By Dr. Evan, Levine, MD

A patient came to me recently with a prescription for Rapaflo, given to him by his urologist. He was told not to fill it until he reviewed the medication and its risks with me, his heart doctor. I told him he should not take it.

“Is it dangerous for my heart?” he asked. “No, but it is dangerous to your wallet,” I told him. I handed him a prescription for generic Flomax and suggested he take that instead.

Rapaflo is one of several drugs, also known as alpha blockers, that are indicated in the treatment of symptoms related to benign prostatic hypertrophy, or BPH, and is sold, and aggressively marketed by Actavis Pharmaceuticals. Prescription drugs of this class work by relaxing the prostate smooth muscle around the urethra to improve the flow of urine and prevent lower urinary tract symptoms (LUTS) like hesitancy in starting the stream of urine or a frequent need to urinate.

In an on-line advertisement for their product Actavis asks:

What makes Rapaflo the right choice for you?

Your symptoms can be disruptive. Get rapid and continue relief?

Learn how Rapaflo targets and relaxes the prostate to quickly relieve symptoms of an enlarged prostate. Explore why it works and its side effects to determine if Rapaflo is right for you.

 

What is lacking in their ads is any comparison with similar medications that cost a fraction of what Rapaflo does. And that’s because they can’t! In a brilliant maneuver Activis labs, the maker of Rapaflo, never conducted any large randomized trials, comparing their expensive drug with less costly generics like tamsulosin, the generic version of Flomax; they just performed studies against placebo and Rapaflo clearly worked far better than nothing. Perhaps fearing that their drug might be equivalent to or not as helpful as a cheap generic, and because the FDA does not require Pharma to compare their drug to a standard treatment for approval, they didn’t.

While generic Flomax has millions of patient-years of tried and proven use, the day Rapaflo was released to the market, after being tested on a far smaller population of patients, it had a very limited data base. If you were to look up what the experts have to say and review the guidelines for the American Urologic Association, you would find this statement: “The older, less costly, generic alpha blockers remain reasonable choices.” The expert panel goes on to mention the newest alpha blocker noting that: “The older, less costly, generic alpha blockers remain reasonable choices. “

I suspect the patient I saw the other day should live at least another 15 years. At the current pricing for both Rapaflo and generic Flomax (tamsulosin — and prices should fall even further) it might cost him, if he paid out-of –pocket, around $27, 960 dollars for his Rapaflo. Generic Flomax would cost about $2,070 dollars for the same period of time (based on the current average price of $466 dollars for 90 day supply for Rapaflo and $46 dollars for generic Flomax). Other medications, like generic Hytrin, although not suited for as many patients as Rapaflo or Flomax, cost just pennies a day. Hytrin can work to lower a patient's blood pressure and perhaps be a perfect medication for a man with poorly controlled hypertension and symptoms of BPH.

Many of you have some form of prescription coverage that will alleviate some of the additional expense of accepting a prescription for Rapaflo instead of generic Flomax. And yet you will be, in a way, as guilty as the drug rep who hawked Rapaflo, as guilty as the expert urologist who accepted payments for speaking for the makers of Rapaflo, or as guilty as the doctor who prescribed it for you, for the escalating cost of healthcare in America.

So why is it that doctors are prescribing Rapaflo to patients in record numbers if the American Urologic Association tells us that less costly generic blockers are reasonable choices and even the makers or Rapaflo can’t say their drug is any better than the older ones? It’s because Activis wants them too. It’s the same reason why millions of Americans are conned into taking other expensive, branded meds through direct-to-consumer ads and doctors who essentially prostitute themselves for Big Pharma. In 2014 , Paul M. Bisaro, the CEO of Activis seemed to be very happy with Rapaflo soaring sales when he wrote, “In our branded pharmaceuticals business, growth during 2013 was driven by strong sales of core products in the U.S., including the Rapaflo”

If you want to contribute to our country’s effort to provide affordable health care for everyone and reduce your health care expenses, then just say NO to Rapaflo!

About the author: Evan S. Levine, MD FACC, is Director of the Cardiovascular Center at Saint Joseph’s Hospital and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or can’t) Tell You”. He lives in Connecticut with his wife and children.