Generic HF drug prices vary widely

NEW ORLEANS — The prices of three generic drugs used to treat HF — carvedilol, digoxin and lisinopril — vary considerably at the retail pharmacy level.

The combined cost of the three generic drugs ranged from $12 to $400, according to data reported at the American Heart Association Scientific Sessions and simultaneously published in JAMA Internal Medicine.

In May, Zackary D. Goff, MD, and colleagues surveyed by phone 175 pharmacies across 52 ZIP codes (153 chains, 22 independent) in the greater St. Louis area encompassing eastern Missouri and Illinois to assess how much they charged uninsured customers for carvedilol (6.25 mg and 25 mg twice daily), digoxin (0.125 mg per day and 0.25 mg per day) and lisinopril (10 mg per day and 40 mg per day).

According to the researchers’ estimates, the combined cash price for the three drugs for 30 days ranged from $20.19 to $256.77 for low doses of the drugs (median price, $67.98) and from $12 to $397.58 for high doses of the drugs (median price, $70.68).

Similar data were obtained for 90-day supplies: price range of $50.89 to $703.97 for high doses of the drugs (median price, $169.67) and $30 to $1,144.98 for low doses of the drugs (median price, $180.46).

Digoxin was the most expensive drug of the three, examined individually. The median price was approximately $40 for low and high doses of the drug in 30-day supplies and $115 for 90-day supplies.

Only 1.7% of pharmacies (n = 3) charged less than $25 for 30-day supplies of the three drugs and 5.3% (n = 9) charged less than $100 for 90-day supplies.

The researchers found no link between price and type of pharmacy or median income associate with the ZIP code in which the pharmacy is located. Moreover, two major pharmacy chains did not have consistent pricing across their own stores, according to a press release. One chain reported consistent pricing across various locations.

“The idea for the study originated with one of our patients, a 25-year old man with [HF], who called the office and said he could not afford to fill a prescription for digoxin,” Paul J. Hauptman, MD, professor of medicine and cardiologist at Saint Louis University School of Medicine in Missouri, said in the release. “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.”

The researchers acknowledged several limitations of this study, including analysis limited to only three drugs, a lack of inclusion of data on pharmacy volumes and a lack of inclusion of mail-order pharmacies.

Future research should focus on the reasons behind the wide variability in pricing observed in this study, implications for adherence and subsequent clinical outcomes, they concluded. – by Katie Kalvaitis

References:

Goff ZD, et al. Poster T2134. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Hauptman PJ, et al. JAMA Intern Med. 2016;doi:10.1001/jamainternmed.2016.6955.

Disclosure: The researchers report no relevant financial disclosures.