Cost of Suboxone

A Reader Writes:

Message:

The State of XXXXXX prescription price list noted Target Pharmacy as the cheapest for Suboxone at $6.99/Suboxone pill, 8mg-2mg, qty. 30. So I started getting my prescriptions filled at Target.

Well, needless to say they raised their prices twice since then and I am now paying $8.158333/Suboxone pill, 8mg-2mg, qty. 30, Nov. 12, 2011.

My question: How can they be alowed to jack their prices up so fast and so high in a short period of time? What can I do? It’s like they pulled a bait and switch on me.

Please write back Dr. Junig

My Reply:

I sympathize with you.  The best thing you can do is have an educated and educatable doctor– someone who has enough humility to recognize when he/she is wrong, and adjust accordingly.  Somebody who recognizes that as physicians, we are constantly sorting through new data, responding clinically to phenomena according to science.  Most importantly, someone who recognizes that in medicine, as in all fields, people make assumptions about things with partial data, and sometimes later learn that their assumptions were wrong.

I realize that is difficult in the current era when people with addictions are considered ‘manipulative’ for simply raising appropriate questions. The truth is also competing with the marketing and persuasion tactics by Reckitt-Benckiser– a company that has found a way to influence policy-makers in government and addiction societies.  I am generally a fan of corporate greed, as I believe that the marketplace is the best stage for ideas to rise or fall (mixing several metaphors, I know!)  But I am appalled by the extent of involvement of Reckitt-Benckiser, the British corporation that makes Suboxone, with physician societies– the groups that are supposed to be advocating for policies that save lives that are being lost to addiction.

The generic tablet of orally-dissolving  buprenorphine, 8 mg, is FDA-indicated for treating opioid dependence.  In Wisconsin, some pharmacies have it for as low as $2.35 per tab;  the more expensive places sell it for $3.00.  It is CLINICALLY IDENTICAL to Suboxone;  the naloxone in Suboxone is not absorbed sublingually (actually, 3%-5% is absorbed, but does nothing clinically), and after being swallowed the naloxone is completely destroyed at the liver by first pass metabolism.

Suboxone is supposedly safer then generic buprenorphine because naloxone supposedly causes withdrawal if injected.  This is the only justification (initially put forth by the folks at Reckitt-Benckiser) for the need for Suboxone.  The justification is flimsy, since many people who would benefit from the lower price of buprenorphine have very little risk of injecting the medication.  But worse, the flimsy justification is a lie. People who have injected Suboxone intravenously (I have met and heard from many of them) report NO withdrawal from naloxone-containing Suboxone.  What’s more, people who wrote to me who have injected both buprenorphine and Suboxone, at different times based based on availability, have all reported the same thing– that the subjective experience from injecting either substance is identical.

I must point out here that there are MANY reasons to avoid injecting any substance– but particularly a substance made to be taken orally.  These compounds contain fillers that destroy the capillary beds of the lungs, where oxygen is absorbed– potentially leading to severe lung damage.  And infection is always a huge risk, when placing poorly-sterilized material directly into the bloodstream.  Please– don’t do it.

Back to taking buprenorphine properly… the high cost of Suboxone is an unfair burden for patients without insurance coverage, when a much cheaper, idential alternative is available.

I am going to remove your name and location, and put up your question on my blog;  you are then welcome to bring a copy of the post to your doctor. You can also tell him/her to read prior posts, where I explain all of this in greater detail.

For Doctors and Insurance Formulary Committees:

I implore you to look into the facts of this situation with an open mind.  I have a PhD in Neurochem, besides 10 years of experience as an anesthesiologist and training and experience in psychiatry.  Some insurers cover buprenorphine;  they are, of course, the smart ones.  Your company can save a great deal of money by simply allowing the generic equivalent to be covered.  States that mandate the use of Suboxone or Suboxone Film could save large sums of money for their taxpayers.  And doctors–  your cash-paying customers could really use the break, especially in this economy.  If you are concerned that a patient is injecting medication, I understand your hesitancy— even though, frankly, it is misplaced, given that BOTH Suboxone and buprenorphine can be injected.  If your patient pays cash, and never injected medication, do you REALLY think that person is going to start injecting buprenorphine– since doing so would not create any effects?  The ‘ceiling effect’ is in place for ANY route of administration, so a patient taking sublingual Suboxone, who injects buprenorphine, will feel… NOTHING.

