Shopping for Drugs: 2004

Studies | Health

No. 270
Monday, October 11, 2004
by Devon Herrick, Ph.D.


Notes

  1. See Ray Moynihan, “Drug Spending in North America Rose by 11% in 2003,” British Medical Journal, Vol. 328, No. 7442, March 27, 2004, p. 727; “Rx Sales Jump 11%, Top $200 Billion,” America’s Pharmacist, April 2004, 10; also see Kathleen D. Jaeger, “Drug Pricing & Consumer Costs,” Presentation to the U.S. Senate Commerce Committee, April 23, 2002; and “Fact Sheet: The Use of Over-the-Counter Medicines,” National Council on Patient Information and Education, January 2002.
  2. National Center for Health Statistics, cited in “Many Patients Receiving Medication,” USA Today Snapshots, USA Today, January 31 – February 2, 2003.
  3. Frank Lichtenberg, “Benefits and Costs of Newer Drugs: An Update,” Working Paper No. 8996, June 2002, National Bureau of Economic Research.
  4. “2002 Missouri Prescription Drug Pricing Survey,” Public Issue Management, 2002.
  5. Al Tompkins, “Monday Edition: Generic Drug Prices,” KHOU (News 11), November 30, 2003.
  6. Kathy Times, “Independents Often Beat Chains in Prescription Prices,” NBC13.com, November 25, 2002.
  7. Barbara West, “Massive Mark-Ups Found on Generic Drugs,” WFTV9, October 21, 2002.
  8. Although some of the following anecdotes are from regional surveys conducted by the news media, the results are consistent with a recent multistate survey by a research institute. See RetireSafe.org, “Take the Rx Challenge: 2003 Retail Pharmacy Pricing Survey,” June 2003, Council for Government Reform.
  9. Editorial, “Generic Meds Not Panacea Some Believe,” Iowa City Press-Citizen , June 18, 2003.
  10. Chris Hopkins, “Generic Drug Price Mark-Ups, WTKR.COM (News Channel 3, Hampton Roads, Va.) April 30, 2004.
  11. ABC Action News, “Pill Patrol: Generic Drugs Marked up as much as 3,000 Percent,” abcactionnews.com (WFTS ABC Action News Tampa, Fla.), November 27, 2003.
  12. Steve Wilson, “Steve Wilson Exposes Huge Prescription Drug Price Markups,” WXYZ.com (Channel 7 Detroit), February 6, 2004.
  13. On the Web site Medicare.gov, select “Find available Medicare-approved drug discount cards, and compare prices for your prescriptions,” http://www.medicare.gov/assistanceprograms/home.asp. Select “Quick Search” and enter the desired drug.
  14. John D. Piette, Michele Heisler and Todd H. Wagner, “Cost-Related Medication Underuse: Do Patients With Chronic Illnesses Tell Their Doctors?” Archives of Internal Medicine, Vol.164, No. 16, September 13, 2004, pp. 1749-1755.
  15. The Web site is www.Rxaminer.com; address confirmed July 12, 2004.
  16. Jim Nuovo, “Cost Comparison of Fluoxetine and Tricyclic Antidepressants,” American Family Physician, December 1, 1999.
  17. First-generation antihistamines also include Clistin (Carbinoxamine), Tavist (Clemastine), Chlor-Trimeton (Chlorpheniramine) and Dimetane (Brompheniramine).
  18. Philipp S. Muether and Jack M. Gwaltney Jr., “Variant Effect of First- And Second-Generation Antihistamines as Clues to Their Mechanism of Action on the Sneeze Reflex in the Common Cold,” Clinical Infectious Diseases, November 1, 2001, pp. 1,483-88.
  19. Ibid.
  20. Allegra was 60mg, Zyrtec 10mg and Clarinex 5mg. Prices surveyed on June 1, 2004.
  21. Price of 10mg Claritin for 100 doses purchased 30 tablets at a time. The price for Loratadine (10mg) was based on buying 180 at a time. Prices were sampled on June 1, 2004, and in July 2004, respectively.
