Overpaying for generic medicine

[jeffrey]

One of the things that I am constantly surprised at is the amount of money people overpay when it comes to generic medications. I think what happens is that the generic brand is so much less expensive than the brand name equivalent that people don't think about comparison shopping on the generic. It also may be because there is an assumption that generic brands all have a set price and would be the same no matter where you buy them. There could be nothing farther from the truth.

There is a huge range in price charged for generic medication between different pharmacies. The exact same generic medicine that costs $90 a month at your local drug store may only be $20 at another pharmacy down the street. It pays to compare generic medicine pricing between drug stores in your area.

If you don't have the time to do comparison shopping for generic medicine, default by getting it at your local Costco. While they may not have the best prices on every generic medicine, they consistently have the best prices on most generic brands. You don't even have to be a Costco member to take advantage of their pricing. The public is allowed to use the Costco pharmacy even if they are not a Costco member due to laws. All you do is tell the person at the front door checking membership IDs that you are only going to be using the pharmacy and they will let you right in.

[pinkpink]

The problem that I have is that my doctor thinks that generic brands are not as good as the name brand for the medication that I take and recommends that I stay with the name brand even though there is a generic brand available.

[FrugalFish]

I have a cat who uses 2 RXs from the people pharmacy- obviously things we have to pay 100% out of pocket. I have found pharmacies, at least in my area, to be very unfriendly when it comes to comparison shopping RX prices. Most refuse to quote a price and accuse you of price-spying for other pharmacies. Some just hang up the phone. Our local Costco was among the least impressive. It's been incredibly frustrating at times trying to get the best price on her meds.

[jeffrey]

Originally Posted by pinkpink

The problem that I have is that my doctor thinks that generic brands are not as good as the name brand for the medication that I take and recommends that I stay with the name brand even though there is a generic brand available.

This is a tough situation which I have had to deal with in my family in the past. The difference was so big between the name brand and the generic that we chose the generic over the name brand at that time when money was tight.

If you have to take brand medication because of a doctor's recommendation, one thing that many people don't realise is that many medications offer discount coupons that can significantly reduce the amount you pay for the brand name medication. These coupons can often save you hundreds of dollars a year.

Brand name companies don't make it easy for you to find these coupons and often change them and where they are found on a regular basis. If you can't find a coupon online, ask your doctor -- they can often obtain free samples or discount coupons from the manufacturer that aren't available to the general public and then pass them on to you.

[disneysteve]

Originally Posted by jeffrey

There is a huge range in price charged for generic medication between different pharmacies. The exact same generic medicine that costs $90 a month at your local drug store may only be $20 at another pharmacy down the street.

If you don't have the time to do comparison shopping for generic medicine, default by getting it at your local Costco.

Very true. Another option is the $4 generic plan started by Wal-Mart and then copied by several other chains including Target, Shop-Rite, Wegman's and others. They provide a 30-day supply of med for $4 and a 90-day supply for $10. I have helped my patients save, probably, tens of thousands of dollars since that plan started. There are even pharmacies that offer FREE antibiotics. Just last week, I got a patient a free 10-day course of generic Cipro by sending her to Shop-Rite pharmacy. It would have been $4 at Wal-Mart but there isn't one near her house and at a chain like CVS, it would probably be $20 or more.

Originally Posted by pinkpink

The problem that I have is that my doctor thinks that generic brands are not as good as the name brand for the medication that I take and recommends that I stay with the name brand even though there is a generic brand available.

Just because he recommends it doesn't mean you have to do it. Tell him you can't afford the brand and ask that he write it to allow for generic substitution.

That said, there are certain drugs that have a very narrow therapeutic dose and sticking with brand is a good idea. These include Coumadin, Theophylline and Thyroid meds among others.

Originally Posted by jeffrey

If you have to take brand medication because of a doctor's recommendation, one thing that many people don't realise is that many medications offer discount coupons that can significantly reduce the amount you pay for the brand name medication. These coupons can often save you hundreds of dollars a year.

Brand name companies don't make it easy for you to find these coupons and often change them and where they are found on a regular basis. If you can't find a coupon online, ask your doctor -- they can often obtain free samples or discount coupons from the manufacturer that aren't available to the general public and then pass them on to you.

The sales reps flood my office with free trial coupons, discount coupons, reduced copay coupons, etc., along with free drug samples. I can't even keep track of all of the offers I get. Definitely ask your doctor. If he can't help, go to the drug company's website and see what deals they have. On popular brand name drugs, you can often find a deal to get the drug for close to the same price as a generic.

[DayByDay]

Just checked out the Lipitor site and signed up my husband for the Lipitor co-pay discount card.

