Diabetes Self-Management Blog

Has this happened to you? You go to refill a generic prescription, and the price has jumped by 100%, or even 1000%. Huge price swings in generics are happening more often, and nobody is sure why.

I got much of this information from Dr. David Belk’s Web site The True Cost of Healthcare. Dr. Belk also writes frequently on health-care costs for The Huffington Post.

San Francisco Chronicle writer Victoria Colliver picked up on some of these crazy price swings in an article dated January 1. She found that between November 2012 and November 2013, the price for 100 milligrams (mg) of the antibiotic doxycycline increased by 6,351%.

The price for 25 mg of the antidepressant clomipramine (brand name Anafranil) went up 3,497%. And 12.5 mg of the blood pressure medicine captopril soared by 2,714%.

The bizarre thing is that the price for other doses of the same generic may stay low. So if the price for 150 mg tablets goes crazy, why doesn’t a pharmacy give you two 75-mg tablets or a 300-mg pill and tell you to cut it in half?

They can’t. Dr. Belk says the law requires pharmacies to give people exactly what is prescribed. The only change they can make is to switch a generic for a brand name. He says that if you’re hit with a price spike, you have to go back to your doctor and ask for another dose.

Perhaps the pharmacist can make that call for you. You can also ask for a different medicine in the same class. The price for 150 mg of irbesartan (Avapro) jumped from 15 cents a pill in October to over $3 a pill in November. But another blood pressure drug, losartan, remains cheap and is in the same class as irbesartan.

“When used as a substitute,” Belk writes, “losartan will have the exact same effect on your blood pressure and no new side effects.”

What causes these price gyrations? Some generics have what is called a “fragile supply chain.” There may be only one or two manufacturers. If something goes wrong with one of them, or they lose access to raw materials for the drugs, supply may collapse and prices soar.

But that doesn’t explain how 75-mg pills can have skyrocketing prices while 100-mg prices stay the same. Dr. Belk compares that to a half gallon of milk selling for $20, while a quart still costs $1.25 and a gallon costs $3.50.

Although such price spikes have happened to glyburide (Micronase and others) in the past, the current list of crazy price jumps does not include any generic diabetes drugs. So that’s one good thing.

You might ask how drug companies can get away with these huge price increases? Well, if you’re paying for your own drugs, you will notice right away and might call your doctor immediately. Or you might not, feeling nothing can be done.

But if your insurance pays, it might be the pharmacist who takes the hit. Pharmacies often contract with insurers in advance for how much they will charge for prescription drugs. If the price of their supply goes up, pharmacies either take the loss or tell you to go to another pharmacy, losing you as a customer.

Either way, the super-high prices can’t last too long. Doctors, pharmacies, and patients find out and gradually change their meds. But that takes time; most doctors and even most pharmacies don’t pay close attention to how much drugs cost. In the meantime, some supplier rakes in big money. The prices seem to snap back into place after a year or so.

Other price madness
Dr. Belk gives many other examples of drug pricing madness in this article.

He notes that 5 ml of ciprofloxacin (an antibiotic eye drop) costs pharmacies $3.79. But 2 ml of ciprofloxacin ear drops cost $47! And 20 mg fluoxetine (Prozac and others) pills cost 16 times as much as the same dose in capsule form. Promethazine (Phenergan and others) suppositories can cost 100 times as much as the same medicine in a pill.

Belk debunks the idea that all these price swings are normal market reactions. I agree. How can there be a fair market when the sellers (doctors, hospitals, drug companies) decide what the customers should buy? That’s crazy. Of course buyers wind up spending too much.

If you’re interested, here is a 138-page list in PDF format of generic and brand name drug prices charged to pharmacies. Perhaps this list could help you shop.

Some of the prices are staggering — 20 mg of the antipsychotic Abilify is $30 per pill — while others are wonderfully cheap. Some are both. Five mg of diazepam (generic Valium) costs about 2 cents a pill. But one 2.5-mg dose of diazepam rectal gel costs over $220! I imagine they don’t sell too much of that.

The only advice I can give is that when prices are unexpectedly high, don’t just automatically pay. Check around and see if there are cheaper doses or similar medications. Ask your pharmacist. See if the meds are cheaper at Costco, Walmart, or CVS. Then ask your doctor for a different prescription, if needed.

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Comments
  1. If you take extended release metformin, be very careful how your doctor writes out the prescription. For my mail order pharmacy, if the prescription is written out for Fortamet ER (with the generic deemed acceptable by the doctor) it will cost you a fortune for 3 months (for me, $300). If it is written out for Glucophage ER, the same 3 months cost was $4.99. It took a phone call to the mail order pharmacy and insisting on speaking to a pharmacist to figure this one out. And the pharmacist was reluctant to discuss pricing.