  22. Diphenhydramine (25mg) is available in quantities of 200 for $13 at Drugstore.com. Price sampled on June 1, 2004.
  23. Calculation was based on $13/200. Cost per tablet would vary based on shipping and dosage. This is especially true of cheaper medications like OTC drugs.
  24. IMS Health, November 2003, cited in Michelle L. Kirsche, “Outlook Bright for 2004 Blockbusters - Chain Pharmacy - Boost in Prescription Drug Sales is Anticipated as Result of New Coverage Provided to 35 Percent to 40 Percent of U.S. Seniors Currently without Prescription Drug Insurance,” Drug Store News, January 19, 2004. Data for October 2002 to September 2003.
  25. Gardiner Harris, “F.D.A. Approves Over-Counter Sales of Top Ulcer Drug,” New York Times, June 21, 2003.
  26. Purchasing 100 doses of Nexium (30 capsules at a time) from RxUSA.com costs $419.83. Price sampled on June 1, 2004.
  27. Purchasing 100 doses of Nexium 30 capsules at a time would cost $419.83 at RxUSA. Switching to Protonix and purchasing larger quantities (90 at a time) Protonix would bring the cost of 100 doses down to $307.74 at drugstore.com.
  28. The price for Prilosec 20mg at Costco.com is $59.50 buying 42 at a time. Price was verified on June 1, 2004.
  29. Zantac (Ranitidine), Pepcid (Famotidine) and Tagamet (Cimetidine) are Histamine H 2-receptor antagonists.
  30. Ranitidine is available over the counter in 75mg tablets but is often prescribed in 150mg or even 300mg doses.
  31. In this example, purchasing 100 150mg doses would require buying 200 75mg tablets and taking two at a time. This is often more economical than purchasing the 150mg prescription strength. Price Kirkland Signature Acid Reducer (Ranitidine), available in packages of 240 75mg tablets, costs $5.99 at Costco.com. Price verified on June 1, 2004.
  32. Packages of Rite Aid Acid Reducer (Cimetidine) containing 70 200mg tablets cost $9.79 on Costco.com. Price verified June 1, 2004.
  33. Purchased in quantities of 240 10mg tablets for $6.99 at Costo.com. A 40mg dose requires four tablets, for a cost of 11.65 cents per dose. Price verified June 4, 2004.
  34. Pat Kelly, “DTC Advertising’s Benefits Far Outweigh Its Imperfections,” Health Affairs, Web Exclusive, April 28, 2004; Joel S. Weissman, et al., “Physicians Report On Patient Encounters Involving Direct-To-Consumer Advertising,” Health Affairs, Web Exclusive, April 28, 2004.
  35. An exception to this rule is direct-to-consumer advertising of OTC products. A drug company launching a name brand for use over the counter may well advertise to gain market share for their product. Here again, consumers should be wary. Name brand OTC products generally sell for more than their generic competitors’ products.
  36. Meredith B. Rosenthal, Ernst R. Berndt, Julie M. Donohue, Richard G. Frank and Arnold M. Epstein, “Promotion of Prescription Drugs to Consumers,” New England Journal of Medicine, Vol. 346, No. 7, February 14, 2002, pp. 498-505.
  37. In 2000, about $7.9 billion drugs were distributed free as samples — about half of the $15.7 billion the pharmaceutical industry spent on marketing. The retail value of free samples increased to $16 billion by 2004. Drug companies employ an estimated 90,000 drug industry reps, and spent $22 billion in 2003 to inform physicians about their products and influence prescribing behavior. For an exposé on many of the drug industry’s marketing efforts, see Jeff Gammage and Karl Stark, “Under the Influence,” Philadelphia Inquirer, March 9, 2002. Also see Liz Szabo, “Health Systems Cutting Costs by Closing Door on Drug Reps,” USA Today, August 25, 2004.