[ktmarvels]

Originally Posted by disneysteve

It would have been $4 at Wal-Mart but there isn't one near her house and at a chain like CVS, it would probably be $20 or more.

If you have a pharmacy/pharmacist that you like going to, or is convenient, ask them if they'll price match Walmart's $4. Many of the larger chain pharmacies will do it, but it may not be something they actively advertise.

[Thriftina]

If you have insurance, your copay for the generic or brand will be the same whereever you go. The only time this is not the case is if your benefits coordinator/insurance company favors mail order over retail.

[marvholly]

I have a generic Rx that I take daily. My insurance co-pay for 3 months w/mail in is $25. Needless to say, I get it at a local pharmacy w/o my insurance where I pay $10-11.

[disneysteve]

Originally Posted by Thriftina

If you have insurance, your copay for the generic or brand will be the same whereever you go. The only time this is not the case is if your benefits coordinator/insurance company favors mail order over retail.

Originally Posted by marvholly

I have a generic Rx that I take daily. My insurance co-pay for 3 months w/mail in is $25. Needless to say, I get it at a local pharmacy w/o my insurance where I pay $10-11.

Thriftina, as marvholly points out, what you pay is NOT the same everywhere. For example, I have many patients who have a $10 copay for generic meds. I send them to WalMart where the same prescription only costs them $4.

Also, some insurance plans don't have a fixed dollar copay but rather charge you a percentage of the cost. My plan is like that. It reimburses 50% of the cost of the prescription so it benefits me to shop at the cheapest pharmacy.

[Scanner]

What makes me wonder about this issue is how everyone is crying "poormouth" in healthcare and then all of the sudden, boom. . .$4 copays start showing up. Makes you wonder if the drug companies, pharmacies, etc. weren't hurting before.

I mean, to me, this doesn't add up - how can it be $4.00 for "any generic?" Don't these organic and inorganic compounds have different levels of difficulty in synthesis? Every generic is just "$4.00"?

Here are 2 name-brands and a generics (as far as I can tell):

Prozac and Fluoxetine

and

Paxil and Paroxetine HCL


So, what. . . Fluoxetine and Paroxetine HCL both just cost $4.00 to make (and bring to the market to sell at a profit at Target/Walmart)? Or is Walmart and Target trying to get you into the store so they can upsell you a plastic Christmas gnome for your lawn and make money on that?

Why was it $11 and $17 before but now it's $4.00?

Sounds like a racket to me.

Am I the only one who asks these kind of questions? Or do people just think:

"Oh, well, Walmart is offering $4 prescriptions now. Good old Walmart. . .they solved the expensive medication problem in the US."

LOL.

I guess I am just a conspiracy theorist by nature

EDIT: And don't think I am also suspicious how the Drug Rep Models are offering freebies at the local medical practice. 1 in 2 pharmaceuticals in the world is consumed in the US. 1 in 2!!!! We consume more drugs per capita than we do oil.

Think about that for a second.

[disneysteve]

Scanner, not all generics are $4.00. Just a small select group of generics, mostly older drugs that have been around for a long time.

The average consumer thinks that since brand name drugs are much more expensive than generics, pharmacies must make more on those. In fact, pharmacies make a whole lot more on generics because the mark-up is far higher. I'm friendly with a pharmacist near my office and several times he has shown me his cost for a brand vs. generic drug. One drug, Mobic, was over $400/100 pills for the brand. When the generic came out (made by the very same company), it was $12/100 pills. His retail price for brand might have been $135/30 pills. Retail for generic could be perhaps $60/30 pills. Customer saves a bundle buying generic but he makes $56 on the generic and only $15 on the brand.

There is more to this story and I'll post later, but I'm on my way out for the day.

[blankcheck]

Something else that has been an issue in my experience (I'm a psychiatrist) is that some people have the idea that all physicians are paid by pharmaceutical companies. As Disneysteve mentioned, those companies certainly do advertise to everyone, including physicians. They will inform us of discounts, provide coupons, any updates to their drug inserts, etc, and provide samples for their newest (read: "most expensive") medications. I certainly see the bias that arises when too many samples of a medication are kept on hand, but I think the intention is usually good natured on the part of the physician.

Hmmm...I have a pt here who needs a medication to lower their cholesterol. There are several options, and I have one on hand which is free for now. It is an appropriate medication, therefore I will give it to them so they are getting good medical care AND I'm saving them money

The downside of this is that the gravy train won't last forever. If you don't have samples on hand and people are asking for them after you gave them last time, then the physician becomes a makeshift pharmacy, and can be regulated as one. This, so far from what I've seen, can be dicey in the long run, and can leave a bad impression with people in general.

