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Where high drug costs hide

Before filling your prescriptions, beware of these 5 traps

Published: November 2012

High drug prices affect everyone—those who pay out-of-pocket, those with private insurance, and even those on Medicare Part D. Some may skip filling prescriptions because they can’t afford them, while others who take expensive drugs may see their insurance premiums rise as a result. The price of prescriptions can be hidden from consumers with insurance because complex drug formularies and co-payments can make it difficult to understand a medication’s true cost. Here are five instances in which medication prices are likely to be especially high, based on our analysis of drug-pricing data, and how you can avoid overspending.

1. In the five years before a brand-name drug loses its patent

Consumer Reports Best Buy Drugs analyzed retail prices for 10 well-known drugs that have either recently become or will soon be available as generics. Using data from nearly 49 million prescriptions filled over the past five years, we found that price increases in some cases were staggering (see box, below). For example, the retail price of the bone-building drug Boniva (ibandronate) went up more than 100 percent during the five years before it became available as a generic. In 2007 the drug Provigil (modafinil), used to treat excessive sleepiness caused by narcolepsy, shift-work disorder, and sleep apnea, averaged $272 for a one-month supply. By 2012 that price had increased 305 percent, to $1,101.

Why does this happen? One reason is that drug companies are producing fewer blockbuster treatments, says Stephen Schondelmeyer, Pharm.D., Ph.D., a pharmaceutical economics professor at the University of Minnesota. A result is that companies are “milking the cash cow to get as much out of a drug as they can before it goes generic,” he says. 

What you can do: Ask whether a generic is available. Other less-costly generics in the same class may often be just as effective and safe as a brand-name medication. According to the Food and Drug Administration, 80 percent of all brand-name drugs now have a generic equivalent available. And for many other medications without a generic, ask your doctor if a therapeutic equivalent is available instead.

2. In new formulations of the same drug

Extended-release, sustained-release, or dissolvable tablets, or even an oral solution, can be convenient medicine—but it can also be expensive. Sometimes the original drug may be available as a generic, as is the case with the sleeping pill Ambien (zolpidem). A week’s worth of 5 mg tablets of generic zolpidem costs an average of $12. But the same amount for the 5 mg tablet of the dissolvable version will run you $55, for which no generic is available.

In the case of the antidepressant Prozac (fluoxetine), the 90 mg tablet taken once a week will cost you $211; the generic version is still pricey at $143 per month. But all of the daily doses (10 mg, 20 mg, 40 mg) of generic fluoxetine can be found on lists of discount generics offered by retail pharmacies for as little as $4 a month or $10 for a three-month supply. “The new formulation really isn’t a new discovery per se,” Schondelmeyer says, “but drug companies claim a new use or a little tweak, receive some additional patent life, and continue to raise the price.”

What you can do: Avoid fancy versions of medication, even if they offer some conveniences. If you don’t mind taking your medication once daily or several times a day instead of once a week or even less frequently, you could save big bucks. The same goes for sticking with traditional tablets when possible. Liquid forms, dissolvable tablets, patches, or creams can also be more expensive, although for some people a more convenient form of the medication may be worth the higher price.

3. At unsuspecting pharmacies

Earlier this year when the blood clot-reducing drug Plavix (clopidogrel) became available as a generic, we contacted 30 pharmacies in the U.S. Our secret shoppers found that retail prices for a month’s supply of 75 mg taken daily ranged from $179 to $210 at the CVS, Target, and Walgreens stores we contacted to less than $15 for the same strength and supply at Costco. Walmart consistently quoted a price of less than $50, and two independent pharmacies offered it for between $19 and $49. The online drugstore HealthWarehouse.com charged $15 for a 30-day supply.

Last year Consumer Reports searched for the best prices for four widely prescribed, expensive brand-name drugs (Lipitor, Nexium, Plavix, and Singulair), which varied a total of $570 to $738. The lowest prices were found among four websites: Costco.com, Drugstore.com, Familymeds.com, and HealthWarehouse.com. Prices at Costco.com were similar to its walk-in stores. Independent pharmacies and Walmart offered the lowest prices among walk-in stores after Costco.