  38. Leigh Page, “More Clinics Ban Drug Samples, Citing Cost, Safety Concerns,” American Medical News, October 16, 2000.
  39. James Frederick, “Mandatory Mail Battle Heats up as Michigan, Chains Lay Gauntlet,” Drug Store News, February 16, 2004.
  40. Price surveys conducted June 1, 2004.
  41. See Diane West, “Mail-Order Rx Chips Away at Retail Sales, Drug Store News, May 20, 2002.
  42. Prices verified on August 5, 2004.
  43. Correspondence from Thomas S. Paul, chief pharmacy officer for Ovations (United Health Group), which administers AARP’s pharmacy program, 2003.
  44. Price verified August 21, 2004.
  45. Amanda Gardner, “How to Break a Blockbuster Drug in Half: Man Invents Device to Cut Odd-Shaped Viagra Pill,” HealthScoutNews, December 5, 2002.
  46. Information obtained from Parrish Blaszka (communications director), Precision Pill Splitters (www.precisionpillsplitters.com).
  47. Ibid. A pill bed is a template designed for the exact shape and thickness of a specific dose of medications. According to the manufacturer, some common medications that may be candidates for quartering are Accupril, Aspirin, Fosamaxx, Imitrex Oral, Levaquin, Lipitor, Norvasc, Pravachol, Viagra, Vioxx, Zocor, Zyprexa and Zyrtec.
  48. Salynn Boyles, “Cutting Pills in Half Could Pose Problems; Pharmacists Suggest Pill-Splitting Practice Can’t Be Mandated,” WebMD Medical News, May 19, 2004.
  49. James E. Polli, Sharon Kim and Brian R. Martin, “Weight Uniformity of Split Tablets Required by a Veterans Affairs Policy,” Journal of Managed Care Pharmacy, Vol. 8, No. 5, 2003, pp. 401-7.
  50. Randal S. Stafford and David C. Radley, “The Potential of Pill Splitting to Achieve Cost Savings,” American Journal of Managed Care, Vol. 8, No. 8, August 2002, pp. 706-12.
  51. Susan J. Landers, “11 Pills Score as Candidates for Splitting,” American Medical News, September 23/30, 2002.
  52. “Bitter Pill: The Rising Prices of Prescription Drugs for Older Americans,” Publication No. 02-104, June 2002, Families USA.
  53. William M. Welch, “VA Offers Medicines at Bargain Prices,” USA Today, June 18, 2003.
  54. Aidan Hollis, “Closing the FDA’s Orange Book,” Regulation, Winter 2001.
  55. The average cost for generic prescriptions was $14.70 in 2002, compared to $77.02 for branded medications. Also see Milt Freudenheim (New York Times News Service), “Prices of Generic Drugs Rising Much Faster than Brand-Name Counterparts’” Naples Daily News, December 27, 2002.
  56. James Frederick, “Stars Align for Generic Drug Industry - Special Report: Generic Drugs,” Drug Store News, February 16, 2004.
  57. The law became effective Aug. 19, 2003. See Joel B. Finkelstein, “Feds Fire on Patent Law that Delays Generics,” American Medical News, June 30, 2003.
  58. Leila Abboud, “Bush Acts to Speed Generics to Market,” Wall Street Journal, June 12, 2003, p. A3.
  59. “Fact Sheet: The Use of Over-the-Counter Medicines,” National Council on Patient Information and Education, January 2002.
  60. Harris Interactive, “Attitudes and Beliefs about the Use of Over-the-Counter Medicines: A Dose of Reality,” National Council on Patient Information and Education (NCPIE), January 2002.