    Posted by Elaine |
  2. Thank you for this excellent and informative post. It is very difficult to understand why there is so much difference in drugs prices. I have been lucky not to have experience such drastic changes in the price of my medications.
    Sara.

    Posted by Sara VDW |
  3. This past week I went to pick up my Pravastatin, which was previously $10 for 3 months supply. It was $52 at Walmart. The pharmacist said it had just fallen off the $10 list!! Since I pay my own, no insurance, this makes a huge difference.

    Posted by Lisa Richardson |
  4. Since the rectal gel of valium is used to try to stop a prolonged seizure, which can be life threatening, people do have to buy it sometimes. But I do wonder if those poor families are being gouged.

    Posted by BK |
  5. Why?? I barely squeak buy as it is since I am one of those x government employees who is not allowed to collect social security (never mind that I worked 30 years and have all my credits)and then to make it worse the government takes 2/3rd’s of my widow’s benefit because they can - so after 30 yrs - most of it not government I am left with a small disability pension from work of $1250 per month and $300 a month for widow’s benefit. Social security says they can take 2/3rds of my widow’s benefit because my husband benefited from my income with the government! He died 5 months after I went to work for the government!!

    So now I have had to go back to work - not easy with my disabilities - just to be able to buy my meds.

    Posted by Sue |
  6. I work in a pharmacy, and I see the crazy price increases all the time. It never use to be this bad. I noticed it more after the the housing market collapsed.
    We just recieved a notice from our drug supplier that there are more increase to come and some of these are over 300%. Like the artical said, it can’t stay like this for very long. Work with your pharmacists and doctor. There are different alternatives out there, just give the pharmacy and doctor time.

    Posted by Kathy |
  7. I take Glucophage xl 750mg. twice daily. I can
    not take generics because of the fillers. my
    doctor tried the generic and it didn’t help
    but as soon as I took the brand name it worked
    and I have been taking it since 2005. is there any
    insurance that covers it

    Posted by barbara |
  8. For Lisa Richardson above: Have your doctor change your pravastatin to simvastatin. It’s the same class of medication so it will lower your cholesterol the same way and it’s still on Walmart $10 list. In fact, it costs only $32.95 a year at Costco.

    Posted by David Belk |
  9. Just found this out with ramipril which went from a tier 2 to tier 3, which. Goes from S5.00 to S75.00.

    Posted by Elaine Griffon |
  10. 100 ramipril cost about $20 at Costco for non members. Here’s the link:
    http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm=r&Drug=RAMIPRIL

    Posted by David Belk |
  11. Thanks to David Belk for sharing this information. It’s nice to have an expert helping us out!

    Posted by David Spero RN |
  12. Thanks for shining light on this. Nadolol (an anti-hypertension drug thats been around for decades) has been selling under $10 for a 3 month supply — until several months ago, when it spiked to the $140 - $160 for the same dose and amount.

    Where I come from this is called price gouging. Americans don’t tolerate price gouging of necessities in a disaster scenario, why should we tolerate this? I see no ethical difference in the scenarios.

    The pharmaceutical companies have been running amok for a long time now. Its time to get a choker leash on them. BAD DOG!

    Posted by Pat P |
  13. My problem this year is the cost of my co-pay for my diabetic drugs (insulin) and my diabetic supplies (pen needles and test strips)has increased from a $15 co-pay to an $80 co-pay. I’m still working but was looking forward to retiring in 2 years. Now I’ve got to save more just to afford my diabeties medicine and supplies in retirement.

    Posted by Olivia Clay |
  14. Nice list of meds EXCEPT some meds are listed by 15’s. Others by 30’s, 90’s, 100’s, 500’s etc. Confusing. Give the cost by 100’s which is easier to figure out.

    Posted by William Tiep |
  15. For William: I’m working on simplifying that list but it will take time. The original list has over 22,000 lines and lists price per unit (ml,g,pill,etc…) and is much more confusing if you’re not a doctor or pharmacist. this was the best we could do in a short time.

    Posted by David Belk |
  16. I can not say I know the ends ands outs. I will say companies are lining there pockets off the back of sick folk. It is a ashame and disgrace. I am looking in every way I can treat myself naturally. I paid $50.00 just for one inhaled medication. It started out being 36.00 but the price has done nothing but raise. Breath or die that is my choice. I will not even speak of the cost of the rest of my medications. This is with insurance.

    Posted by pat |

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