Price Variability Could Potentially Make Generic Drugs Unaffordable

Investigators recently found that generic heart failure drugs vary greatly in price, and may prevent certain patients from receiving proper treatment.

Generic drugs are generally thought to be cheaper alternatives to costly branded drugs, but these findings suggest that this may not always be the case.

In the United States, approximately 7.3 million Americans with heart disease are either uninsured or underinsured. A lack of insurance can significantly affect which medications are considered affordable, and which patients will have to do without based on costs.

“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,” said lead investigator Paul J. Hauptman, MD. “When I found out that a month's supply was going to cost him $100, 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.”

In the study published by JAMA Internal Medicine, investigators surveyed 175 pharmacies located in 55 different zip codes in the St. Louis region to determine what they charge for certain generic heart failure medications. Prices at mail order pharmacies were not included since they are typically not available to this subset of patients.

Specifically, they looked at the out-of-pocket costs for digoxin, lisinopirl, and carvedilol for uninsured patients.

Included in the 3-week survey were 153 chain and 22 independent pharmacies. The cash price for a 30-day supply for the 3 drugs ranged from $20.19 to $256.77 for low doses, and $12 to $397.58 for the high doses of the drug, according to the study.

The investigators reported that they discovered similar data for a 90-day supply of the drugs. Interestingly, the oldest drug, digoxin, was the most expensive medication of the 3 generics.

There was no link discovered between price, geographic location, and type of pharmacy. Investigators also did not find any link between socioeconomic status of the surrounding area and the pharmacy’s pricing. Price variations were even seen among the different locations of major pharmacy chains.

Patients with heart failure typically take 5 or 6 different medications, and these findings suggest that patients in low income areas may not be able to access medication, according to the study. These patients are at a high risk of complications related to heart failure, and not having access to affordable medication could result in disease worsening and poor patient outcomes.

Pricing transparency has become of great interest in the pharmaceutical industry with certain medications such as the EpiPen dramatically increasing in price each year. Additional understanding of pricing practices in retail pharmacies is needed, according to the study.

Investigators said that this study should be conducted in other geographic locations, and looking at the pricing for other generic drugs.

These findings may also help guide future health policies to make medication costs more consistent in order to improve affordability, the study concluded.