  61. Ipsos, “Doctor Recommendations of Over-The-Counter Drugs Boost Consumer Loyalty,” PharmTrends, September 23, 2002.
  62. Ipsos, “Doctors Play Key Role in Sales of Non-Prescription Drugs,” PharmTrends, September 17, 2003.
  63. Martin S. Lipsky and Theresa Waters, “The ‘Prescription-to-OTC Switch’ Movement: Its Effects on Antifungal Vaginitis Preparations,” Archives of Family Medicine, July/August 1999, pp. 297-300. However, the Consumer Healthcare Products Association (CHPA) claims 700 OTC medications were previously available only by prescription.
  64. For a discussion of the process the FDA follows in approving a drug’s move from prescription to OTC, as well as a list of classes of medications available OTC, see Lori R. Jacobs, “Prescription to Over-the-Counter Drug Reclassification,” American Family Physician, May 1, 1998.
  65. Ipsos, “Doctors Play Key Role in Sales of Non-Prescription Drugs,” PharmTrends, September 17, 2003.
  66. Price surveyed August 2002.
  67. Sixty Claritin tablets cost $31.39 while 180 generic (Lirkland AllerClear) tablets cost $15.99. Prices surveyed at Costco.com on September 20, 2004.
  68. Price surveyed in May 2003.
  69. Price surveyed September 20, 2004.
  70. Gaye Perry and Peter Mansell, “Rx-to-OTC Switching: The Way Forward for the Global Pharmaceutical Industry?” research report, Urch Publishing Ltd., September 2000.
  71. Holly M. Spencer, “The Rx-to-OTC Switch of Claritin, Allegra, and Zyrtec: An Unprecedented FDA Response to Petitioners and the Protection of Public Health,” American University Law Review, pp. 999-1050.
  72. Amy K. Erickson, “Rx-to-OTC Switches Offer Golden Opportunity,” Pharmacy Today, 2002.
  73. Gardiner Harris, “F.D.A. Approves Over-Counter Sales of Top Ulcer Drug,” New York Times, June 21, 2003.
  74. Price of Prilosec OTC is $26.45 for a box containing 42 capsules at Drugstore.com. Price verified July 12, 2004.
  75. Erickson, “Rx-to-OTC Switches Offer Golden Opportunity.” New York Times, June 21, 2003.
  76. The prices of H 2 antagonists fell by two-thirds after they were switched to OTC status. See Gail D. Newton et al., “New OTC Drugs and Devices 2001: A Selective Review,” Journal of the American Pharmaceutical Association, 2002, pp. 267-77.
  77. Prescription sales of Claritin totaled $3.1 billion in 2001.
  78. David Vaczek, “Top 200 Prescription Drugs of 2003,” Pharmacy Times, undated. Online http://www.pharmacytimes.com/article.cfm?ID=1314. Accessed August 21, 2004. Due both to tightening of health plan requirements and the movement of Claritin to the OTC market, sales of nonsedating antihistamines fell 22 percent from July 2003 to June 2004. See Jane Erikson, “Allergy Drug Copays Rising,” Arizona Daily Star, August 18, 2004.
  79. Bill Hogan, “The Pharmacist Who Says No to Drugs,” AARP Bulletin online, September 2004. Accessed September 8, 2004. Available: http://www.aarp.org/bulletin/prescription/Articles/a2004-08-26-pharmacist.html.
  80. Margie Rauch Goulding, “Inappropriate Medication Prescribing for Elderly Ambulatory Patients,” Archives of Internal Medicine, Vol. 164, No. 3, February 9, 2004, pp. 305-312.
  81. Ibid. Panel members defined drugs to be inappropriate if risk of adverse reactions outweighed potential benefits. Also see “1 in 12 Drugs Inappropriately Prescribed to Elderly,” Healthfacts, March 2004.
  82. Lesley H. Curtis, et al., “Inappropriate Prescribing for Elderly Americans in a Large Outpatient Population,” Archives of Internal Medicine, Vol. 164, No. 15, August 9/23, 2004, pp. 1621-1625.
  83. “Everything you Need to Know about Statin Drugs – Almost,” Healthfacts, November 2003.
