This past summer when Debbie Diljak, 54, of Raleigh, N.C., went to pick up her pain medication from a nearby pharmacy, she was shocked when she says she found that the price had skyrocketed from $38 to almost $200 for a month’s supply. Diljak didn’t have insurance, so she simply didn’t fill the prescription for duloxetine (generic Cymbalta), an antidepressant that also is used to treat certain types of pain. Instead, she took another anti-inflammatory drug that cost less. What happened next wasn’t a big surprise: “I stiffened up and hobbled around a lot,” Diljak says. “But I just couldn’t afford the drug at that price.”
Like Diljak, millions of Americans have been hit with high drug costs within the last year. In fact, a recent Consumer Reports National Research Center poll of 1,037 adults showed that a third of those who currently take a drug said they experienced a spike in price in the past 12 months—anywhere from just a few dollars to more than $100 per prescription.
According to the American Society of Health-System Pharmacists, big price jumps can be due to anything from a product shortage to a change in your insurance coverage. And in rare instances, manufacturers may raise prices simply because they have no competitors also selling the medication. (Because this landscape can be so confusing, Consumer Reports Best Buy Drugs evaluates medications for price as well as safety and efficacy; go to CRBestBuyDrugs.org to learn more.)
Frustrating as sudden price hikes can be, our poll shows that most people just fork over the money. Only 17 percent comparison-shopped to see whether they could get a better deal. If you have a standard insurance co-pay, it might not occur to you to shop around. But sometimes the price you’d pay out of pocket (what those without insurance are charged) might be less than your co-pay —a fact pharmacists may neglect to mention. Case in point: Metformin—used to treat type 2 diabetes—sells for just $4 for a month’s supply, or $10 for a three-month supply, at stores such as Target and Walmart, while a co-pay for a month’s worth averages about $11.
And if you do decide to pay out of pocket, the prices retailers charge can vary a lot. To find out what various retailers were charging, we had secret shoppers check prices for five common generic drugs at stores around the country, including chain drugstores, big-box retailers, supermarkets, and independent pharmacies.
In our national price scan, secret shoppers made more than 300 phone calls in all, to more than 200 pharmacies in six cities and their surrounding areas across the U.S. They requested prices for five common generic drugs: Actos (pioglitazone), for type 2 diabetes; Cymbalta (duloxetine), an antidepressant also used to treat muscle and bone pain; Lipitor (atorvastatin), for high cholesterol; Plavix (clopidogrel), a blood thinner; and Singulair (montelukast), for asthma. What we found was startling. In short, prices can vary widely from retailer to retailer, even within the same ZIP code.
Drugs could cost as much as 10 times more at one retailer vs. another. We’re not talking about regional differences; we found big variations at retailers in the same area. For example, where Debbie Diljak lives in Raleigh, N.C., the cost for a month’s worth of the generic Cymbalta she takes ranged from $249 at a Walgreens to $43 at Costco. (At Walgreens, the pharmacist did suggest using the store’s discount program to lower the price to $220, but it comes with a $20 annual fee.) See more examples in the map below.
Similar patterns emerged across the U.S. In Dallas, a shopper was quoted a price of $150 for generic Plavix at a centrally located CVS. But Preston Village Pharmacy, an independent just a 20-minute drive away, said it would sell the drug for just $23. In Denver, the grocery store Albertson’s Save-On said its price for generic Actos was $330, but nearby Cherry Creek Pharmacy said it would sell it for just $15. For the variety of prices we found, see the chart below.
The price isn’t always set in stone. Shoppers sometimes found that they could get a discount, but only after they asked. At a supermarket pharmacy outside of Des Moines, a shopper was first quoted a price of $75 for generic Actos, but after asking whether there was a better deal, she was offered the drug for $21.
“It sounds crazy that you would need to approach buying prescription medications like you would a used car—by shopping around and haggling. But that’s the reality of today’s pharmaceutical marketplace,” says Stephen Schondelmeyer, Pharm.D., a pharmacoeconomics professor at the University of Minnesota.
Retail pharmacies don’t really expect anyone to pay those high prices, says Adam Fein, Ph.D., president of Pembroke Consulting. “A list price is just a fantasy number,” he adds. In fact, reps from both CVS and Rite Aid told us that they expect cash buyers to access discounts. “Pricing surveys fail to take into account the various value and discount programs available at most pharmacies for cash-paying customers,” according to the CVS representative. And Rite Aid directed us to its Rx Savings Program, which has no annual fee and offers a 30-day supply of certain generics for $9.99; a 90-day supply, for $15.99. But none of the newer generics we priced were on the posted list.
And many pharmacies don’t quote a bottom-line price until they have your prescription in hand, or in the computer. “At that point, they basically have your business,” Schondelmeyer says. “They count on customers not wanting to hassle with transferring their prescription elsewhere.”
