Combo Generics vs Individual Components: Cost Comparison

When you’re managing a chronic condition like high blood pressure or type 2 diabetes, your doctor might prescribe a combination pill-a single tablet with two or more medications in one. It sounds convenient. Fewer pills to remember. But is it cheaper? The answer might surprise you: in most cases, buying the same drugs as separate generic pills costs far less-even when one of the ingredients is still under patent.

Take Janumet, a popular combo for type 2 diabetes. In 2016, Medicare Part D spent over $1.4 billion on just this one branded combination. Why? Because it combines sitagliptin and metformin. But metformin? It’s been generic for years. At Walmart, a 30-day supply costs as little as $4. The branded Janumet? Around $472 for the same amount. That’s more than 100 times the price. And Janumet isn’t an outlier. A 2018 study in JAMA Internal Medicine found that 29 branded combination drugs cost Medicare $925 million more than if patients had simply taken the generic versions of each drug separately. That’s not a rounding error. That’s billions of dollars wasted.

Why Do Combo Pills Cost So Much?

It’s not about manufacturing. It’s about pricing strategy. Drugmakers know that once a drug goes generic, its price crashes. So they bundle it with a newer, still-patented drug. This creates what experts call “evergreening”-a way to keep charging premium prices even when one component is dirt cheap.

For example, Nexlizet combines ezetimibe (a generic cholesterol drug) with bempedoic acid (a newer, expensive one). Even though ezetimibe costs pennies, Nexlizet still sells for $12 a day in the U.S. Why? Because the patent on bempedoic acid lets the company set the price. The system doesn’t force them to lower the combo price just because one ingredient is generic. In fact, the average combo pill costs 60% of what two branded versions would cost-but 300% to 1,000% more than the same drugs bought separately as generics.

The Math Doesn’t Add Up

Let’s break it down with real numbers. Here’s what happens when you compare combo pills to their individual generic parts:

• Entresto (sacubitril/valsartan) for heart failure: $400/month. Valsartan alone? A generic version costs $12. Sacubitril? Still branded, but even if you add the cost of generic valsartan + branded sacubitril, you’re still under $200.
• Kazano (alogliptin/metformin): $425/month. Metformin? $10/month as a generic. The math is clear: you’re paying $415 extra for convenience.
• Advair Diskus (fluticasone/salmeterol) for asthma: $300/month. Both ingredients have generic versions available. A generic combo exists, but even that costs more than buying two separate generics.

The pattern is consistent: when one drug in the combo is generic, the combo still costs 10 to 15 times more than buying the two separately. And yet, doctors keep prescribing them. Why? Because they’re easier to manage. Fewer pills. Fewer refills. Less confusion for patients.

But What About Adherence?

Drug companies argue that combo pills improve adherence. And they’re not wrong. Studies show patients are 15% to 20% more likely to take their meds when they’re in one pill instead of two or three. For someone with diabetes, heart disease, and high blood pressure, that matters. Missing doses can lead to hospitalizations, which cost far more than the drug difference.

But here’s the catch: that benefit doesn’t justify the price gap. A 2020 University of Michigan study found that switching patients from branded combos to separate generics didn’t hurt adherence-especially when pharmacists helped with packaging. One pill in a blister pack, labeled clearly, works just as well. And it saved the health system $1,200 per patient per year.

Who’s Paying the Difference?

Medicare Part D paid $925 million more in 2016 for these combos than it should have. That’s not a drop in the bucket. It’s money taken from the pockets of taxpayers and beneficiaries. The Congressional Budget Office projects that over the next decade, Medicare will spend an extra $14.3 billion on these overpriced combos compared to generic alternatives.

Private insurers aren’t immune. Many require prior authorization before approving combo drugs. Some even have “carve-outs”-they exclude certain combos from their formularies entirely. Why? Because they’re too expensive for the benefit they deliver.

Meanwhile, generic manufacturers are stepping in. More generic combos are hitting the market. But even those often cost more than buying two separate generics. And many patients don’t know they have a choice.

What Can You Do?

If you’re on a combo drug, ask your pharmacist or doctor: “Can I get the same ingredients as separate generics?” If one of the drugs is already generic, the answer is often yes.

Here’s how to check:

1. Look up the brand name of your combo pill.
2. Find out what active ingredients it contains.
3. Search for those ingredients individually as generics.
4. Compare prices at pharmacies like Walmart, Costco, or CVS. Many offer $4 to $10 generic programs.
5. Ask your doctor if switching is safe. For most conditions-hypertension, diabetes, high cholesterol-it is.

Some doctors worry about switching. They think it’s risky. But the science says otherwise. The American College of Cardiology acknowledges that for many patients, separate generics work just as well, especially with proper counseling.

The Bigger Picture

The Inflation Reduction Act of 2022 started to change this. It lets Medicare negotiate drug prices-including combos-for the first time. That could bring down prices. But it won’t fix everything. Until pharmacies and prescribers routinely offer generic alternatives, patients will keep overpaying.

Pharmaceutical companies aren’t evil. They’re following the rules of a broken system. The system rewards high prices for combos because it doesn’t link payment to actual value. It doesn’t penalize companies for bundling cheap generics with expensive new drugs. And it doesn’t make it easy for patients to choose the cheaper option.

The real solution? Transparency. Clear labeling. Pharmacist-led counseling. And insurance plans that cover the cheaper option first.

For now, the power is in your hands. Don’t assume the combo pill is the best choice. Ask the question. Do the math. You could save hundreds-or even thousands-each year.