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

"Nexium is more effective at controlling acid and better in healing acid-related damage," he said in a statement. "More patients have better acid control with Nexium than with other branded medications of its type."

Few drugs in the United States have been as widely advertised as Nexium, which was introduced in 2001 to replace Prilosec when that drug's lucrative patent expired. (Prilosec is still available in a prescription form and a lower-dose over-the-counter version.) Nexium was the most heavily advertised drug in 2004, with $2.2 million spent, said Christine Franklin, spokeswoman for DTC Perspectives, a consulting company.

The result is "the triumph of marketing over science," said Sharon Levine, a physician who oversees pharmacy operations for Kaiser Permanente's Northern California group. "There's no science behind this being a superior drug. It's a purely promotional and marketing success."

She does not blame drug companies.

"This is not evil on the part of manufacturers. It's a strategic business decision to try to preserve and extend the length of a patent," she said. "It's the job of prudent prescribers and prudent purchasers to ask the question: Is this just new, or is it new and improved?"

Nationwide, medications to treat heartburn and ulcers were second in sales, behind cholesterol-lowering drugs, in 2004, according to IMS Health, an independent research firm. As the Pentagon's second-costliest class of drugs -- at $379 million last year -- proton pump inhibitors were a prime target, said Col. James H. Young, director of the Defense Department's pharmacy programs.

A team of doctors and pharmacists reviewed 15 studies and concluded there were "no significant differences clinically in those drugs," he said, and "Nexium was far more costly." Of the five heartburn medications, Nexium represented 33 percent of total retail purchases for military personnel last year -- more than 528,000 prescriptions.

As of July 17, people insured by the Pentagon will be offered the four other heartburn drugs -- Zegerid, Protonix, Aciphex and Prevacid -- for a $9 co-payment per prescription. Patients, with the backing of their physicians, can request an exemption if the other drugs fail to bring relief and only Nexium works. Or the patient can pay the Pentagon's negotiated price of $22, still a bargain compared with the retail price of more than $120. And the military will save money not only by dropping Nexium but also as a result of lower prices offered by AstraZeneca's competitors, Young said.

AstraZeneca spokesman Albaugh said the company did not bid on the military contract because the Pentagon based its decision "exclusively on price."

Some health care purchasers have grown frustrated with what they say are attempts to game the market, by introducing "me, too" drugs or clamping down on supplies of generic versions as a way to force patients to stick with the more expensive brand name.

In Arkansas, officials introduced incentives for state employees to switch from prescription medications to the over-the-counter version of Prilosec, said Jill Johnson, a consultant to the state and a professor at the College of Pharmacy at the University of Arkansas for Medical Sciences. But for a sudden and suspicious shortage of the nonprescription Prilosec OTC, the state would have saved $4 million in the first year, she said.