UninsuredinAmerica.org

Dr. Stephen Blythe

PRESCRIPTION DRUGS: Shop ‘till you drop?

Yesterday I received an e-mail from a patient for whom I had prescribed a standard 30-day course of ciprofloxacin (Cipro®) as a treatment for prostatitis (inflammation of the prostate gland). He wanted to let me know that he had shopped around for his prescription – and the cost he would have incurred (for sixty 500mg tablets of the generic) at various pharmacies were:  

Walgreen:         $92  

CVS:                $44 

          Walmart:          $10

I happen to know that the wholesale cost for a generic ciprofloxacin tablet is less than $0.20 each, so Walgreen was trying to make a “killing” on this prescription, while Walmart at best was breaking even.

As in other areas of medicine, pharmacies have negotiated such low reimbursements from insurance companies they try to make up the difference elsewhere - which generally means the uninsured! Traditionally generic drugs, which may cost only pennies, were sold for anywhere from $25 to $120. 

Walmart has made the decision to place generic medications as a huge "loss-leader" to get you into their store. A patient recently complained that she "always had to wait 30 minutes" to get her prescription at Walmart. "Of course you do," I said. "They want you to shop!" Although Walmart is a mixed blessing sometimes in our communities (their low-price generics now make it hard for small private pharmacies to stay in business), for many people Walmart's $4 generic drug plan has been a life-saver. They have also just started a list of medications, including birth control pills, which are available for $9 per month.

Advice: Take a copy of the Walmart $4 list of medications with you when you go to the doctor - if given a prescription, ask them to pick something appropriate from the list. Someone on Diovan for their blood pressure, for example, may do OK with lisinopril - at a savings of $70 per month.  More information is available in the "Uninsured in America" book.

Should I Buy from Canada?

The government prohibits us from ordering medications from Canada because they "cannot guarantee their safety". Yet the FDA has only inspected about 2% of the Chinese factories that make generic medications for export! Clearly they are protecting the drug companies and their investors - not us! I have ordered medications from Canada and have had no problem getting them, although technically they can be confiscated at the border. Generally the most medication savings from Canadian pharmacies are with those medications that are available as generics there but not yet here (their patent protection does not last as long). Some brand name medications are cheaper in Canada, and very few generics are cheaper than the same generics if available here.

Samples of Savings from Canada:

(None of the medications below are available as generics in the United States. Prices as of February, 2009 )

Medication:

Canadian Generic:

Canadian Brand:

U.S. Brand:

Actonel 75mg  

$172/6 tablets

$279/6

$313/6

Advair 250/50 (1 month/60 doses)

$82

$109

$209

Arimidex 1mg

$299/90

$570/84

$920/90

Casodex  50mg

$489/90

$630/84

$1,564/90

Celebrex 200mg

$113/90 capsules

$145/90

$356/90

Cialis 20mg

$218/32 tablets

$486/30

$439/30

Combivent Inhaler

$89/3 inhalers

$109/3

$330/3

Diovan 160mg

$109/90

$129/84

$220/90

Effexor XR 150mg

$149/90

$225/84

$369/90

Efudex Cream 5%

$29/30g

$69/40g

$415/40g

Entocort 3mg

$60/100

$227/90

$716/90

Evista 60mg

$129/90

$154/84

$303/90

Flomax 0.4mg

$79/90

$139/90

$307/90

Hyzaar 100/25

$89/90

$140/84

$288/90

Lexapro 10mg

$116/90

$175/84

$260/90

Lipitor 40mg

$114/90

$213/90

$360/90

Nexium 40mg

$172/90

$274/84

$470/90

Plavix 75mg

$199/100

$279/84

$430/90

Protonix 40mg

$114/90

$228/90

$369/90

Singulair 10mg

$130/90

$226/84

$337/90

Xalatan Ophthalmic 2.5ml

$121/3 bottles

$149/3 bottles

$235/3 bottles

I have a patient currently who has ulcerative colitis. He reacts poorly to the standard treatment and needs to be on Entocort, starting at three times daily. Not having insurance, you can see that the ability to purchase an inexpensive generic for $60 from Canada versus $700 here makes the difference in him getting treatment or not - and failing to keep this disease under control means having your colon surgically removed!  Likewise, very few of my uninsured patients with asthma or emphysema can afford to buy Advair and Combivent inhalers. I routinely refer them to a Canadian pharmacy.

Patient Assistance Programs

 I have real mixed feelings about the patient assistance programs run by the drug companies. If you are really poor and have no access to medications, it is possible through these programs to get many of the expensive brand-name medications that would be prohibitive.  But wouldn’t it be more reasonable to simply price these medications so that people can afford them? As in so many areas, those middle-income Americans get no assistance, and when a patient who takes five or six medications can spend $600 per month on them, that gets pretty difficult.  Having these programs – and patting themselves on the back with their feel-good advertising of these programs allows the drug companies to keep their prices high for those who pay cash for their drugs. That being said, they can be a huge benefit for those who really have no resources.

Eligibility for these programs is generally income-based (usually 200% of the Federal Poverty Level or lower), and those with insurance that covers medications are usually not eligible, although there are some exceptions. There are some discount programs that allow higher income but offer discounts, not free medication.
Family Size: Income Limit:(200% FPL for 2009)
1 $21,660
2 $29,140
3 $36,620
4 $44,100
PAP Eligibility:
I spoke with the director of Pfizer's PAP about meeting eligibility requirements for those recently unemployed. Most programs request a copy of the applicant's last IRS 1040 form to document low income - but this could lag over a year behind an employment setback. I was told that eligibility can be met with a letter stating that the applicant recently lost their job - this could be aided with a letter from their physician stating that the patient is needy due to a job loss.
Warning:
In some states insurance companies are now allowed to sell bare-bones insurance policies. The ones now being marketed in Florida, for example, have limited coverage of generic medications only. This is almost pointless, since many generics can now be had for $4 - BUT - any insurance coverage of ANY medications disqualifies patients from participation in a PAP program.

You can check various PAP web sites to find out if you can get a needed medication - start by finding the manufacturer of your medication (if generic, the brand name might be available - find out who makes the brand name version). Then go to their web site:

Rx Assist Patient Assistance Program - lets you enter the name of a medication and it will direct you to any PAP available for that medication.

Together Rx discount card program.(multiple companies)

Pfizer Patient Assistance Program

Merck Patient Assistance Program

Wyeth Patient Assistance Program