Americans are used to negotiating prices–some call it haggling–for big-ticket items like cars and houses. Sometimes parents arm-wrestle colleges over tuition aid. But rarely do we bargain over the price of a cup of coffee, a pair of shoes or prescription drug prices. That last item could be a big mistake.
Prescription Drug Prices Are Highly Variable:
It turns out that there is enormous variation in the prices that pharmacies in the same region may charge for an identical drug. This has been brought into sharp relief by an article published in JAMA Internal Medicine (online Nov. 15, 2016).
The authors investigated prices of generic drugs to treat heart failure in the city of St. Louis, Missouri. These medications are not optional: they are crucial for survival. But they are also not fancy new brand-name medications. They’ve been around for years, so doctors and patients both expect them to be affordable.
The investigators were inspired to collect data on drug prices when one of them got a call from a patient who couldn’t afford his heart pills. He had a bill for $100 at a local pharmacy. The doctor was startled, since he’d expected the bill would be closer to $5.
Investigating Prescription Drug Prices:
So he and his colleagues called pharmacies in two states in the greater St. Louis metropolitan area. They requested prices for three heart drugs: carvedilol, digoxin and lisinopril. Over 150 chain pharmacies and 22 independent pharmacies were queried.
The data they got were all over the map, with prices for a 30-day supply of digoxin, for example, ranging from $4 to $300. For the combination of all three drugs, often prescribed together, the lowest price was $12 and the highest was $397.58.
Pharmacy type, state, neighborhood and ZIP code were not consistently associated with the variation in price. This seemed to change with each individual store, and was not determined by dose or duration of prescription. According to the researchers:
“Only 1 chain had consistent pricing across its stores…In conclusion, generic drugs for HF [heart failure] show wide variability in pricing at the retail pharmacy level.”
Negotiating Prescription Drug Prices:
What can patients do when faced with such a chaotic situation? The first lesson is that you have to shop around. Prices may be vastly different between two pharmacies around the corner from each other.
The other lesson: hone your negotiating skills. That was perhaps the most surprising advice offered by Consumer Reports last summer (July 29, 2016).
Ask the pharmacist, “Is this your best price?” Some are prohibited from volunteering such information but can respond to a direct question. And certain pharmacies may be willing to match the lowest price you find elsewhere. Even though we shouldn’t have to haggle over the price of medications, what is at stake for heart failure patients is their life as well as their money.
The Downside of Shopping Around:
One disadvantage of shopping multiple drugstores for the best price is that the responsibility for keeping track of overlapping or interacting medications falls more heavily on the patient. Those who must use several pharmacies should always keep a complete list of their medicines and ask about interactions each time they get a new drug. It is also important for the prescriber to double check for drug incompatibility. Remind your physician or PA about all the medicines you are taking and make sure she verifies there are no dangerous interactions.
Shopping Online for Better Deals:
There is rarely a reason to shop online for generic drugs. That’s because U.S. prices are nearly as low as any place in the world. In the U.S. the generic drug business is cutthroat. Most of the generic drugs purchased in this country are now made abroad in countries like China and India. Insurance companies and third party payers often force pharmacies to purchase the lowest cost generics without requiring research on the reliability of the manufacturers. Of course, the investigators who carried out the recent research that was published in JAMA Internal Medicine found that even the cost of generic drugs can vary from pharmacy to pharmacy in the U.S.
If you are looking to purchase brand name products, you may be even more surprised by the difference in price. The people at PharmacyChecker.com recently analyzed some commonly prescribed medications that have a narrow therapeutic index (NTI). Such drugs should have little to no variability in quality because the dosage must be kept within a very narrow range.
In the U.S. the brand name anticoagulant Coumadin could cost more than three times the price in a Canadian pharmacy. There was an even greater price discrepancy between the heart drug Lanoxin when it was purchased in the U.S. vs. in Canada.
If you are struggling with sticker shock at the drugstore yourself, you may be interested in our Guide to Saving Money on Medicines. It is available online at PeoplesPharmacy.com. In it, you’ll discover our ten tips for saving money, including shopping around, bargaining and checking to see if you qualify for free medicine.