November 23, 2012

Hidden Drug Costs

So what if this is Black Friday and I'm supposed to be following the masses to the malls.  I hate shopping in general and shopping malls in particular.  Thank God for Amazon one-click!

Rather than go out and spend money, I'll be a contrarian and talk about  possible ways of saving money on prescription drugs.

We know about costs hidden in the products we buy. Without giving it much thought when we purchase something, we’re also paying for packaging, for research and development, for marketing, for transportation, for employee salaries and benefits, for building maintenance… the list goes on.

The same issue -- hidden costs -- applies to the drugs we buy, as a recent article in Consumer Reports’ “onHealth” bulletin reminded me. In this case, though, it helps to know exactly where those hidden costs lie, because we might actually be able to do something about them.

Analyzing drug pricing data, Consumer Reports identified five circumstances which create the likelihood of high prescription drug costs. Here they are:

Watch out for costs in the five years before a drug loses its patent.
It’s pretty amazing how drug costs skyrocket before generics become available. Some examples:
  • The average cost for Provigil (excessive sleepiness) went from $272 in 2007 to $1,101 in 2012, a 305% hike. Its generic is now available. 
  • Boniva (osteoporosis) increased from $119 to $240 in the same period, up 102%. Generic now available. 
  • Crestor (high cholesterol) increased from $112 to $214, up 91%. Its generic won’t be on the market until July 2016, so watch the price continue to climb. 
  • Actos (type 2 diabetes) went up from $200 to $377, an 89% hike. Generic came out this past August. 
  • Lipitor (high cholesterol) increased from $127 to $237, up 87%. Generic now available. 
  • Plavix (heart disease) increased from $142 to $261, 84%. Generic now available. 
  • Cymbalta (anxiety and depression) went from $139 to $241, up 73%. Its generic hits markets next June. 
Why the giant leaps? BigPharma, Consumer Reports suggests, is nailing us while they can. Their incentive? They’re not creating blockbuster products often enough to keep gargantuan profits coming in, so they make existing products PAY.

What can we do about it? Insist on generics. The FDA estimates that 80% of all brand name drugs have available generic equivalents. A cheaper generic in the same class, or some therapeutic equivalent, may be as effective as the pricey brand name product. Initiate the conversation with your doctor and pharmacist.

Beware “New Formulations” of the Same Old Drug
BigPharma cleverly tweaks existing products, thereby creating prolonged patent life… and, as a result, higher prices for the consumer. Extended release, sustained-release, dissolvable tablets, oral solutions, patches, creams… all these modified products might well be making your drug bill go UP. Here’s just one example: the 90mg Prozac (antidepressant) pill, taken once a week, costs about $211. Its generic (fluoxetine) 90mg once-a-week tablet runs $143 a month, not cheap. But the daily dosages (10, 20, and 40mgs) of fluoxetine are available for as little as $10 for a three-month supply! Is that convenience – not having to remember taking a daily medicine – really worth paying thousands of dollars every year?

What can we do about it? Simple. Avoid flashy new versions of old products, even if the convenience claims are enticing. Take meds in more regular, daily or even hourly, doses. Save your money!

Some Pharmacies Just Don’t Know
Consumer Reports’ secret shoppers asked 30 different pharmacies about their prices for a month’s supply of 75mg of the Plavix generic clopidorgrel (for heart disease), taken daily. The quoted prices varied widely:
  • CVS, Target, Walgreens: $179 to $210 
  • Walmart: under $50 
  • Two independent pharmacies: $19 to $49 
  • Online drugstore $15 
  • Costco: under $15 
In 2011, CR looked online for the best prices on four popular and expensive brand-name drugs: Lipitor, Nexium, Plavix, and Singulair. Four websites offered the lowest prices:
What can we do about it? The old stand-by: shop around. Your time could really pay off. Ask about discount programs, especially for generics. CR reports that most pharmacies offer those program, although their secret shoppers found that pharmacists rarely offered the discount program on their own. Ask!

Does Your Doc Know You Care About Price?
Our doctors -- understandably -- consider first a drug's effectiveness, not its cost. In a survey conducted by CR, half the people who take regular prescribed meds said their docs didn't take cost into consideration. About 40% of those surveyed said their doctors tended to prescribe newer, more expensive medications.

What can we do? Bring drug costs into the conversation with our healthcare professionals. They may not know how much our insurance programs will cover, but they likely know that newer and brand-name meds cost more. Ask if a less expensive generic is available, or if there might be some other, cheaper therapeutic equivalent. Our doctors won't know that cost matters to us if we don't tell them.

Beware of discount coupons and free samples.
CR's survey found that about 16% of people who took medication regularly last year used some kind of manufacturer's discount coupon. Key brand-names that offered such coupons include Abilify, Actos, Crestor, Cymbalta, Effexor, Lipitor, Nexium, and Plavix. If you can get a discount on anything, that's a good thing, right?

Nope. BigPharma hopes to snare us with an initial discount -- or even a freebie -- hoping we'll decide to keep taking their product long after the "good deal" has come and gone. There's another reason to think twice about discounted and free drugs: they tend to increase costs for everyone covered under your insurance program. If everyone gets suckered by the offer of a quick, initial savings, we all end up paying more in the long term.

What can we do about it? Avoid the gimmicks, alluring though they are. In most cases, that freebie isn't even the most effective product for you, and could wind up costing you lots of money down the road, once the pill becomes a daily reality.

CR gave an example. Actos is a costly brand-name drug prescribed for treating type two diabetes. It does not have a generic equivalent, but there are at least three low-cost generics -- metformin, glimepiride, and glipizide -- that are at least as effective. The cost of a month of Actos: about $380. The bill for a month of any of those three generics: less than $30. Beginning a long Actos habit --because you got snared by a discount or freebie trial sample-- could be a very costly proposition.

The example above illustrates another important lesson: don't settle for a high-priced brand-name just because no generic equivalent exists. There is a likelihood that some other generic, perhaps even in a different category than that brand-name, can treat your condition just as well.

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