Pentagon to Drop Nexium From Its List Of Covered Drugs for Military Personnel

'Purple Pill' Nexium the First to Be Cut

Beginning this summer, nearly 140,000 active and retired military personnel and their family members will find that the Pentagon has stopped picking up the tab for their Nexium, the blockbuster heartburn drug marketed as the "healing purple pill."

It is the first time the Defense Department has decided for financial reasons to drop a licensed medication, and a harbinger of many difficult choices Pentagon officials envision as they try to rein in a $5 billion-a-year pharmaceutical budget that has exploded by 500 percent in the past four years.

Taking a cue from the corporate world and a direct order from Congress, the Pentagon is in the early stages of implementing a program that discourages use of expensive "me, too" medications that have been found to provide no major medical advantage and yet are priced significantly higher than competing drugs. This mini-rebellion against a drug that generated $4.8 billion in U.S. sales last year is part of the more aggressive tactics health care purchasers are employing in the ongoing battle over soaring medical bills.

"Nexium is not worth the money, period," said Mike Krensavage, a pharmaceutical industry analyst at Raymond James Financial. "It's pretty dubious to pay $4 a pill for Nexium when you can get over-the-counter Prilosec for 67 cents."

By switching patients from Nexium to one of four cheaper medications for heartburn and ulcers, the Pentagon expects to save "many tens of millions" of dollars a year, said William Winkenwerder Jr., assistant secretary of defense for health affairs. He also intends to tighten access to the more expensive versions of drugs that treat such illnesses as skin infections, hypertension and erectile dysfunction.

"The goal is to ensure that the best value is obtained for our beneficiaries," he said in an interview.

For decades, private employers, insurers and some state Medicaid programs have refused to pay for some pricey medications by creating a preferred drug list, or formulary. Long ago, major insurers such as WellPoint and Kaiser Permanente refused to put a host of copycat drugs, including Nexium and the antihistamine Clarinex, on their preferred lists.

But for the military, which until now has covered virtually every legal medication, the decision to drop the "new purple pill" represents a cultural shift. After providing unlimited, gold-plated medical care for 9 million members of the armed services and their families, Pentagon leaders suddenly must contend with the same financial burdens that have prompted many small businesses to drop health insurance entirely and large corporations such as General Motors to contemplate equally drastic steps.

When patients complain of severe heartburn or acid reflux, they frequently ask for Nexium by name, said Lt. Cmdr. Robert Catania, a staff surgeon at the National Naval Medical Center in Bethesda.

"A lot of people will say, 'I heard Nexium is the best drug, so that's what I think I should be on,' " he said, noting that the comments mimic almost verbatim Nexium's commercials. He tries to steer patients toward cheaper alternatives. But with 25 million Nexium prescriptions written in the United States last year, Catania said, it seems few doctors resist pressure from patients and drugmaker AstraZeneca.

"My mother went to her primary-care doctor with heartburn, and he gave her Nexium right away" when Tums might have sufficed, Catania said.

AstraZeneca spokesman David Albaugh disputed assertions that Nexium is effectively the same as other proton pump inhibitors.