At WholeHealth Chicago, we really do try to avoid prescribing prescription drugs whenever we can, opting instead for lifestyle changes that can keep you away from a chemical pill you might have to take for the rest of your incarnation.
But sometimes…because we won’t play games with your health you’ll leave with instructions to pick up your medication at the drugstore.
I don’t know if other doctors are doing this, but for new meds I routinely do a quick price comparison, a real eye-opener for many patients. Other times, with someone new to WholeHealth Chicago, I’ll share a price comparison as I review her medication list alongside her drug benefits.
Honestly, if the person has great prescription coverage I don’t spend time on pricing. But occasionally we’ll luck out and our patient will leave the office knowing she’ll be saving a serious amount of money every month.
Understanding drug pricing
First, let’s get a handle on brand name drugs versus generics. Of course there are spectacular differences in price, which is why your insurer hates it when your doc prescribes a brand-name drug. Insurers also didn’t want you to know anything about these high-priced, brand-name drugs and as a result were greatly opposed to the direct-to-consumer drug commercials you’ve been seeing on TV for decades. Here’s a good piece on the mid-1980s controversy.
You’ve also read there can be real differences in quality between brand-name and generic. The brand-name drug goes through an excruciating amount of testing before the FDA allows you to swallow the first pill. Generic drugs come primarily from chemical plants in China and India and are then repackaged in a wholesome-sounding place like Des Moines.
Plus, even though the generic drug manufacturer checks on its own production (fox, please watch henhouse) and signs a statement that its product is identical to the brand-name version, as for quality control at the point of manufacture there is very little. Ranitidine, the recently-recalled generic version of Zantac, probably was contaminated for years with the carcinogen NDMA.
Second, brand-name drug prices are fixed by the manufacturer and protected by its patent. Interestingly, even after the drug goes generic the price of the brand-name version must remain unchanged.
Your prescription for a brand-name drug will cost pretty much the same high price at Costco as at Walgreens. Sometimes, but unfortunately less and less often, a branded drug will be sold for a lower price via a Canadian pharmacy. Using a Canadian pharmacy is just fine, but these days people are discovering that with comparison shopping, price-wise you can do just as well in the US.
Third, when we look at generic drugs prices they’re are all over the place. If you’ve got excellent drug coverage and your insurer will pony up for a generic (some are quite costly), that’s fine. But too often a patient hears from the pharmacist “Your insurer won’t cover it.” The subtext being: “Ask your doctor to prescribe the less expensive, older version that no one uses because it doesn’t work and has terrible side effects. Your insurance will pay for that!”
Eye-popping prices
“Oh,” you tell the pharmacist, “Since it’s a generic, I’ll just pay out of pocket.”
The next thing you know you’re waking up on the floor in front of the pharmacy counter. The pharmacist peers down into your face and gently says, “You fainted. It’s sticker shock. We see it all the time.”
The following table, which compares the prices of two common drugs available both as brand-name and generic (Crestor/atorvastatin and Viagra/sildenafil), will explain why you passed out. The table shows prices for the brand-name version (the higher price) and the generic. Note: the first price is retail, the second is with a goodrx discount card (more on that below).
Yes, if you tell the Walgreens pharmacist you have no insurance and you don’t have a goodrx discount card, she will charge you $576 for brand-name Crestor. She could say “Hey, go online, get a discount card, and walk across the street to the Mariano’s, where it will cost you only $15.” Of course, she’d be unemployed at the end of the day.
| Drug | Walgreens | CVS | Osco | Mariano’s | Costco |
| Crestor
/atorvastatin 90 tabs | $576/$192 | $533/$49 | $270/$19 | $193/$15 | $48/$15 |
Viagra/sildenafil
30 tabs $1376/$553 $1288/$333 $393/$25 $1994/$20 $1146/$19
I could go on. Other drug pricing can be less dramatic, but generally Walgreens (and often CVS) are at the very least three times more expensive than Osco, Mariano’s, and Costco. Walmart and Sam’s Club are about the same as Costco.
Ubiquitous Walgreens
Now you’ll ask yourself “How did I end up using Walgreens, anyway?” Well, let’s face it, like nail salons and foot massage places, Walgreens is everywhere. But in addition you may have gotten instructions from your insurer that Walgreens is their “preferred prescription partner” and that you’ll be able to use your pharmacy coverage there and have a delectably low co-pay of $10 or less.
“But,” you protest, “Is Blue Cross (or United or Aetna or Medicare Part D) actually paying Walgreens $192 for 90 days of Crestor when they could pay $15 at Mariano’s?”
Probably not, but you’ll never actually know. Prescription drug prices negotiated between insurance companies and pharmacy giants include a middleman called a Pharmacy Benefit Manager. Like hospital charges, their math is better hidden than Donald Trump’s tax returns.
But keep in mind that as long as an insurer pays a high price for an inexpensive generic it can pass that high price on to you (or your employer) in the form of higher insurance premiums.
Next steps
I don’t want to make all this sound overly complicated, so here’s what I suggest:
—Line up all your medications and write down how much you’re paying out of pocket for each. If all you’re forking over is a roughly $10 co-pay, then great. And if in order to get that price you must use Walgreens, then go ahead and do so.
You can click here to read an older Health Tip on why Walgreens so thoroughly irritates me. Or you can click here to learn how abject company greed made both Walgreens and CVS major players in the current opioid crisis.
—If your prescription isn’t covered or if your co-pay is more than $10, go to goodrx.com, look up your drug, and see if you can find it somewhere less expensive. Important note: when you use goodrx pricing, you are not using your insurance.
Just remember, our current healthcare system routinely places profits above your well-being. There’s a reason US lifespans are declining and chronic illnesses are on the rise. You must be a pro-active patient and if you work at it you can…
Be well,
David Edelberg, MD