The market for painkillers is huge. People dont like pain and inflammation, and last year Americans spent nearly $4 billion on just two of them Vioxx and Bextra. Those two drugs, part of a family of non-steroidal anti-inflammatory drugs known as COX-2 inhibitors, were withdrawn from the market recently amid concerns that they can cause heart attacks and strokes. The loss of these two drugs to the marketplace is huge, as they were the two largest sellers in a fairly narrow field. COX-2 inhibitors differ from traditional non-steroidal anti-inflammatory drugs in that they inhibit production of the COX-2 enzyme that causes inflammation but do not interfere with COX-1, the enzyme that protects the stomach lining. Patients who use these drugs are thought to suffer less from internal discomfort and bleeding than those who took traditional anti-inflammatories, such as naproxen and ibuprofen.

With the withdrawal of these two blockbusters, patients with chronic pain, such as arthritis sufferers, are now going back to older painkillers, such as Mobic, Motrin, and Relafen. Since the more popular Vioxx and Bextra are no longer available, these older drugs are enjoying a resurgence in popularity, and sales are up across the board. So, it seems, are their prices. A recent study by a popular consumer publication shows that prices of some three dozen anti-inflammatory medications have gone up since Vioxx was withdrawn from the market in September 2004. The increases average about ten percent. Why have the prices of these older, established medications all gone up at once?

The answer, simply, is that the pharmaceutical companies have raised the prices because they can. The market for drugs is wildly competitive, and manufacturers are constantly seeking any advantage they can find in the marketplace. The sudden withdrawal of two of the most popular and profitable medications has provided a rare opportunity for manufacturers to increase both sales and prices at the same time, as the drug makers know that patients must switch to another medication. Its good for their stockholders, but bad for those who suffer from pain.

Will the high prices last? Probably not. Pricing of highly competitive medications tends to be volatile. The prices may stay up in the short term, but other medications may be introduced soon, or Bextra or Vioxx may be returned to the market. The introduction of other drugs will restore more competition to the market, and prices may drop once again. The market for painkilling drugs is a bit of a crazy one, and patients should simply exhibit some, well, patience.