Consumers can keep prescriptions within reach


by ROGER YU / The Dallas Morning News

The Dallas Morning News

As early as 2006, seniors on Medicare may be able to lean on the federal government for help with prescription drug costs.

While President Bush and Congress tussle over the details of legislation that would introduce drug benefits to Medicare, seniors and those without private insurance continue to pay a heavy price for their medications. The insured, too, are paying more as companies shift more costs to employees.

Americans spent about $161 billion on prescription drugs in 2002, up 14.3 percent from 2001, the Centers for Medicare and Medicaid Services reported this year.

Consumer group Families USA found that the price of the 50 drugs prescribed most often to senior citizens rose nearly 3.5 times the rate of inflation in 2002. A 30-day supply of some common drugs can run $200.

Consumers have alternatives that can slice a few dollars off prescription costs, though none can replace comprehensive drug benefits.

Among the choices are buying generic or substitute drugs, comparing prices at various outlets, shopping on the Internet, using manufacturer discount cards and buying in bulk.

Buying generics, available for drugs whose patents have expired, is an underused way to save, experts say.

Generics deliver formulations that are similar or identical to brand-name drugs, but at a fraction of the price. The average cost of a generic prescription was $14.70 in 2002, compared with $77.02 for branded drugs, according to a recent report by the National Center for Policy Analysis.

Many consumers are wary of using generics because certain types of drugs have "a narrow therapeutic index," meaning that even a slight change in dose can compromise their effectiveness. Some of those drugs include phenytoin (brand name Dilantin), carbamazepine (Tegretol), valproic acid (Depakene) and divalproex sodium (Depakote), according to Drugstore.com, based in Bellevue, Wash.

The company advises that any change in or substitution of prescription drugs should be done in consultation with doctors and pharmacists.

A dearth of consumer tools for comparing drugs has hindered wider use of generics, experts say.

Tony Copeland, a consultant for AARP, said his organization has sought to fix that by working with Oregon state officials in compiling data on how some popularly used categories of drugs fare in efficacy when compared with generics, he said. But the project is ongoing and won't compare individual drugs.

Devon Herrick, an analyst at the National Center for Policy Analysis, is a big proponent of buying generics or cheaper substitutes when possible.

He cites ulcer treatment Prevacid, which costs as much as $4 a pill. Its over-the-counter substitute, Prilosec, is available starting this fall and costs less than $1 a pill.

The allergy drug Clarinex is often still prescribed for those whose co-pays are lower than the price paid for over-the-counter anti-allergy drugs such as Claritin. But for those without insurance, the generic loratadine can be a cheaper option.

Ninety tablets of 5 milligrams of Clarinex cost $184.99 at Drugstore .com. But 100 tablets of 10 mg of loratadine cost about $80.

About half of the brand-drug manufacturers' marketing budget is spent "to convince doctors to say that this is the best," Mr. Herrick says. "People should realize there are options. Whatever doctors give them, they don't stop to think and ask, 'Is this the only thing that works?' "

Shop around. For those shouldering the entire cost, shopping around is crucial because prices vary greatly among stores.

Smaller, independent pharmacies tend to be cheaper than larger stores for generic medications, the center for policy analysis' study said.

A survey in Pennsylvania found that 100 units of 20 mg capsules of fluoxetine - better known as Prozac - was selling for $18.18 at one store and $286.99 at another, the center said.

The Internet has emerged as a convenient and important place to shop and compare prices. Still, it's rife with scams, wholesalers selling counterfeit drugs and other commercial chicanery.

The Food and Drug Administration recently warned the public against fake drugs and called for changes in the way drugs are packaged and distributed. While the FDA says counterfeits are only a small part of the overall supply, experts say many of the fake drugs sold originate from Internet transactions.

A sure sign of a less-than-wholesome online pharmacy is if it fails to list a phone number and physical address.

Consumers are advised to look for online pharmacies that carry the VIPPS seal, which stands for Verified Internet Pharmacy Practice Sites. The seal is issued by the National Association of Boards of Pharmacy and ensures that the pharmacy is properly licensed.

Most large drugstore chains allow consumers to fill prescriptions through their Web sites. And some of their Internet-only competitors, such as Drugstore.com, are gaining a following.

Be informed. The Internet also has resources to help steer consumers on drug choices.

DestinationRX.com collects prices from several competitive pharmacies, but the listed retailers are limited in number.

Rxaminer.com, founded by cardiologist Joseph Rogers, allows consumers to input a drug and see a list of cheaper drugs that could be considered generics or suitable substitutes. The site takes no clinical responsibility and urges prior physician consultation before switching medications.

Discount cards. Drug savings cards - often run by manufacturers and pharmacy benefit managers, or PBMs - have been a popular, if controversial, source of savings for many seniors and those without pharmaceutical coverage. Some programs are available for all, while others require that the applicant's income fall below a certain eligibility limit.

Some Web sites - Helping patients.org and Needymeds.org - offer more detailed information on drug cards.

Drug companies that offer such cards often tout that they can deliver big savings. Some of these claims are questionable since their savings are based on the average wholesale price.

A 2001 study by the U.S. House of Representatives found that some popular drug card programs offered only a slight discount from the prices found on Drugstore .com.

The comparison "doesn't take into account the effect of the annual membership fee that the discount drug card programs charge," it says. "These fees can be substantial."

Consumers should generally stick with savings cards that don't charge membership fees, experts say.

Prices available with a manufacturer-sponsored card are typically lower than prices obtained using PBM-administered cards, said a study released this month by the United States General Accounting Office.

Cards issued by PBMs, such as Irving-based AdvancePCS Inc., are available to all adults. But manufacturer cards - generally limited to Medicare beneficiaries and to those with incomes below a certain level - require users to buy the manufacturers' own drugs.

PBMs, which manage drug benefits through private insurance contracts, may monitor the spending habits of their savings card customers to influence medical decisions.

AdvancePCS collects information to conduct "drug utilization reviews" for its members, said Kirby Bessant, a company executive who heads the program. He said such reviews are used to alert consumers of any adverse reaction or other clinical help.

Other ways to order.Consumers with chronic conditions should also consider buying in bulk through the mail, which is generally cheaper than buying at retailers. Mail order has become more popular in recent years and now makes up 17 percent of the market, the center for policy analysis said.

Some consumers also may find savings in ordering drugs from abroad through the mail, which is technically illegal and has sparked debate in this country.

Experts say many foreign drugstores - typically claiming to be from Canada - offer cheaper prices, mostly on brand drugs, not generics. But the products aren't always what they claim to be, some argue.

Freebies.Consumers often overlook ways to get prescription drugs for free, experts say.

Some manufacturers run patient-assistance programs, in which they provide their own drugs at no charge if the applicant falls within certain income eligibility limits.

For example, Merck & Co. offers the program free to patients of any age, as long as they prove that they have no pharmaceutical coverage and that they have an income below $18,000 for individuals and $24,000 for a household. Those with incomes above these levels may also be eligible on a case-by-case basis, it said.

Drugstore.com pharmacist Chris Pierce suggests that patients ask their doctors for free samples when introduced to a prescription drug.

"Doctors often receive samples from pharmaceutical companies to encourage prescriptions of their products," he says.

E-mail ryu@dallasnews.com