Give your patient the gift of affordable treatment as a Christmas present.  You may be saving someone’s life.

JJ

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3 thoughts on “Cost of Suboxone”

  1. I really appreciate someone advocating for the many still suffering opioid addicts who could afford treatment through HDB (high dose buprenorphine) if they were allowed to take generic Subutex. I can name at least 4 individuals right off the top of my head, that were doing really well taking Suboxone and then they eventually lost their health insurance through their parents when they turned 26 or their own insurance would only pay for the medication for a certain period of time. All of these people asked if they could switch to generic Subutex because they couldn’t afford to pay out of pocket for both the Dr.’s appointments and the name brand which can cost up to $8 per tab. All of them were told they couldn’t switch even though 3 of them had no prior use of needles. As of the last time I spoke to them, they had all started using again and only 1 person are now caught up in active addiction. It just doesn’t make sense considering how much more money is spent in tax dollars to pay for their frequent jail and ER visits and the public defenders that represent them when they “catch a case”. It would be alot less expensive for all of us if they were allowed to take generic. I was lucky nough to have a dr. who allowed me to take generic after my parents insurance dropped me a year ago. I have a hard time affording the treatment even though my dr. is only charging me $50 per visit once every 2 months and both my wife and I have fulltime jobs. It really saddens me to think about a corporation (R&B) trying to wring every cent they can out of addicts and programs like Medicaid. I hate to say it but they know damn well that most addicts are in financial catastrophe by the time they even consider getting treatment. That’s not to say I don’t expect them (R&B) to not make a profit but by repackaging the same medication into a film they’ve virtually created a monopoly. Apparently they didn’t notice that they’ve already enjoyed the butt loads of money they made over the period before the patent on their Suboxone/Subutex tablet patent!

  2. There are two separate and distinct issues involved regarding the astronomical price of Suboxone.

    1. Why is the most efficacious drug to come along and treat opioid dependency cost $9.00 and up? Sure does make it damn hard for the average addict who uses a bundle a day or more to come up with $500 and up at one time. This drug is not advertised. There is no dedicated sales force. The drug is detailed to physicians as an afterthought. Why is this important? Considering that Reckitt Benckiser Pharmaceuticals already footed the bill for the patent and only a small percentage of the companies budget is spent on advertising; why does Suboxone cost so much and continue to rise in price?

    2. The generic is NOT CLINICALLY THE EQUIVALENT. According to the U.S. Food and Drug Administration (FDA), generic drugs are identical or within an acceptable bioequivalent range to the brand-name counterpart with respect to pharmacokinetic and pharmacodynamic properties. What does that mean; bioequivalent range? The word range does not make me think of the word identical or equivalent. It gets better. Check this out. The FDA’s use of the word “identical” is very much a legal interpretation, and is not literal. Really? Identical does not really mean identical? Nope. Here’s the deal on generics: as long as said generic has from 80%-108% bioequivelent range, it falls within FDA guidelines. That is some range. How do you get an accurate blood-serum level? By the way, Subutex. is not a generic form of suboxone. It’s a different drug entirely. Subutex is Buprenorphine only. Suboxone is Buprenorphine and Naloxone. Naloxone is a drug used to counter the effects of opiate overdose. The primary reason Nalaxone is added to Buprenorphine, thus making Suboxone is to decrease potential use of cooking the drug.

    If you go to the website, the company does offer a $45.00 monthly reduction for six months. How generous.

  3. I mostly agree. I have had many patients take the generic form of Subutex– i.e. buprenorphine– and they found no difference between that medication and Suboxone. I am not getting into the argument over generics for non-generics– my point is that Suboxone and Subutex are clinically identical. Naloxone is an intravenous medication that is not active orally– and not active sublingually. It is included in Suboxone theoretically to prevent intravenous use of buprenorphine. BUT– in reality, it doesn’t even do that. Naloxone binds with a very low affinity to the opioid site, and so it does little or nothing to compete with the actions of buprenorphine.

    I agree 100% that Reckitt Benckiser has been gouging patients for years. My frustration now is that they are effectively preventing generic manufacturers from entering the market, by falsely convincing insurers and state agencies that Suboxone tablets are not safe. Funny– they are saying that as they continue to make them!