The Cost of Prescriptions
I recently was reminded of the plight of countless patients who try to balance paying the high cost of prescribed medications with other necessary expenses such as food, rent, and clothing. Not only are the elderly particularly at risk but so are millions of Americans included in the growing number of working poor and medically uninsured. Ms. LS, one of my patients, is a 78-year-old woman living in the community. She helps out several neighborhood families by caring for young children during the day to allow their mothers to remain employed and to add a small amount to her income from Social Security. She has a hard time making due with her limited income. Fortunately, she is taking only a few medications, is relatively fit, and rates her health as “good.” I have been treating her osteoporosis and have placed her on alendronate.
Each time I see her, I emphasize the need for her to take this medication correctly to avoid gastrointestinal side effects. She has tolerated the medication without problem and is due for a repeat DEXA scan in a few months to help reassess bone status. This week, when I again began to discuss the medication I had put her on, she volunteered that she had to pay more than $235 to fill her last three months’ prescription; she questioned whether this medication was “definitely necessary” given its cost. Even with the new Medicare prescription plan, the cost of medications will remain a burden for many and will likely continue to place many individuals at risk of not being able to easily afford their prescriptions. Few consider what actually goes into the cost of a medication. How much are the costs of the actual ingredients, expense of pharmaceutical company research and development that was necessary to bring the medication to the consumer, product marketing and detailing to physicians, actual profit to the pharmaceutical company, and markup and profit to the drugstore that dispenses the medicine to the patient?
Although these costs vary greatly, consider the results of a recent study conducted by an investigative reporter for a news station in Detroit. As you would expect, the actual cost to a drugstore for a generic drug is small. How small? Generic atenolol, for example, reportedly cost a pharmacy less than $1 for 100 50-mg pills. The average cost to the consumer, however, was reportedly $104! Similarly, 1 mg of generic alprazolam cost the same drugstore approximately 2.4¢ for 100 pills. The $136.80 charged to the consumer represented a phenomenal markup of more than 5000%! These numbers may not be representative of all drugstores or regions throughout the country, but they illustrate the tremendous markup at all levels as medications pass from production to the consumer.
Generic drugs are considered to be cheaper than brand name products and are usually automatically substituted unless specified that a brand name must be given; they may not always be the best in a given circumstance or even available as an equal substitute. Generic drugs also have undergone a considerable markup on their way to the consumer. They have the same need for storage and pharmacist time. Drugstores must make a profit, so some markup would be expected; however, few realize the extent of this contribution to the cost a consumer must bear. Pharmaceutical companies are usually blamed for the high cost of drugs; pharmacies, however, profit greatly and appear to be a major cause of the high cost of medications passed on to the consumer. We need to remember to advise our patients that not all drugstores charge the same for a medication, and the difference may be significant and worth the extra time and effort to “shop around.” The generic prochlorperazine, for example, was being sold for $55 for 60 pills at a local nationally named pharmacy at the same time that a discount pharmacy was selling 100 of the same pills for $19.89.
There are many other examples of similar potential savings. Although consumers cannot negotiate lower prices by themselves, they can in certain circumstances call ahead to ascertain the price of a given prescription and hopefully compare prices prior to their visit to the store. Consumer groups might also consider accumulating cost comparison data and making it available to patients seeking to purchase necessary medications at the best possible price. Perhaps posting this information on the Web would be useful for some. Unfortunately, although the local store may not be the cheapest, it may be the only one available in a given neighborhood and the person who needs the medication may be in no position to travel to some distant pharmacy or to take the time to explore cost options. It appears that something must be done to bring the cost of medications within reasonable limits. Is it too much to expect that profit margins be regulated at all levels as medications pass along to the consumer to ensure that life-sustaining medications remain within the reach of all who need them? Just how much profit is reasonable to those along the prescription chain, and can medications alone be regulated without altering the economic principles on which our economy has been based? The prescription plan under Medicare will clearly not solve this problem; another solution must be found if we are to ensure proper health care for all. The questions remain: when will this happen, and who will take up the fight?
I welcome your comments. Steven R. Gambert, MD, AGSF Editor-in-Chief, Clinical Geriatrics Send comments to Dr. Gambert at email@example.com.