Retail pharmacy chains such as CVS and Rite Aid set high retail “list,” or usual and customary, prices because that helps determine what the insurance companies will pay for the drug, Schondelmeyer explains. Still, those huge discrepancies are puzzling. As with other consumer products, such as toothpaste and cereal, we’d expect prices to be more consistent among stores competing for your business. Though chains have their own contracts with drug suppliers, it’s unlikely, according to Schondelmeyer, that the wholesale price would vary that widely. So we reached out to a few retailers, but they would not comment on the wild swings we’ve seen.
In a written statement, a Rite Aid representative told us that its pricing strategy was “proprietary” and that “we regularly evaluate our pricing strategy to make sure we remain competitive.” Similarly, a CVS rep wrote that the full list prices of drugs aren’t relevant because the majority of its customers are just charged their insurance co-pay. But our follow-up analysis suggests that many people do pay out of pocket. For example, in Raleigh last year, some 3,000 prescriptions for generic Cymbalta cost consumers an average of $242 each, or a total of $716,000.
That gets at the heart of the matter, Schondelmeyer says. Retail chains such as CVS and Rite Aid aren’t concerned about consumers who pay out of pocket, he says, because they typically make up less than 10 percent of their business. What does concern them is how much third parties, such as insurance companies, will pay, usually either a negotiated reimbursement fee or the list price —whichever is lower. So retailers intentionally set the list price very high so that there’s no chance it could undercut what they get paid by insurers. “If your pharmacy quotes a cash price of $40, then a third-party payer will balk if you turn around and charge them $75,” Schondelmeyer says.
Of course, as Fein explains, “very few consumers understand pharmacy economics well enough to negotiate with their pharmacist. That’s why retail pharmacies earn much higher profits on uninsured and underinsured individuals.”
We found one exception to that practice: Costco.“We just price products as low as we possibly can and still make a modest profit,” says Victor Curtis, R.Ph., senior vice president of pharmacy. Costco does that by scrupulously controlling expenses so you can expect more of a no-frills experience: no 24-hour drive-thru or Sunday hours, for example. One big cost savings comes from filling prescriptions at a central facility and shipping them overnight to stores. So when your phone in a refill, you might be asked whether next-day pick up is okay. “That halves our labor cost,” Curtis says. (Customers can still opt for same-day service.) According to Curtis, Costco pharmacies have four times more cash customers than the national average.
Because retail pharmacy chains set the list price of drugs so much higher than places like Costco, we also wondered whether they are charging insurance companies more. “Unfortunately, the true costs are hidden,” Schondelmeyer says. For example, he notes that if you have insurance and see your doctor, you’ll receive an explanation of benefits, or EOB, which shows your costs and how much your insurance company paid. But when it comes to drugs, there’s no EOB, so it’s not clear how much pharmacies actually charge. “The sad part is even consumers who try to find the true cost in this crazy market just can’t do it,” Schondelmeyer adds.
The situation for consumers could worsen as new marketplace changes occur: CVS recently bought Target’s pharmacy business. And Walgreens has announced its intention to take over Rite Aid. “Having effective competition at all levels in the supply chain is critical for protecting consumer choice,” says George Slover, senior policy counsel for Consumers Union, the policy and advocacy arm of Consumer Reports. “That’s why it’s so important that antitrust enforcers examine these types of mergers carefully.”
Earlier this year, we had secret shoppers make calls to the pharmacies of more than 200 stores across the country to price a market basket of five common generic prescription drugs. We followed up with half of them recently and also checked one online pharmacy, to get the most up-to-date prices. The numbers in the chart below are averages of the price retailers quoted for a one-month supply. Retailers are listed from least to most expensive for the total price of our market basket.
With rising drug costs, people whose insurance company stops or reduces coverage of a drug—or those without coverage at all—will feel the pinch. Even those with insurance may still face higher out-of-pocket costs as co-pays and deductibles increase.
Not being able to afford medications has consequences: About 40 percent of people in our survey said they cut corners with their medication to make ends meet—they split pills without their doctor’s okay, for example, skipped doses, or like Debbie Diljak, simply didn’t fill their prescription. People hit with high drug costs were also twice as likely as others to avoid seeing their doctor or to forego a medical procedure. But as Diljak discovered, there may be other options that are better for you and your wallet.
Regardless of which drugstore or pharmacy you use, choosing generic over brand-name drugs can save you money—as much as 90 percent in some cases. Talk to your doctor, who may be able to prescribe lower-cost alternatives in the same class of drugs. For more ways to save money on your next prescription, see our list of tips, below.
Last, once you’ve done the work to find a pharmacy that you like and that offers a good price, our medical consultants advise filling all of your prescriptions there. Keeping all of the drugs you take in one system helps avoid duplications and dangerous interactions.
This article also appeared in the January 2016 issue of Consumer Reports magazine.
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