by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Jun 13, 2014 | Drug Importation, Drug Prices
A few weeks back we wrote about drug affordability problems related to high deductible Obamacare silver plans. A new report finds problems across all four tiers for patients requiring expensive specialty drugs. Many plans have co-insurance rather than a fixed co-pay for these medications, which means patients pay a percentage of a drug’s price rather than a flat fee. In fact, over 50% of bronze, silver, and gold plans studied had co-insurance rather than fixed co-pays for specialty drugs. That compares to only 38% for platinum plans.
According to Wellmark, “Specialty drugs are prescription medications that require special handling, administration or monitoring. These drugs are used to treat complex, chronic and often costly conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.”
Pamela Morris, of Zitter Health Insights, said “A lot of times, if someone has coinsurance their first exposure to OOP [out of pocket costs] is at the pharmacy, where they may be unsure if they’ve met their deductible or if the costs are purely coinsurance.”
So how big could this price shock be? Let’s look at Tecfidera, a sample oral Multiple Sclerosis drug. The cash price is around $6,000 for 60 capsules of the 120 mg dose. Even if your co-insurance is 25%, that’s $1,500. You can purchase the same amount for $1,200 from an international online pharmacy. Still expensive, but a $300 savings is nothing to scoff at. And it’s likely that the co-pay would be even more than 25% in which case the international savings could be much higher.
Gleevec, a medication used to treat certain types of leukemia, is around $29,000 for 90 pills. That will cost you $7,500 if your co-insurance is only 25%. Using an international online pharmacy, you can purchase 90 pills of generic Gleevec for $725 from a Canadian pharmacy. This may even be cheaper than using Novartis’s patient assistance program for brand name Gleevec. The program has strict eligibility requirements but is worth pursuing if you believe you’re eligible.
We’re sorry to report that many specialty meds may not be safe to order from an international online pharmacy. Some might be extremely temperature sensitive, others are administered in a clinical setting, only sold by specialty pharmacies, and some aren’t even approved for sale outside the U.S. For some specialty drugs, the savings might not even be that great, as prices are high globally!
We promise to research all avenues of savings for these medications and report back to you soon…
Tagged with: Gleevec, Obamacare, specialty drugs, tecfidera
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Jun 6, 2014 | Drug Importation, Drug Prices, Generic drugs
Americans who take Celebrex to fight arthritis may be pleased to know that a generic version has been approved by the FDA. The New York Times’ coverage reports, in a somewhat predictive fashion, that generic drugs “can cost 30 to 80 percent less than the branded products.” While that’s true, don’t expect generic Celebrex to be so cheap. What’s most likely is that its price will initially be around 80%, and then creep downwards.
Millions of Americans have seen this pricing trend over the past few years, as many popular medications have recently gone generic. A patent’s expiry does not necessarily mean cheaper drugs, at least immediately. That’s because the FDA grants marketing exclusivity for a generic to a single drug company for six months, so only two drug companies – the brand name manufacturer and the first generic manufacturer – are competing. As more drug companies enter the market the price will eventually cost a fraction of the brand name counterpart. But that first generic to market will usually only be about 20% cheaper than the brand.
When atorvastatin (generic Lipitor) first came out you could actually save a lot of money by purchasing the brand from an international online pharmacy instead of the generic from a U.S. pharmacy. Now, with many companies manufacturing atorvastatin, generic Lipitor in the U.S. can be found for about $15 per month if you use a discount card. International online pharmacies that once had a leg up on U.S. pharmacies lose big once competition drives U.S. generic drug prices down.
A perfect example is the popular antidepressant Cymbalta. Currently, the cash price of a 90 day supply of duloxetine (generic Cymbalta, 60 mg) is around $250 – and that’s after using a discount card at the pharmacy. A 90 day supply of brand name Cymbalta is only $90 when ordered from an international online pharmacy – a 64% discount!
We expect this pricing pattern for Abilify, Gleevec, Crestor, and many other drugs coming off patent down the pipeline. In the initial phase of a new generic’s release, the brand version from an international online pharmacy will probably be much cheaper, but eventually your neighborhood pharmacy will be your best bet. So if you take Celebrex expect to celebrate a low cost U.S. generic in early 2015!
