An Irish-domiciled pharmaceutical company has put a price tag of almost $3,000 (€2,400) on a bottle of two-in-one painkillers that can be bought separately for $36, in another instance of price gouging in the United States, the world’s largest healthcare market. 
 
 Horizon Pharma has continually raised the price of Vimovo, a common painkiller combined with a drug that prevents stomach irritation, since it acquired the US rights to the medicine in November 2013 from AstraZeneca. 
 
 The Dublin-based company raised the average wholesale price again earlier this month by 9.9 per cent, according to data reported by the Financial Times, taking the cost of a bottle of 60 pills to $2,979. 
 
 When AstraZeneca was selling the drug in the US, the price was $138 per bottle. But since Horizon has owned the rights, it has raised the price on 11 occasions by an aggregate of more than 2,000 per cent. 
 
 Soaring drug costs have been at the forefront of public debate in the US ever since biotech entrepreneur Martin Shkreli raised the price of a cancer and Aids medicine by 5,000 per cent. 
 
 US president Donald Trump addressed the issue in his State of the Union address last month, saying the administration would “make fixing the injustice of high drug prices one of our top priorities” and pledging “prices will come down”. 
 
 Vimovo is a mixture of two medicines: naproxen, an anti-inflammatory that treats pain but can also cause gastrointestinal problems such as ulcers and bleeding; and esomeprazole, a medicine known as a proton-pump inhibitor, which lessens the risk of stomach problems. 
 
 If purchased individually, the drugs can cost as little as $36 and both are available in over-the-counter forms: naproxen is sold under the brand name Aleve, made by Bayer, while AstraZeneca sells esomeprazole as Nexium. 
 
 Painful experience 
 
 “Companies often try to come up with equations where one plus one equals three. In this case, it appears one plus one ends up costing 83 times more,” said Michael Rea, chief executive of Rx Savings, which makes software to help patients reduce their drug bills. 
 
 He added: “It’s a painful experience for unsuspecting patients and insurers.” 
 
 Horizon also markets another two-in-one painkiller, Duexis, which is a mixture of ibuprofen, an anti-inflammatory drug, and famotidine, an antacid. A bottle of 90 tablets is priced at $2,979, while buying the pills separately can cost as little as $15. 
 
 The company generated $134 million in sales from both products in the first nine months of last year. 
 
 “Based on the mechanism of action of these drugs, I see no reason why these products can’t be taken individually,” said Mr Rea. 
 
 Express Scripts, a pharmacy benefits manager that negotiates with drugmakers on behalf of its employer and health insurer clients, said it included Vimovo and Duexis on the list of medicines it will reimburse but that they did not have “preferred” status. 
 
 To discourage people from picking more expensive “non-preferred” medicines, Express Scripts clients can ask patients to pay out of their own pocket. 
 
 But like other pharma groups Horizon tries to counter this by offering patients a savings card that can reduce their personal outlay to zero while continuing to bill the insurer for their full share. 
 
 Express Scripts said: “The constituent parts of these medications are available separately as generics for much less.” 
 
 It added that some of the PBM’s clients require patients try the individual drugs first before they will reimburse Horizon’s two-in-one medicines. 
 
 Step therapy 
 
 Horizon said this practice, known as “step therapy”, was in “direct conflict” with prescribing information from the US Food and Drug Administration, which says patients should not substitute the combination pills for individual tablets. 
 
 A company spokesman added: “There are no FDA-approved generic, over-the-counter or clinically equivalent medicines to Duexis and Vimovo, and any assertion otherwise is completely inaccurate.” 
 
 He also said Horizon operated patient assistance programmes that meant the majority of people pay less than $10 out of their own pocket. 
 
 However, patients still end up paying more for expensive drugs such as Vimovo and Duexis in the form of higher insurance premiums. – Copyright The Financial Times Limited 2018 ||||| An Irish drugmaker has jacked up the price of a painkiller to nearly $3,000 a bottle. The drug is 22 times more expensive than when the company acquired it in late 2013. 
 
 The sticker shock for Horizon Pharma's Vimovo drug is magnified by the fact that the painkiller's two main ingredients can be purchased separately -- for just $36. 
 
 Although patients typically pay just a fraction of the price for Vimovo, the dramatic price increase underlines what critics describe as a murky and wasteful system that ultimately leads to higher health care costs for all Americans. 
 
 A spokesman for Dublin-based Horizon said that the $2,979 wholesale price does not reflect "the cost to patients or the cost to the system." The company said it has programs to ensure that commercially-insured patients have access "at an affordable price" -- even if the patient's insurance refuses to cover the cost. Horizon estimates that 98% of all insured Vimovo patients pay $10 or less out of pocket. 
 
 The drug industry has come under increasing pressure from a series of scandals in recent years, including extreme price hikes on an AIDS drug by "pharma bro" Martin Shkreli and on lifesaving allergy treatment EpiPen by Mylan (MYL). 
 
 President Trump has repeatedly vowed to bring drug prices down. Just last month, Trump promised in during his State of the Union Address that his administration will work to fix the "injustice of high drug prices." 
 
 The day after Trump's speech, Horizon (HZNP) raised the average wholesale price on Vimovo by 9.9% to $2,979 per bottle. Horizon confirmed to CNNMoney the price increase, which was first reported by The Financial Times. 
 
 It's the latest in a series of about a dozen price hikes for Vimovo, which was listed at just $138 per 60-pill bottle in November 2013. That's when Horizon acquired the drug from AstraZeneca (AZN) and began raising prices. Today, the painkiller accounts for just over 10% of Horizon's annual sales, providing cash the company uses to develop treatments for rare diseases. 
 