[Scanner]

Blankcheck:

Welcome, if I haven't welcomed you before. I am a chiropractor so we all come from our biases and how we are socialized, don't we? You'll see those socialization differences come up on discussions, especially on the subject of healthcare.

We are pretty much the last vocal semi-unified profession on how Americans are just plain consuming too many pharmaceuticals. We consumer 25% of the world's oil and 50% of the world's pharmaceuticals. Yet, Japan, Luxemborg, France, etc. all beat us on measuring health indexes. If we gain limited prescriptive powers (a big political "if"), then that will be pretty much it, we will become biased too in our recommendations other than much weaker professions such as naturopaths, acupuncturists, etc.

I know the subject is generic/branded pharmaceuticals and I am not trying to hijack it but I think the broader subject is how much medicines in general that Americans consume on a yearly basis.

If people are looking to cut costs, rather than having Walmart give them prescriptions for $4, perhaps actually looking to actually open up the Unsacred Discussion with their doctor of:

Do I really even need to be taking this medicine?

Interestingly. . .kidney failure is up 25% since 1980 (my website partner is a nephrologist).

Now, why is it that?

Could be a lot of reasons:

1. Americans are living longer
2. Insult to the kidneys from pharmaceuticals/NSAIDS
3. Obesity

And talk about an expensive condition to manage. . .I am sure you know what end stage renal disease costs to manage but maybe the forum doesn't know. . .100's of thousands of dollars.

I guess what's frustrating to me/us as a professional is that we try to make lifestyle changes in our patient populations but you guys just outcompete us too much.

I'll say, "Let's work on a wellness program to reduce your weight and cholesterol" and it's, "Don't worry. . .got my cholesterol fixed. . .Crestor."

I admit. . .I can't compete with that. A little pink pill against nourishment, exercise, and/or behavior modificaton? Not going to happen.

The thing is. . .sooner or later, you are going to have to answer the italicized question posted above, because as an elderly person can't afford that 8th medicine they are on. . .you are going to have to figure out what needs rationed. I"m sure it's already happening.

Obama won't be able to help you or them.

Just my thoughts.

[disneysteve]

Originally Posted by Scanner

Americans are just plain consuming too many pharmaceuticals.

If people are looking to cut costs, rather than having Walmart give them prescriptions for $4, perhaps actually looking to actually open up the Unsacred Discussion with their doctor of:

Do I really even need to be taking this medicine?

Interestingly. . .kidney failure is up 25% since 1980 (my website partner is a nephrologist).

Now, why is it that?

Could be a lot of reasons:

1. Americans are living longer
2. Insult to the kidneys from pharmaceuticals/NSAIDS
3. Obesity

And talk about an expensive condition to manage. . .I am sure you know what end stage renal disease costs to manage but maybe the forum doesn't know. . .100's of thousands of dollars.

I guess what's frustrating to me/us as a professional is that we try to make lifestyle changes in our patient populations but you guys just outcompete us too much.

I'll say, "Let's work on a wellness program to reduce your weight and cholesterol" and it's, "Don't worry. . .got my cholesterol fixed. . .Crestor."

I admit. . .I can't compete with that. A little pink pill against nourishment, exercise, and/or behavior modificaton?

Scanner, I totally agree that Americans take far too many meds, but don't go blaming the doctors. I do my best to counsel my patients to eat well, exercise, lose weight, quit smoking, etc., but I might as well be talking to the wall for all the good it does. So if I have a patient who weighs 300+ pounds, smokes a pack/day and has a BP of 180/110, a sugar of 250 and a cholesterol pushing 300, what am I supposed to do? If the patient refuses to do what is needed to help the problem without meds, I'm forced to prescribe a slew of meds to try and keep them from killing themselves. That patient is likely to end up on 2 or more BP meds, 2 diabetes meds and a cholesterol med, so 5 pills at least, maybe more. Is it the best way to treat the person? Absolutely not. If I don't prescribe and the patient has a stroke or heart attack or develops kidney failure, guess who is liable. Yep, I'd be getting served with malpractice papers.

As for the increase in kidney disease, I'm not sure but I'm willing to bet it is due to the rapidly rising rate of diabetes which, in turn, is due to the obesity epidemic. People are eating themselves to death in this country and nobody has a clue what to do about it.

[blankcheck]

Originally Posted by disneysteve

As for the increase in kidney disease, I'm not sure but I'm willing to bet it is due to the rapidly rising rate of diabetes which, in turn, is due to the obesity epidemic. People are eating themselves to death in this country and nobody has a clue what to do about it.