  84. PREMIER Collaborative Research Group, “Effects of Comprehensive Lifestyle Modification on Blood Pressure Control,” Journal of the American Medical Association, Vol. 289, No. 16, April 2003, pp. 2083-2093.
  85. Rena R. Wing, et al., “Behavioral Science Research in Diabetes: Lifestyle Changes Related to Obesity, Eating Behavior, and Physical Activity,” Diabetes Care, January 2001.
  86. Marian McDonagh and Susan Carson, “Drug Class Review on Proton Pump Inhibitors,” Oregon Evidence-based Practice Center, Oregon Health & Science University.
  87. “Diuretics Proved to be Superior to other, more Expensive Anti-hypertensive Drugs,” Healthfacts, January 2003.
  88. Philip B. Gorelick, “Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients,” Journal of the American Medical Association, June 11, 2003, pp. 2,947-57.
  89. Price comparisons were obtained from DestinationRX.com. A patient taking two (250mg) tablets per day purchased in quantity (e.g., 100 tablets) could spend at little as $26.81 at Costco.com compared to $90.30 per month at Eckerd.com.
  90. When combination therapy was taken at the first sign of a migraine headache. See Patrice G.W. Norton, “OTC Product Beats Sumatriptan for Early Migraine: Study of 171 Patients - Clinical Rounds,” OB/GYN News, September 15, 2003.
  91. Ibid.
  92. Gastroenterologists say most patients with GERD should first try H 2 receptor antagonists. See Marian McDonagh and Susan Carson, “Drug Class Review on Proton Pump Inhibitors,” Oregon Evidence-based Practice Center, Oregon Health & Science University.
  93. Emily R. Cox et Al., “Prescribing COX-2s for Patients New to Cyclo-oxygenase Inhibition Therapy,” American Journal of Managed Care, Vol. 9, No. 11, pp. 735-42, November 2003. For a layman’s discussion see “A New Study from Express Scripts, Inc. Indicates that Patients are being Prescribed Expensive Cox-2 Inhibitor Drugs even When they have no Increased risk for Gastrointestinal Events,” Drug Cost Management Report, November 21, 2003.
  94. Theresa Agovino (Associated Press), “Study: Pricey Drugs Overprescribed Oft-Hyped Pain Relievers Often Found Unnecessary, Raise Health Plan Costs,” Detroit News, June 4, 2002.
  95. “Over Half of COX-2 Patients take Aspirin, Possibly Negating the COX-2 GI Benefits,” Medi-Lexicon (pharma-lexicon.com), June 15, 2004. For a discussion see Emily R. Cox, Mark Frisse, Andrew Behm and Kathleen A. Fairman, “Over-the-Counter Pain Reliever and Aspirin Use Within a Sample of Long-term Cyclo-oxygenase 2 Users,” Archives of Internal Medicine, Vol. 164, No. 11, June 14, 2004.
  96. Mitchel L. Zoler and Winnie Anne Imperio, “Drug Update: NSAIDs for Rheumatoid Arthritis,” OB/GYN News, June 1, 2000.
  97. Emily R. Cox, Brenda R. Motheral and Doug Mager, “Verification of a Decision Analytic Model Assumption Using Real-World Practice Data: Implications for the Cost Effectiveness of Cyclo-oxygenase 2 Inhibitors (COX-2s),”The American Journal of Managed Care, Vol. 9, No. 12, pp. 785-94, December 2003.
  98. Vioxx was pulled off the market by its maker Merck & Co in September 2004.
  99. Francis K.L. Chan, et al., “Celecoxib versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis,” New England Journal of Medicine, Vol. 347, No. 26, December 26, 2002, pp. 2,104-10; M. B. Kimmey and A. Lanas, “Appropriate Use of Proton Pump Inhibitors with Traditional Nonsteroidal Anti-inflammatory Drugs and COX-2 Selective Inhibitors,” Alimentary Pharmacology & Therapeutics, Vol. 19, No. 1, February 2004, pp. 60-65. Also see American College of Gastroenterology 68th Annual Scientific Meeting and Postgraduate Course, reviewed in Charlene Laino, “Proton Pump Inhibitor May Help Prevent Ulcers in Chronic NSAID Users,” Medscape Medical News, October 15, 2003.