 Related: How Trump plans to cut prescription drug prices 
 
 Vimovo is especially controversial because it was created by combining naproxen, which is sold under the brand name Aleve, and esomeprazole, a medicine that lowers the risk of stomach problems caused by pain relievers. Those ingredients can be purchased by patients very cheaply separately. 
 
 However, Horizon said that Vimovo is a special formulation that's not the same as simply combining the two main ingredients. 
 
 A Horizon spokesman noted there are no FDA-approved generic, over-the-counter or clinically "equivalent" medicines to Vimovo. 
 
 Still, Horizon warned investors in an SEC filing in November that the "higher cost" of Vimovo compared with generic or branded forms of their active ingredients "may limit adoption by physicians, patients and healthcare payers." The company said "we have faced challenges due to pharmacists increasingly switching a patient's intended prescription" from Vimovo to a generic or over-the-counter brand of its active ingredient. 
 
 The sticker shock led at least two large pharmacy benefit managers, which negotiate with drug makers on behalf of employers and health insurers, to balk. Express Scripts (ESRX) and CVS Caremark put Vimovo on their exclusion lists until last year. 
 
 To counter the pricing concerns, Horizon has entered into rebate agreements with pharmacy benefit managers that lower the cost. 
 
 An Express Scripts spokeswoman said that Vimovo is currently on its non-preferred list. "This simply means it is not excluded from coverage, but also is not preferred," she said. 
 
 CVS Caremark (CVS) did not respond to a request for comment. 
 
 Related: These states want to import cheaper drugs from Canada 
 
 Pricing in the pharmaceutical supply chain is notoriously-murky, despite the enormous consequences on the nation's bloated health care costs. 
 
 Confidential rebates and side deals between drug makers, PBMs and insurers make it almost impossible to determine who is really cashing in when drug prices go up. 
 
 "There is no transparency. It's a big black box," said Annabel Samimy, an analyst at Stifel Financial who covers Horizon. 
 
 Consider how Vimovo's net price -- the amount that Horizon makes after rebates -- has recently gone down. Horizon's filings indicate that Vimovo sales tumbled 54% through the first three quarters of 2017 due mostly to "lower net pricing." 
 
 "What you see between the gross price and net price is a big bubble -- and we don't know where the savings are passed on to," Samimy said. "You need to understand who's in the middle between the manufacturers and the patient." 
 
 Samimy noted that pharmacy benefit managers and insurers are extremely profitable even as patients grapple with higher premiums and some drug makers deal with lower net pricing. 
 
 "The system in the U.S. has created warped pricing. Everyone points fingers at each other and nothing gets fixed," said Samimy. 
 
 — Editor's note: The headline on this story has been updated. ||||| Recurring price hikes by pharma companies have caught plenty of criticism lately, but the attention isn't dissuading some industry players. This month, Horizon Pharma increased the price on Vimovo to $2,979 per 60-pill bottle, according to the Financial Times. 
 
 February's hike is the 11th price increase on the med—a combo of Bayer's Aleve and AstraZeneca's Nexium—since it picked up U.S. rights from AstraZeneca in 2013, according to FT. 
 
 Horizon paid $35 million up front for the rights and a minimum of $5 million in royalties in 2014 and $7.5 million each year after. Since the deal, Horizon has raised Vimovo's price from a starting point of $138, according to FT. The components are available over the counter and can cost under $40. The FDA approved Vimovo in 2010 as a therapy to relieve symptoms for patients suffering from osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. It's also approved for certain patients to decrease the risk of developing gastric ulcers. RELATED: Allergan, Teva and others start 2018 with price hikes: analyst 
 
 A Horizon spokesperson confirmed the 9.9% price hike on Thursday. But he said the average wholesale price is "not reflective of the cost to patients or the cost to the system." As a result of Horizon's access programs, he added, 98% of commercially-insured patients can get the drug at $10 or less out of pocket. 
 
 Still, critics of pharma's price increases say patients end up paying through higher insurance expenses. 
 
 Horizon was among a group of specialty pharmas to increase prices at the end of 2017 or beginning of 2018, as highlighted in a note early this year by Jefferies analysts. According to the analysts, the company increased its prices on Actimmune, Buphenyl, Procysbi and Ravicti by 9.9% effective on Dec. 29. 
 
 An ultra-orphan med, Ravicti is among the world's most expensive drugs and costs $405,000 per year after discounts, a spokesperson previously told FiercePharma. He noted that fewer than 500 patients receive the drug annually.
– A painkiller that cost $138 a bottle less than five years ago now hovers at close to $3,000—the latest price hike to put the pharmaceutical industry in the spotlight. CNNMoney reports Horizon Pharma's latest increase on Vimovo, which has seen nearly a dozen such rate rises since Horizon acquired it from AstraZeneca in 2013, amounts to a 9.9% increase on a 60-pill bottle, making the wholesale price $2,979. The high cost of the med—which FiercePharma explains is prescribed to help ease symptoms from certain forms of arthritis and to prevent gastric ulcers—is also raising eyebrows because its two main ingredients, naproxen (sold as the Aleve brand) and esomeprazole (commonly sold as Nexium), are sold separately for under $40. "Based on the mechanism of action of these drugs, I see no reason why these products can't be taken individually," the CEO of a company that makes software to help ease drug payments tells the Irish Times. Horizon Pharma disagrees: It says taking the meds separately isn't the same as taking the combo pill; it adds there's no generic or OTC version of Vimovo. The company also pushes back on the steep price, noting it has rebates that allow all but 2% of insured patients to get the drug for less than $10 out of their own wallet. However, analysts say the price hike ends up raising insurance prices overall. It also underlies the murkiness of what happens when drug prices rise, as no one's really sure who's making money off the deal; besides the manufacturer, insurers and pharmacy benefit managers are also in the mix. (Walmart has a plan for your leftover opioids.)