AstraZeneca’s gastrointestinal drug Nexium (esomeprazole) has become the first licensed drug to be dropped from the US Department of Defence’s medicine formulary in a money-saving drive.

Nexium had been included in the list of proton pump inhibitors in the basic care formulary (BCF), which was set up in 1998 and makes up the list of drugs prescribable at treatment facilities serving the armed forces. But the Department of Defence has decided to drop Nexium from the BCF in favour of other, cheaper drugs in the proton pump inhibitor class.

The Pentagon’s decision to rein back its $5 billion dollar spend on drug treatments, first reported by the Washington Post, could also claim other high-margin casualties, and marks a trend by formularies in the US to be a lot more selective in their choice of drugs, with greater emphasis on the use of generics and over-the-counter products. This could suggest tough times ahead for AstraZeneca, as Nexium is now its biggest-selling product, with quarterly sales topping $1 billion in the first three months of this year [[28/04/05a]].

Despite a number of positive comparative trials [[05/11/03f]], AstraZeneca has in the past found it difficult to persuade prescribers that Nexium is significantly more effective than other PPIs, including its own forerunner Prilosec/Losec (omeprazole). With cheaper generic copies of omeprazole now on the US market, the lead taken by the Department of Defense is a worrying development for the drug’s future prospects.