What you can do: Shop around. Ask whether your pharmacy has a discount program for generics. Almost all have them, which offer excellent prices, sometimes as little as $10 for a three-month supply. Also ask about other discount programs the pharmacy may offer. For example, Kmart has a Prescription Pharmacy Savings Club that offers members 5 to 20 percent discounts on all brand-name drugs and 5 to 35 percent off generics that aren’t already discounted. Consumer Reports’ current and past secret shoppers have found that pharmacists rarely offer cost-cutting information spontaneously.

Increase in drug prices over the past five years

Brand-name drug (generic name) Used to treat                  
Avg. retail cost per prescription in 20071 Avg. retail cost per prescription in 20121 % change in price Generic available2
Actos (pioglitazone) Type 2 diabetes $200 $377 89 Now
Boniva (ibandronate) Osteoporosis 119 240 102 Now
Crestor (rosuvastatin) High cholesterol 112 214 91 July 2016
Cymbalta (duloxetine) Depression, anxiety, fibromyalgia 139 241 73 June 2013
Lipitor (atorvastatin) High cholesterol 127 237 87 Now
Lunesta (eszopiclone) Insomnia 115 203 77 May 2014
Plavix (clopidogrel) Heart disease 142 261 84 Now
Provigil (modafinil) Excessive sleepiness 272 1,101 305 Now
Seroquel (quetiapine) Bipolar disorder, treatment-resistant depression, schizophrenia 203 381 88 Now
Singulair (montelukast) Asthma 115 205 78 Now

1. For all strengths of the medication.  2. Dates are subject to change.

4. With a doctor who’s not cost-conscious

When your doctor gives you a prescription, she is most likely to first consider the effectiveness and safety of the medication—as she should. But affordability is often not considered. Nearly half of respondents to our 2011 Consumer Reports Best Buy Drugs Prescription Drug Tracking Poll who regularly take a prescription medication said that doctors don’t consider cost when prescribing a drug. And 4 in 10 said that doctors tend to prescribe newer, more expensive medication.

What you can do: Ask about drug costs. This is particularly important for medication taken for many years or for the rest of your life. Although your doctor may not know immediately what your insurance will cover, he can determine if a less-expensive and appropriate generic or therapeutic equivalent may be available. Doctors are also aware that most brand-name medication is probably more expensive.

5. From drug maker discount coupons and “freebies”

To combat higher co-pays on brand-name medication, drug manufacturers have offered more discount coupons and programs in recent years—and more consumers are using them. Last year alone our drug-tracking poll found that among those regularly taking a medication, some 16 percent had used manufacturers’ coupons in the last year to save on medication costs.

Many major name-brand drugs are offered in these discount programs, including Abilify, Actos, Crestor, Cymbalta, Effexor, Lipitor, Nexium, and Plavix. But the programs are often designed to capture interest and retain or expand the companies’ market share with low initial costs. Once the program ends or you’re no longer eligible, you’ll have to pay the original price. The coupons also can increase costs for everyone covered under your insurance plan, according to a recent report by the Pharmaceutical Care Management Association, an insurance industry advocate.

For example, if a brand-name drug costs the insurance company $150 for a one-month supply, and the co-pay is $50, they still pay $100 for your prescription regardless of whether you use a coupon that reduces your co-pay. The same report estimated that coupons could increase drug expenditures by $3 billion annually. Those costs could be passed on to you as higher premiums.

What you can do: Skip the coupons and freebies. The offers can be enticing, but they’re usually not for drugs that are the best first choice. That’s also true for most free drug samples, because after the sample runs out and it’s time to fill the prescription, you could be stuck taking an expensive drug.

One example, according to a Consumer Reports Best Buy Drugs analysis, is Actos (pioglitazone), a brand-name medication that’s used to treat type 2 diabetes. A month’s supply can cost as much as $380. (It has recently become available as a generic, though it is still expensive.) But three other low-cost generic medications actually work as well as or better than Actos: metformin, glimepiride, and glipizide, alone or in combination. A month’s supply of each of those is less than $30, and they can be found on the generic-drug lists of many chain pharmacies for as little as $4.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
   

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