Ah, the corner pharmacy. It’s been there for years, it’s just a short drive down the road, and the pharmacists are always so friendly, aren’t they?
I hate to break it to you, but behind those smiling faces at the counter, your corner pharmacy is hiding something from you. Specifically, its prices.
Jacob Milbradt, a pharmacist who blogs, has been writing about the fact that pharmacies often make big — even outrageous — profits on generic medications. The reasons for this include (1) that most people don’t comparison shop among their neighborhood pharmacies; and (2) that people assume that if a pharmacy is inexpensive for one drug, it’s probably relatively inexpensive across the board.
Take Wal-Mart, for example. With all the attention Wal-Mart has received for its $4 generics program, many consumers just assume that Wal-Mart is always going to give them a low price on their prescriptions.
But when Jacob did some comparison shopping for the generic form of Risperdal, he found extreme variations in pricing — and look who was overcharging the most for 90 1mg tablets:
Sams is charging about 30% of Wal-Mart’s price. Sams [owned by Wal-Mart] and Wal-Mart are obviously paying the same amount for this medication . . . yet Wal-Mart is charging an additional $275 compared to Sams.
The pharmacist, who has done this kind of price comparison for many drugs on his blog, generally finding the same wide price variations, laments that buyers must think twice before trusting their corner pharmacy:
People TRUST their pharmacist and pharmacy not to rip them off. Yet that’s exactly what happens every day throughout the nation. When it comes to managing your prescription costs, you have to realize that nearly every other entity only has their own interests in mind. Everyone’s looking out for #1 . . . and you’re left to foot the bill.
So always comparison shop when purchasing prescription drugs. You can save even more money by including Canadian pharmacies in your search.
Last week, the FDA approved the new antipsychotic drug Saphris for the treatment of schizophrenia and bipolar disorder in adults. Saphris is one of a class of brand-name drugs called “atypical antipsychotics” that includes Risperdal, Abilify, Seroquel and Zyprexa.
These “atypical antipsychotics” are distinguished from older, “typical antipsychotics” that include perphenazine, loxapine, haloperidol, thiothixene, and fluphenazine. All of these drugs have long been available as low-cost generics.
And last year, the first generic atypical antipsychotic — a generic version of Risperdal (risperidone) — hit the market, too. The price for risperidone has dropped dramatically in the past year … although your corner pharmacy isn’t necessarily passing along those savings.
For example, a pharmacist blogger did some research and found that while brand-name Risperdal goes for around $500 for 90 1mg tablets, pharmacies he called quoted him anywhere from $126.68 to $410 for the generic equivalent. He noted that many pharmacies cited the higher brand-name price first, so any generic price would sound good by comparison.
So is your best bet a brand-name antipsychotic, generic risperidone, or one of the older antipsychotic drugs?
Well, let’s compare the newest drug to hit the market — Saphris — with risperidone. According to reports:
In clinical trials with schizophrenia patients, Saphris was effective and well tolerated. Although Saphris demonstrated lower efficacy on positive symptoms than [risperidone] … Schering-Plough’s drug presented fewer adverse events than other atypical antipsychotics and some improvements on negative and cognitive symptoms compared to [risperidone]. However, Saphris’s twice-daily dosing regimen may be perceived to be inconvenient in the light of several other once daily options.
So it looks like a trade-off. The FDA, in announcing its approval of the drug, would only say that Saphris worked better than a placebo. We’ll have to see over time if Saphris proves to be worth paying brand-name prices.
My guess is that in most cases — or at least an increasing number of cases — doctors and psychiatrists are prescribing Risperdal first, and then the pharmacy is filling it as a generic, either as required by the insurance provider or at the customer’s request. While doctors like to have a variety of medications to choose from since all patients react differently, the brand-name antipsychotics face a declining market.
As for the older, “typical” antipsychotics, recent research indicates that they in many cases are similar in effectiveness to the newer drugs.
Bottom line: When you talk with your doctor or psychiatrist about antipsychotic medications, be sure to understand why he recommends a specific drug. Some doctors like to start their patients out on a typical antipsychotic first and move on to an atypical antipsychotic only if the initial treatments fail. But most today go straight to the atypicals. If you are concerned about cost, share this with your doctor so he can take this into account in making a recommendation.
Proposed legislation introduced in Congress on Friday by Sen. Jay Rockefeller (left) could have a huge impact on drug costs for Americans with big prescription bills.
The Affordable Access to Prescription Medications Act of 2009 would cap monthly out-of-pocket costs for medications at $200, including drugs under Medicare Part D as well as those in the private insurance market. Here are some additional details of the bill:
A growing number of insurers are moving vital medications onto specialty tiers, effectively pricing those treatments out of reach for many … While the patient typically pays an increasing but fixed amount for medications on the first three tiers of a formulary, the fourth tier, or specialty tier, imposes a co-insurance or percentage (20-35 percent or more) of the drug cost…
The Affordable Access to Prescription Medications Act would help control this cost-sharing system and create a monthly $200 per medication cap on all out-of-pocket prescription drug costs, and a monthly $500 per person cap for those taking more than one medication. Many health care reform proposals seek to cap yearly out-of-pocket drug costs, but this legislation takes it one step further by capping monthly out-of-pocket drugs costs.
