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. 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." 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. 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”. 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. This month, Horizon Pharma increased the price on Vimovo to $2,979 per 60-pill bottle, according to 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. 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. 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. 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. 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. Consider how Vimovo's net price -- the amount that Horizon makes after rebates -- has recently gone down. 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.
– 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.)