Getting a bit sidetracked, but have to say something here. We pretty much know what to do about it (eat less, exercise, maintain a routine of sleep and moderation of stressful stuff for our bodies and minds) but the implementation is a whole 'nother problem. That's where physicians come in, and frankly, I wonder much like you what we can do about it.


...as for the whole "doctors use pills too much," It's that old joke:

-you're sick, here eat this root.
-we found what's in the root, and concentrated it. drink this extract.
-we have a modified version and we're trying to reduce side effects. take this pill
-this pill doesn't agree with the way your body processes things. Take this herbal supplement.
-this supplement is just a knockoff version of the whole thing. Here, eat this root...

If we don't value this type of investigation, then by all means, let me know on the whole and psychiatrists can just concentrate on the perfect talk therapy for schizophrenia instead of relying on antipsychotics too.

[disneysteve]

Originally Posted by blankcheck

Getting a bit sidetracked, but have to say something here. We pretty much know what to do about it (eat less, exercise, maintain a routine of sleep and moderation of stressful stuff for our bodies and minds) but the implementation is a whole 'nother problem. That's where physicians come in, and frankly, I wonder much like you what we can do about it.

For sure, I know exactly what to do to treat and prevent obesity. The problem is nobody wants to listen.

[Scanner]

RedThunder/DisneySteve

I am not trying to "blame" anyone for the pharmaceutical expenditure/consumption of our nation. . .it's not family doctor's fault or psychiatrist's faults, etc. . .I am saying that I think it's a cultural problem. I hope I didn't come across as finger pointing.

I am merely pointing that out that everyone doesn't ask any questions (except for me) as to how and why all of the sudden drugs are available at $4.00.

What if a drug dealer said to you, "I can get you your pot now at $4/bag? So don't worry about that daily reefer getting too expensive."

Aren't you the least bit suspicious?

Again, I am not a conspiracy theorist but there's something rotten in Denmark as they say.

That's why I made the reference of the world per capita consumption of oil in comparison with our per capita consumption of pharmaceuticals. I very, very much beleive that 99% of doctors (real ones, not like me) do their best to limit medications. That's not just a platitude offered to DS and blankcheck; I sincerely beleive it working along side with primary care (they are in my office) for 4 years now.

Despite everyone's best efforts, here we are.

(Clarification: what I meant by "lessor profession" was I meant "less politically powerful", not lessor in any other way. I would say chiropractors are probably the most politically powerful drugless profession out there but our voice is a tiny squeak in the huge chorus of pharmaceutical and insurance symphony. We are simply drowned out. Nothing against naturopaths or acupuncturists)

1 in 3 ads during prime time TV are for direct market pharmaceutical ads. 1 in 3!!! That has a cultural effect.

So, okay, enough chat about it - like DS says, there is only so much you can talk before people will change.

I say you have to hit people where it hurts - their pocketbook.

Tax the following:

1. Liquor
2. Cigarettes
3. Sugary drinks and foods
4. Attach a 10% health premium on every 10% over a normal BMI they are.

You would see lifestyle diseases plummet. And then instead of 5 medications as DS points out, you would maybe see 1 and not "lifestyle drugs."

The solution will have to be societal as I don't think the medical profession, any profession, has the ability to enact a public health change.

[disneysteve]

Originally Posted by Scanner

I am merely pointing that out that everyone doesn't ask any questions (except for me) as to how and why all of the sudden drugs are available at $4.00.

Scanner, I don't think there is anything suspicious here at all. It isn't that the wholesale cost of the drugs suddenly plummeted. The price has been dirt cheap for a long time and pharmacies were making a bundle on the huge mark-up in retail price. WalMart came along and decided that they could sell them for $4 and still make a profit, plus draw a lot of customers into their stores who would likely buy other things. Personally, I think it is brilliant marketing.

I gave an example of the mark-up earlier. Pharmacies would price generics to make them seem like a good deal vs. the brand but make a fortune in the process. If the generic is $.05/pill and the brand is $1.00/pill but you sell the brand for $1.25 and the generic for $.75, you make a lot more money on the generic.

[Scanner]

Okay, I am just paranoid, I guess.

There's nothing rotten in Denmark. Walmart just saved the day. Every generic regardless of difficulty of synthesis, costs $4. To me, it would make sense to me that one generic may cost $3 and another generic would cost $11. . .but okay, every generic drug costs $4.

But that's why the forum keeps me around - because I am the Forum Cuke and advocated things like buying silver in 2006.

And I appreciate the party-line analyses more than you know because I think so non-traditionally about subjects. . .I do think I am lost sometimes.