I can tell you from my own family’s experience, we have had to deal with major illnesses like cancer, where in many cases the drugs are very expensive and you are forced to pay a significant percentage of the cost despite being insured. We have had months where we have had to pay $2,000 or more just on the copays of our prescribed drugs.
Rockefeller cites stats showing that many chronically ill people with such out-of-pocket costs are simply not filling their prescriptions:
Prescription drugs represent the highest out-of-pocket cost for patients, comprising almost 31 percent of total out-of-pocket spending. The higher the out-of-pocket cost, the fewer individuals fill their needed medications. In fact, about 20 percent of individuals with out-of-pocket spending greater than $250 a month do not fill their prescriptions and further exacerbate their already serious health conditions. Out-of-pocket expenses are only getting worse, especially as prescription drug costs increase.
Let’s hope this legislation passes. In the meantime, you can always find the lowest prices on your prescription drugs at Freebee Foreign Pharmacy.
I got a call from a friend the other day who had received a letter from Humana, his insurance provider. The letter was headlined, “Why Not Spend Less On Your Medications?”
Here’s an excerpt:
Dear ….:
Did you know that you can save as much as $360 annually on your prescriptions? Don’t spend more than you need to on your medications.
Take advantage of the guidance (sic) Humana’s Maximize Your Benefit Rx program. Our pharmacist offer (sic) helpful information about saving money through the use of lower-cost alternatives and prescription home delivery.
Our records show you recently filled a prescription for Lipitor. Did you know that you can request a lower-cost medication? Ask your doctor whether you can replace your higher-priced medication with a lower-cost alternative … Just take this letter to your doctor to discuss the alternatives our pharmacists suggest in the table below.
So, is Humana thinking of you — or its own bottom line — when it makes this kind of recommendation?
First, it’s important for you to know that, while the alternatives suggested by Humana are generic drugs, Lipitor does not have a generic equivalent on the U.S. market. That’s why it’s the top-selling drug in the United States.
The other drugs suggested by Humana are all in the same class as Lipitor. They are statins, and all are prescribed for lowering blood cholesterol.
However, they do not necessarily have the same levels of efficacy. Lipitor can have a greater impact on lowering cholesterol than any of these generics, according to studies. In general, if you have a mild or moderate case of high cholesterol, a generic might work well for you. But most doctors think Lipitor is the best cholesterol drug on the market.
So, as always, ask your doctor. But don’t expect your health insurance provider to have your best interests at heart when they make this kind of recommendation.
Onglyza was approved by the FDA on Friday to compete with Januvia, the DPP-4 diabetes drug that has enjoyed a monopoly in its class since 2006. Januvia’s maker, Merck, sold $1.4 billion of the drug worldwide in 2008 alone.
All indications are that Onglyza is virtually identical in substance and effectiveness to Januvia — so you would think this might lead to lower prices for these drugs, wouldn’t you?
That’s what competition is all about, right?
Nope.
According to Reuters, AstraZeneca and Bristol-Myers Squibb, the makers of Onglyza, have decided to price the drug at a U.S. wholesale price of $5.72 per pill for common dosages.
That’s identical to Merck’s price for Januvia.
What a coincidence!
This is a great example of what’s wrong with our healthcare system. These drugmakers all know that the market is a mess — with copays, insurance companies, pharmacy benefit managers, and pharmacies themselves all standing between you and price transparency. They know that it’s difficult for consumers to fight back and demand price-based competition.
And so they have their little “gentlemen’s agreements” to not get into price wars. So everybody gets to pay the monopoly price.
This means that in the onslaught of Onglyza advertising you can expect to see on your television beginning any day now, you won’t hear a word about price.
In fact, when’s the last time you saw a pharmaceutical commercial where the drugmaker advertised that its product was cheaper than the competition? If you said “never,” you’re probably right.
Fortunately, as of today, you can find Januvia for less than $2 per pill in the Freebee Foreign Pharmacy database. Onglyza is not yet available from our member pharmacies, but we hope to add it shortly.
Ah, the corner pharmacy. It’s been there for years, it’s just a short drive down the road, and the pharmacists are always so friendly, aren’t they?
Last week, the FDA approved the new antipsychotic drug Saphris for the treatment of schizophrenia and bipolar disorder in adults. Saphris is one of a class of brand-name drugs called “atypical antipsychotics” that includes 
Proposed legislation introduced in Congress on Friday by Sen. Jay Rockefeller (left) could have a huge impact on drug costs for Americans with big prescription bills. 
I got a call from a friend the other day who had received a letter from Humana, his insurance provider. The letter was headlined, “Why Not Spend Less On Your Medications?”
Onglyza was approved by the FDA on Friday to compete with 
