: Many patients are burdened by prescription costs, yet it is not clear whether brand-named fixed-dose combination medicines are less expensive than the sum of the cost of their generic components. Methods: We used the Medical Expenditure Panel Survey, a rigorously conducted, nationally representative, population-based survey, to examine the out-of-pocket and third party costs associated with the most commonly prescribed, brand-named fixed-dose combination antihypertensive drugs. We compared the out-of-pocket and third party cost for a 30-day supply of each of these combination drugs with the sum of these costs for their individual generic components. Results: Twenty-seven combination antihypertensive medicines were examined. Overall, combination products had higher out-of-pocket costs and lower total costs than did the sum of the costs of their components. For example, the out-of-pocket costs were greater for 24 of 27 combination drugs examined, and the mean increase in monthly out-of-pocket costs associated with combination therapy was $13.38 (95% confidence interval, $12.27-14.50). In contrast, the total cost was lower for 23 of the 27 combination drugs examined, and the mean decrease in monthly total costs was $20.89 (95% confidence interval, $20.10-21.68). Conclusions: Given patient burden and nonadherence from out-of-pocket prescription costs, the clinical benefits of brand-named fixed-dose combination antihypertensive therapy should be balanced with their greater out-of-pocket costs.