When you’re managing a chronic condition like high blood pressure or type 2 diabetes, you don’t just want your meds to work-you want them to be affordable. That’s where the choice between a combo generic pill and buying the same drugs as separate generics comes in. At first glance, a single pill with two medicines sounds convenient. But is it worth the extra cost? The answer might surprise you.
Why Combo Pills Cost So Much More
Fixed-dose combination (FDC) drugs combine two or more active ingredients into one tablet. On paper, it makes sense: fewer pills to remember, better adherence, simpler dosing. But when those combo pills are brand-name versions-especially when one or both ingredients are already available as cheap generics-the price jumps way out of line. Take Janumet, a combo of sitagliptin and metformin. In 2016, Medicare paid an average of $472 for a 30-day supply. Meanwhile, generic metformin? Around $4 at Walmart’s $4 generic program. Even if you paid full price for the sitagliptin (which was still under patent at the time), the total cost of buying them separately would’ve been less than half. And that’s not an outlier. A 2018 study from Boston University looked at 29 brand-name combo drugs used by Medicare Part D. They found that if patients had instead taken the same drugs as separate generics, Medicare would’ve saved $925 million in just one year. That’s not a rounding error-it’s nearly a billion dollars wasted because of how these drugs are priced.The Math Doesn’t Add Up
Here’s the weird part: combo pills aren’t priced like the sum of their parts. If you added up the cost of two separate generic pills, you’d expect the combo to be slightly higher-maybe 10-20% more to cover packaging and convenience. But that’s not what happens. IQVIA’s 2022 analysis showed that branded combo drugs typically cost about 60% of what two branded pills would cost together. Sounds good, right? Except when the individual components are already generic, that 60% rule doesn’t apply. In those cases, combo drugs often cost 10 to 15 times more than buying the same ingredients separately. For example, Kazano (alogliptin + metformin) cost patients $425 a month. Generic metformin alone? Less than $10. Even if you paid full price for alogliptin-which was still under patent-the total would’ve been under $150. So why pay $425? Because the manufacturer knows that once you’re on the combo, switching back feels complicated. And insurers often don’t force the issue.When One Drug Is Generic, the Other Isn’t
This is where pharma companies play a long game. They take an old, off-patent drug-like metformin or valsartan-and pair it with a new, expensive one. The result? A combo pill that looks innovative, even though one ingredient has been around for decades. This tactic is called “evergreening.” It lets companies extend their monopoly on the new drug by bundling it with something cheap and generic. Patients get stuck paying premium prices for a pill that could be made for pennies. Take Entresto (sacubitril/valsartan). Valsartan has been generic for years. Sacubitril is still under patent. But Entresto costs over $500 a month. Buy the two separately? You’re looking at maybe $150 total. That’s a 300% markup on the generic component alone.
Why Do Doctors Still Prescribe Them?
It’s not that doctors don’t know. Many do. But there are real reasons combos get prescribed. Studies show patients are 15-20% more likely to stick with their meds when they take one pill instead of two or three. For someone juggling five different drugs for diabetes, heart disease, and high cholesterol, reducing pill burden matters. Missed doses lead to hospital visits-which cost way more than any drug. The American College of Cardiology found that in complex patients, combo pills can improve adherence by up to 25%. That’s not trivial. Fewer ER trips, fewer complications, better long-term outcomes. But here’s the catch: that benefit doesn’t justify paying $400 a month for a pill that could be made for $20. If the goal is better adherence, why not prescribe the generic components separately and give the patient a pill organizer? Or use a mail-order pharmacy that delivers everything in one box?How Insurance Plans Handle This
Medicare Part D plans know this is a problem. That’s why 62% of them require prior authorization for high-cost combo drugs. Some plans even have “carve-outs”-meaning they won’t cover the combo at all unless you’ve tried the generics first. Pharmacy benefit managers (PBMs) are starting to push “preferred generic” policies. That means if you can get the same effect from two separate generics, your plan will make it cheaper-or even free-to take them that way. A 2020 study from the University of Michigan Health System found that switching patients from branded combos to separate generics saved an average of $1,200 per patient per year. That’s money that goes back into the system-or into the patient’s pocket.
What You Can Do
If you’re on a combo drug and you’re paying a lot for it, ask your pharmacist or doctor this:- Are both ingredients available as generics?
- Can I get them as separate pills for less?
- Is there a prior authorization process to switch?
