Studies | Health

No. 262
Monday, June 02, 2003
by Devon Herrick

Table of Contents

1. Executive Summary
2. Introduction
3. Comparing Prices
4. Therapeutic Drug Substitution
5. Pill Splitting
6. Generic Drug Substitutes
7. Switching to Over-the-Counter Drugs
8. Mail-Order Pharmacies
9. Global Options
10. Financial Assistance to Lower Drug Costs
11. Price Comparisons for Specific Drugs
12. Conclusion
13. Notes
14. Appendix
15. About the Author

Therapeutic Drug Substitution

"Patients should ask their doctors if there are cheaper medications available."

Patients can take the first step to saving on drugs at their physicians' offices. This involves asking the physician if a prescribed medication is the only one available or whether there are cheaper alternatives - which may include alternative drug therapies, generic substitutes or over-the-counter drugs. For example, a recent study in the Journal of the American Medical Association found that two daily aspirins were as effective at preventing recurrent strokes in African Americans as a daily 500mg dose of the drug Ticlopidine.¹² This is significant, given that Ticlopidine can easily cost patients from $60 to almost $100 per month.¹³

The notion that patients should leave the choice of medications to physicians without any input is outdated. Unless they are informed, physicians may not consider the cost of medications, or be aware of their patient's income or out-of-pocket costs. Physicians may not consider the willingness of patients to replace a branded drug with a less expensive generic drug that works just as well. By communicating with their doctors, patients may find a wealth of drug options. Two conditions for which alternative medications are readily available are allergies and heartburn.

Case Study: Allergy Medications. Patients suffering from seasonal allergies have a myriad of choices, including prescription drugs, over-the-counter drugs, decongestants, antihistamines and nasal inhalers. All of them offer symptomatic relief, but some have fewer or less severe side effects than others. The most popular sinus allergy medications are antihistamines, the cheapest of which are first-generation antihistamines. They are economical and available over the counter, but they can cause drowsiness.¹⁴ Studies have shown that these sedating antihistamines are often just as effective as newer, non-sedating ones.¹⁵

Second-generation antihistamines like Claritin are popular because they do not cause drowsiness.¹⁶ Although Claritin and its generic equivalent (Loratadine) are now available over the counter, they are more expensive than older OTC antihistamines. However, Claritin is cheaper than prescription alternatives, such as Allegra and Zyrtec.

How much can patients save by considering other treatments for their allergies? [See Appendix A.] Consider that:

• For the newer (prescription-only) antihistamines, patients shopping at Drugstore.com's Web site can expect to pay about $123 per 100 doses of Allegra compared to about $181 for Zyrtec and more than $205 for Claritin's prescription-only replacement (Clarinex).¹⁷
• However, OTC Claritin (Loratadine) and its generic equivalent are available from Walgreens for less than $65, about two-thirds less than other competing (second-generation) antihistamines.¹⁸
• For some patients other substitutes may work, such as the first-generation antihistamine Benadryl and its generic equivalent Diphenhydramine, which are available at Drugstore.com for about $12 if purchased in quantities of 100 tablets.¹⁹ Although Benadryl causes drowsiness, those suffering with nighttime allergies might find this is the ideal drug. And at 12 cents per tablet, it costs 90 percent less than newer prescription drugs.²⁰

"Another way to lower drug bills is to seek generic equivalent medications."

Case Study: Heartburn Medications. Patients also have many choices of stomach medications to treat peptic ulcers and gastroesophageal reflux disease (GERD) [see Appendix B]. Drugs to treat gastrointestinal (GI) conditions have been among the top sellers for well over a decade. For those with severe GERD, proton pump inhibitors (Prilosec, Prevacid, etc.) are the treatment of choice. Proton pump inhibitors were the most popular class of drugs in 2002 - with $13 billion in sales.²¹ But they are not cheap. The cost for 100 doses of Prilosec is almost $410 if purchased in small quantities from Walgreen's Web site.²² Prevacid is similarly priced. However, purchasing 100 doses of generic Prilosec (Omeprazole) from Eckerd would save $73.²³ For patients with little more than occasional indigestion, a histamine receptor antagonist such as Zantac or its generic equivalent Ranitidine may be sufficient.²⁴ Although Ranitidine is now available over the counter in 75mg tablets, it often prescribed in 150mg doses.²⁵ Among patients' options:

• Purchasing 100 (150mg doses) from AARP's Web site would cost slightly less than $27, or 27 cents a dose.²⁶
• The AARP mail-order pharmacy sells 300mg generic Tagamet (Cimetidine) in quantities of 100 tablets for $20.44, or about 20 cents per dose.
• Patients who do not do well on Zantac or Tagamet can choose the generic equivalent of Pepcid (Famotidine) for around 75 cents per 40mg tablet at Drugstore.com.²⁷
• Beginning in the fall of 2003, patients can purchase an OTC version of Prilosec for an anticipated price of $25 to $30 per month.²⁸

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