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.
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.
We all know that generic drugs are much cheaper than brand-name drugs. The reason is simple: generic drugs create competition in the market. Until there is generic competition, the brand-name drug manufacturer can charge whatever it wants, because it has a monopoly on the product — and in many cases on the whole drug category.
After competition is introduced, the free market sets the price, and prices come down — dramatically.
I know that you know this. But what I bet you didn’t know is that brand-name drug manufacturers are currently allowed by law to pay generic drugmakers to stay off the market — to not compete. That’s good for the drug companies — they all make money — but bad for consumers, because it means we still have to pay inflated, monopoly prices.
Fortunately, it looks like legislation is on the way to correct this glaringly anti-competitive practice, and in the process save American consumers billions of dollars.
A bill currently before Congress, the Preserve Access to Affordable Generic Drugs Act, would prohibit brand-name drug manufacturers from using pay-off agreements to keep cheaper generic equivalents off the market.
Earlier this week, FTC Chairman Jon Leibowitz said that putting an end to these pay-for-delay deals would save Americans $3.5 billion a year.
According to U.S. Senator Herb Kohl, who introduced the bill:
We cannot profess to care about the high cost of prescription drugs, while turning a blind eye to anti-competitive backroom deals between brand and generic drug companies that only serve the companies involved.
Please contact your Congressman and Senator to tell them you support the Preserve Access to Affordable Generic Drugs Act!
On Monday, the drug maker Cephalon announced that its best-selling drug, modafinil (branded as Provigil), is now available at pharmacies nationwide in a much-hyped longer-lasting formulation, branded as Nuvigil. Modafinil is prescribed to improve “wakefulness” for those who suffer obstructive sleep apnea, shift work sleep disorder (SWSD), and narcolepsy.
To encourage patients to transition from Provigil to the “new and improved” Nuvigil, Cephalon is offering a financial incentive in the form of help with prescription drug co-payments. To assist insured patients with co-pay costs, Cephalon is offering the Nuvigil Prescription Savings Program. Through this program, eligible patients will receive a co-pay savings at the pharmacy to reduce their out-of-pocket costs to fill the prescription. For many patients, with an average co-pay of about $40, this will lower monthly co-pays to $10.
But that’s not all. Even for those without prescription drug insurance, Nuvigil is now cheaper than Provigil. As the Wall Street Journal reports:
The company has set the stage for the switch campaign by raising prices for Provigil — to the dismay of some patients. The Wall Street Journal reported in November that Cephalon boosted the price sharply twice last year, and it was 74% more expensive than four years earlier. The drug now sells at an average price of $10.08 per pill.
To encourage people to switch to Nuvigil, Cephalon is selling it at an 11% discount to Provigil, or an average of $8.98 per pill, said Mike Derkacz, vice president of the central-nervous system therapeutic business at Cephalon.
So, with these financial incentives, is making the switch from Provigil to Nuvigil a good idea for you?
This is a decision that should be made by you and your doctor together. For some patients on modafinil, a longer-lasting version could make a big difference. For others, it won’t be very important.
But you should not make your decision based on the financial incentives alone, because they are short-term promotions. In 2012, when Provigil begins facing generic competition in the United States, it will become much cheaper than Nuvigil. Nuvigil won’t face generic competion until 2023, so you can expect its $8.98 per pill price to increase over time.
Teva Pharmaceuticals, a leading maker of generic drugs, is taking on overpriced brand name drugs in a campaign patterned after the Mac vs. PC ads. Here are two of the spots, which emphasize that generics are equal in effectiveness to branded drugs, while costing far less.
Most educated consumers understand this, one would hope. The real problem is when our federal government does not permit generics to compete with branded drugs (in the name of patent protection). This gives drug makers long-term monopolies on thousands of prescription medications, enabling them to gouge the public with sky-high prices.
That’s when turning to competitors in Canada is the best alternative. In fact, I’d love to see a Canadian pharmacies vs. U.S. pharmacies version of the Mac vs. PC ads!
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 
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?”
We all know that generic drugs are much cheaper than brand-name drugs. The reason is simple: generic drugs create competition in the market. Until there is generic competition, the brand-name drug manufacturer can charge whatever it wants, because it has a monopoly on the product — and in many cases on the whole drug category.
On Monday, the drug maker Cephalon 