  100. “Canadian Pharmacies,” Drugstore News, December 16, 2002.
  101. David Gratzer and Neil Seeman, “Granny Goes North: The Truth about Canada and Prescription Drugs,” National Review, May 22, 2000.
  102. Bernard S. Bloom and Ronald C. Iannacone, “Internet Availability of Prescription Pharmaceuticals to the Public,” Annals of Internal Medicine, December 7, 1999, pp. 830-33.
  103. Ibid.
  104. Ibid.
  105. Sample was of 45 Internet pharmacy Web sites claiming to be Canadian. See “An Analysis of Terrorist Threats to America’s Medicine Supply,” GlobalOptions, Inc., May 22, 2003.
  106. “Mexican Drugs Shipped to US via Canada, say Consumers,” Scrip: World Pharmaceutical News, No 2942, April 9, 2004, p. 17.
  107. Marv Shepherd, “Statement on Importation of Prescription Drugs Submitted by the Academy of Managed Care Pharmacy to the United States Department of Health and Human Services Task Force on Drug Importation,” May 14, 2004.
  108. Michael A. Veronin and Bi-Botti C. Youan, “Magic Bullet Gone Astray: Medications and the Internet,” Science, Vol. 305, July 23, 2004, p. 481.
  109. Donna Young, “FDA Clarifies Importation Law as Internet Pharmacies Proliferate,” American Journal of Health-System Pharmacy, Vol. 60, No. 8, May 2003, p.729.
  110. See, for example, William K. Hubbard, Senior Associate Commissioner for Policy, Planning and Legislation, Food and Drug Administration, “Continuing Concerns over Imported Pharmaceuticals,” Testimony before the Subcommittee on Oversight and Investigations, U.S. House Committee on Energy and Commerce, June 7, 2001.
  111. Michael F. Conlan, “How Safe Is the Drug Supply?” Drug Topics, October 15, 2001.
  112. Paul M. Rudolf and Ilisa B.G. Bernstein, “Counterfeit Drugs,” New England Journal of Medicine, Vol. 350, No. 14, April 1 2004, pp. 1,384-6. Also see U.S. Food and Drug Administration, “FDA Takes Action Against Foreign Websites Selling Counterfeit Contraceptive Patches,” FDA News, U.S. Food and Drug Administration, U.S. Department of Health and Human Services, February 12, 2004.
  113. Tracy Wheeler “Web May not be Rx for Your Drug Needs,” Akron ( Ohio) Beacon Journal, July 06, 2004.
  114. Ibid.
  115. Julie Appleby, “Report Attempts to Show Impact of Cross-Border Access,” USA Today, May 17, 2004.
  116. See Centers for Medicare and Medicaid Services, “Guide to Choosing a Medicare-Approved Drug Discount Card,” Centers for Medicare and Medicaid Services, March 31, 2004. Available online http://www.medicare.gov.
  117. All prices in this section were surveyed using the Medicare.gov Web site on July 27, 2004, for a 5-mile radius of the north Dallas, Texas ZIP code 75251.
  118. All prices in this section were surveyed using the Medicare.gov Web site on July 28, 2004, for a 5-mile radius of the north Dallas, Texas, ZIP code 75251.
  119. For a list of discount programs for specific medications, see Needymeds.com. Also, www.helpingpatients.org can help patients determine whether or not they qualify for various programs. Accessibility to both Web sites verified July 12, 2004.
  120. Richard Cauchi (NCSL Health Care Program), “State Pharmaceutical Assistance Programs,” National Conference of State Legislators, July 2004, accessible at http://www.ncsl.org/programs/health/drugaid.htm. 

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