June 10, 2009 -- When it comes to prescription drugs, it really does pay to shop around.
A study of prices for drugs commonly taken by diabetes patients showed that mail-order retailers and big-box discounters can save consumers thousands of dollars a year compared to the local pharmacy.
Overall, Medco by Mail and Wal-Mart were the least expensive, while neighborhood and chain pharmacies generally charged the most, according to Dr. Clifton Jackness and Dr. Ronald Tamler, both of the Mount Sinai School of Medicine in New York City.
"Being an informed consumer is clearly beneficial," they told colleagues at the American Diabetes Association meeting.
The total monthly out-of-pocket price for all 10 drugs most commonly prescribed to diabetes patients for any indication ranged from a low of $428.35 with Medco to a high of $641.90 with Rite Aid.
The researchers said lower prices may encourage patients to stick with their medications and stay healthier, since nearly one in five adults with diabetes reports cutting back on their prescriptions because of cost.
However, there is often a tradeoff for lower prices, said Dr. Paul Robertson, ADA's president of medicine and science.
"Pharmacies, especially local ones, offer more than drugs," he said. "They offer service and the opportunity to talk to a pharmacist."
Giving that up in exchange for a lower bill might be worthwhile for some patients who are on a stable regimen and familiar with their medications, whereas for others it might not, Robertson noted.
The stakes in shopping around are collectively enormous. According to the American Diabetes Association, there are 23.6 million diabetics in the United States, or 8 percent of the population. And their number is growing as the nation ages and unhealthy lifestyles lead to an increase in diabetes diagnoses.
To calculate the impact of shopping around, the researchers tabulated the most common prescriptions filled by diabetes patients under age 65 -- a population expected to have at least some out-of-pocket cost associated with their medications -- from a database compiled by 91 health insurance plans across the United States.
Cost of Top Prescriptions Varies, Study Says
After excluding non-chronic medications such as antibiotics, the top medications in order of number of prescriptions were:
Lisinopril (Prinivil, Zestril)
Rosiglitazone (Avandia), excluded from the analysis because of declining use since the time covered by the database
Furosemide (Lasix, Furocot)
Insulin glargine (Lantus)
Interestingly, the list contained several drugs that were not strictly diabetes-related, including statins that fight cholesterol and medications to lower blood pressure.
Jackness noted that diabetes patients take an average of 8.9 medications, and believes the typical patient would be on the majority of drugs on the list, he said.
The cost of a 30-day supply of each -- assuming no prescription drug coverage by public or private insurance -- was determined from price data collected by the New York and New Jersey State Attorneys General.
These offices maintain publicly accessible Web sites on current prescription drug prices at the pharmacies in their respective states. The researchers confirmed the prices by direct contact with the pharmacies.
For some drugs, the price differences between pharmacies were dramatic.
Consider metformin, one of the most popular diabetes drugs in the United States and the 10th most popular generic drug prescribed overall in 2008, with 40 million prescriptions written, according to Drug Topics magazine.
According to the new study, a 30-day supply of metformin sold for $4.00 in the generic drug discount program at Wal-Mart and Target and for $5.00 at Kmart. But the local neighborhood pharmacies averaged $38.95 and pharmacy chain Rite Aid charged $39.99.
While stores such as Wal-Mart have heavily marketed their low-cost generic programs, they tended to offer more competitive prices for non-generic drugs as well, the researchers found.
Cost Differences May Save Diabetics Hundreds Per Month
And, although the superstores and mail-order pharmacies did not consistently offer lower prices for every medication, none of the local chains or independently-owned pharmacies had the lowest price for any drug on the list.
When prices for the 10 drugs most commonly prescribed to diabetes patients were added (excluding rosiglitazone), the monthly totals were:
$428.35 for Medco by Mail (excluding shipping and handling)
$432.53 for Wal-Mart
$483.94 for Kmart
$501.65 for Drugstore.com (excluding shipping and handling)
$505.95 for Target
$584.44 for CVS
$633.11 for Duane Reade
$638.31 for Walgreen's
$639.20 for local pharmacies
$641.90 for Rite Aid
Unfortunately, this kind of price information is not readily available in most states, said Dr. Patricia Coon of the Billings Clinic in Billings, Mont.
Nevertheless, savvy patients and physicians can find this information locally by doing their homework, said Coon, who was not involved in the study.
"They do a lot of shopping from pharmacy to pharmacy to get the lowest price," Coon said. "It's not unusual for patients to be asking to be switched to generics or the generic that's offered by a Wal-Mart or large brand."
Jackness agreed, noting that even if it is not posted in a central location, price information is available with a phone call.
"People shouldn't assume a drug is the same price everywhere," he said.
In his own New York City practice, Jackness said he often recommends low-priced local outlets to patients at financial risk.
"If we see patients without insurance we tell them to go down to Penn Station and go to Kmart," he said.
But realizing the savings from purchasing all medications at a superstore or mail-order company may not be possible for all patients, the researchers noted.
"The patient must have the physical ability and means of transportation to travel to these stores or order online," they said.
They cautioned that the study did not take into consideration insurance coverage, which might limit how much its findings can be generalized.
Drug Affordability a Big Issue for Patients
But regardless of patients' insurance status, the findings should serve as a wakeup call for physicians to take an active role in ensuring patients are able to obtain their prescribed medications, Jackness and Tamler concluded.
If adherence is an issue, physicians should ask patients about the impact of medication costs and suggest cost-lowering strategies, Robertson said.
The researchers reported no funding or conflicts of interest. Coon and Robertson reported no conflicts of interest.