Heart failure patients can pay as little as $30 for a 90-day supply of three mainstays of therapy or as much as $1,144 a month, depending on where they shop, researchers reported.
This article first appeared November 17, 2016 on MedPage Today.
By Ed Susman
NEW ORLEANS -- Heart failure patients who go to their local pharmacy for generic formulations of lisinopril, carvedilol, and digoxin can pay as little as $30 for a 90-day supply of all three mainstays of therapy or as much as $1,144 a month, depending on where one goes shopping, researchers reported here.
A 30-day supply of the high-dose angiotensin converting enzyme inhibitor lisinopril could be purchased for as little as $4, but at another pharmacy the same script could cost $87.59, Paul Hauptman, MD, of Saint Louis University School of Medicine, reported at the American Heart Association meeting and simultaneously online in JAMA Internal Medicine.
Hauptman and colleagues reported that they surveyed 175 pharmacies in the greater St. Louis area encompassing eastern Missouri and neighboring Illinois to assess how much they charged uninsured customers for the three generic medicines.
"The idea for the study originated with one of our patients, a 25-year-old man with heart failure, who called the office and said he could not afford to fill a prescription for digoxin," coauthor Zachary Goff, BS, a medical student at the university, told MedPage Today.
"When I found out that a month's supply was going to cost him $100," Hauptman said, "I couldn't believe it. Like me, I think a lot of doctors assume that if you're writing a prescription for a generic drug that it will be affordable -- and that's not necessarily the case."
Hauptman said that the price differential was not affected by where in the region the survey occurred – some of the prices were wide ranging even if the pharmacies were across the street. He said that price differences even occurred between pharmacies in the same pharmacy chain.
For example, the researchers said that the combination of the three low-dose medications ranged from $20.19 for 30-days to $256.77. The median cost would be $67.98.
The 90-day supply ranged from $50.89 to $703.97, with a median of $169.67.
Individual prices included a range of $10 for a 90-day supply of high-dose digoxin at one pharmacy to $910.99 at another pharmacy.
Hauptman added that it is common for patients with heart failure to take five or six medicines to treat the condition, making it even more difficult for patients to get the lowest combined price of the drugs they need.
"It's not reasonable to expect patients who are sick and of limited financial means to call or visit half a dozen pharmacies to get the best price," he said. "What is more likely to happen is that patients visit a pharmacy and find out that the drug is too expensive, so they don't fill the prescription and therefore do not garner benefit from guideline-directed medical therapy."
In commenting on the study, Frederick Masoudi, MD, of the University of Colorado Anschutz Medical Campus in Aurora, told MedPage Today, "The range of prices that an uninsured patient would have to pay depending on the pharmacy for these generic formulations of common medication for heart failure ranged from about $30 to more than $1,100. That's a 40-fold difference for generic drugs."
"This creates a challenge for physicians that many of us were unaware of," Masoudi said. "I presumed there was some differences in the pricing of drugs if they were generic but I was not aware at all that the price differentials were so high.
"I think it is important for clinicians to realize where their patients can get drug[s] inexpensively. For example, Walmart and other stores have discount formularies where you can get 90-day prescriptions of these medications for $10. But it is important for physicians to know what is in the formulary. For example, the current Walmart formulary does not include digoxin, so patients couldn't get digoxin for $10.
"We as physicians have to be cognizant that patients who are getting generics and don't have an insurance plan could be facing substantial costs for their medication be it for heart failure or anything else. For that reason we have to be aware what kind of barrier to adherence that might be for these patients."
Because a greater understanding of pricing practices at the retail pharmacy level is required, the researchers said their study should be replicated across other parts of the country and with different generic drugs to treat other medical conditions.
Hauptman said he would expect the results of such studies to be similar. "With heart failure, we have a chronic condition that affects millions of people and usually requires treatment with several drugs. Why would it be different for other conditions?"
He said that there is so little transparency in how the prices are set that his researchers could not determine if the high prices are set by the manufacturer, the distributor, or the local pharmacy.
Goff said that the researchers just called the pharmacies and asked for their prices as uninsured patients. He said asking for the insurance plan price could not be done because it would require having insurance plan numbers for myriad companies and plans.