Shopping for Drugs: 2004
Table of Contents
- Executive Summary
- Introduction
- Comparing Prices
- Therapeutic Drug Substitution
- Bulk Buying
- Pill Splitting
- Generic Drug Substitutes
- Switching to Over-the-Counter Drugs
- Weighing the Cost and Benefits of a Drug
- Case Studies: Price Comparisons for Specific Drugs
- Buying Drugs Abroad
- Special Opportunities for Seniors: Medicare Discount Drug Cards
- Financial Assistance to Lower Drug Costs
- Conclusion
- Notes
- Appendix
- About The Author
Weighing the Cost and Benefits of a Drug
Patients often begin taking a drug and never question the necessity later. They should periodically ask their doctors if they still need to take a prescribed drug. 79 Furthermore, not all prescriptions are appropriate for older patients. According to studies published in the Archives of Internal Medicine, a senior receives one inappropriate medication for roughly every 12 doctor visits. 80 The likelihood of inappropriate medication is about double for women and increases when multiple drugs are prescribed. 81 Currently, some 20 percent of seniors are taking at least one medication that is not recommended for their age group, 15 percent are taking two drugs and 4 percent are on three drugs deemed inappropriate. 82
“Some conditions can be treated with lifestyle changes.”
Patients taking expensive medications often overlook the possibility of nondrug alternatives. For instance, the drugs most widely used by seniors are cholesterol-lowering medicines called statins (antihyperlipidemics). Yet many seniors would probably be healthier if they controlled cholesterol through diet. 83 Physicians say losing weight and exercise are the best option for controlling high blood pressure. 84 The first line of defense against obesity and Type-2 diabetes is prevention by changing diet and exercise. 85 The same is true for GERD. Gastroenterologists suggest most patients with GERD should first change their lifestyle before trying H 2 receptors antagonists or before taking the more costly PPI drugs. 86
Patients also often overlook cheaper drug options. For example, research has found that a “water pill” (diuretic) is more effective than newer, more expensive antihypertensive medications. 87 In addition, a recent study in the Journal of the American Medical Association found that two daily aspirins were as effective in preventing recurrent strokes in African Americans as a daily 500mg dose of the drug Ticlopidine. 88 This is a significant finding, given the fact that Ticlopidine can easily cost patients up to almost $90 per month. 89
Treatment of migraine headaches provides another example. A drug trial found that acetaminophen combined with aspirin and caffeine (ACC) provided more sustained relief than the prescription drug Sumatriptan. 90 Those taking Sumatriptan reported faster relief — 29 percent versus 19 percent of those on AAC had little or no pain after 30 minutes. But at two hours, the AAC treatment group fared significantly better (84 percent versus 65 percent).91
Some seniors may not be getting their money’s worth from the new generation of “super-aspirins” called Cox-2 Inhibitors. They relieve pain and inflammation without the stomach irritation sometimes experienced by taking daily doses of aspirin, ibuprofen or naproxen. But they may offer most seniors only modest benefits over cheaper drugs. 92
A recent study found that two-thirds of patients on Cox-2 inhibitors were not at risk for gastrointestinal conditions like ulcers or bleeding, and most of them had not tried cheaper alternatives. 93 Another study by Express Scripts, a pharmacy benefits management company, found that about three-quarters (76 percent) of these prescriptions are written for patients who are not at risk of gastrointestinal side effects. On average, patients receiving new prescriptions of Cox-2 inhibitors use the drugs for less than 60 days. This suggests that the drug is not necessarily prescribed for conditions that require long-term therapy, where the risk of serious gastrointestinal bleeding is a concern. 94 Furthermore, a recent study found that many patients taking Cox-2 inhibitors also take aspirin daily to benefit their heart, which can negate the gastrointestinal benefits associated with the more expensive pain reliever. 95
“New drugs may have fewer side effects.”
There are more than a dozen selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain from such diseases as arthritis. 96 [See Table III.] The price per dose ranges from $2.35 per capsule for Cox-2 inhibitors to mere pennies for aspirin. Cox-2 inhibitors and other (nonselective) NSAID pain relievers are equally effective at controlling pain, but Cox-2 inhibitors cost more — up to $1,420.47 per year for someone taking 50mg per day of Vioxx, for example. 97 Some experts say they are not always worth the additional price. 98 In fact, many patients taking the more expensive Cox-2 inhibitors may do as well on nonsteroidal anti-inflammatory drug pain relievers taken with proton pump inhibitors. 99 For example, 20mg Prilosec OTC costing 63 cents per day, if taken with 12 tablets of 200mg Ibuprofen throughout the day, would cost only $343 annually compared with $900 or more for most COX-2 Inhibitors.