Tagged with: Atorvastatin, Celebrex, Cymbalta, Patent Cliff
by Sam Werbalowsky | May 23, 2014 | Drug Prices, Healthcare Reform
A new report shows that out-of-pocket prescription costs may be twice as high for plans created by the Affordable Care Act, also known as Obamacare, than traditional employer plans. This burden falls on patients with high deductibles who must pay out-of-pocket for 100% of their costs until they hit their deductible, which tends to be around $2,000 for Silver plans.
That isn’t to say these new plans are bad; preventative care is usually covered for free and can sometimes stave off the need for medications in the first place. The problem will usually hit hardest on those who depend on medications for a chronic condition. However, unforeseen medical issues could throw anyone into this cost predicament.
The goal of the Affordable Care Act was to make healthcare, well, affordable, and it won’t be for people who cannot afford drugs because of weak pharmacy benefits. The report also showed that Silver plans have higher co-insurance and co-pay rates than typical employer-sponsored plans.
If you’re finding yourself facing a high deductible, and generic alternatives at your local pharmacy are not available, you might consider an online pharmacy. You can save up to 90% on brand name medication from verified international pharmacies.
Tagged with: Affordable Care Act, Obamacare, Silver Plans
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | May 16, 2014 | Advocacy, Drug Prices
AIDS prevention may be revolutionized if healthcare providers start to write more prescriptions for Truvada as a preventative measure for people at high risk for contracting HIV. As reported in the The New York Times, the U.S. Centers for Disease Control and Prevention is pushing for expanded use of Truvada as a prophylactic to prevent new HIV cases. To date, it has been primarily used to treat people who have already contracted HIV. If this recommendation is adopted, the number of prescriptions written for Truvada could increase from less than 10,000 per year to 500,000 per year, hopefully lowering the rate of new HIV infections, which has remained steady at 50,000 per year over the past decade.
But what if patients can’t access Truvada because of its cost? After all, a drug doesn’t work if a patient can’t afford to take it. The drug has a monthly cash price of about $1,500 at local U.S. pharmacies. Fortunately, Truvada is usually covered by insurance and Gilead offers an assistance program that covers the first $200 of a co-pay. They also have a program that covers the full cost of the drug for eligible uninsured or underinsured patients. Eligibility is not guaranteed to all!
Even if you’re insured and prescribed Truvada, the high cost might mean difficulties when it comes time to fill the prescription. Many pharmacy benefit formularies put the drug in tier 2 or 3, which means high co-pays. Other formularies place Truvada on a list of drugs that require pre-certification. In that case, the drug might not even be covered at all!
According to FiercePharma, dramatic increases in the number of prescriptions written for Truvada (and therefore requests for pharmacy benefit reimbursements) could increase co-pays and also curtail assistance programs. If that happens, patients may find themselves having to fork over a lot of cash for higher copays, deductibles or co-insurance. Some may very well end up stuck with a $1,500 per month bill.
For these patients, or anyone else who falls through the cracks, international online pharmacies may be an option. Truvada – the brand – is available for about $543.00 internationally; the generic – emtricitabine/tenofovir – not yet available in U.S. pharmacies, is $224.00. This could provide a lifeline for Americans who are prescribed Truvada in the coming years.
Tagged with: AIDS, CDC, Gilead Sciences, HIV, Truvada
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | May 2, 2014 | Drug Prices
If you’ve never heard of a non-profit pharmacy, that’s ok – there are only three of them in the country. Non-profit pharmacies can charge lower prices because they don’t have to realize profits for shareholders or owners.
One such pharmacy, Community First Pharmacy, located in Hamilton, OH, has recently been praised for putting its customers ahead of profits. According to coverage in Daily Dayton News, one of the biggest hurdles is getting customers in the door, as many folks are under the wrong impression that the pharmacy only serves the uninsured or under-insured. That is not the case – Community First Pharmacy maintains two separate inventories, one for private-pay patients and one for uninsured and underinsured patients who need assistance with medication payment. The pharmacy also receives steeply discounted drugs by participating in the 340b program, a federal program open to non-profit healthcare organizations.
Overall, this system allows the pharmacy to profit from privately insured customers while offering low prices to those who could not otherwise afford their medicine. For instance, the pharmacy can match the popular $4/month plans found at retailers like Target or Walmart, or even offer a lower price, without having to make up the lost profit by marking up other drugs. One patient only paid $1.20 to get his prescription filled!
I couldn’t find much information on the other two non-profit pharmacies in the country. Pharmacy Over the Rhine, located in Cincinnati, OH, serves local residents who often found it difficult get to actually get to a pharmacy, due to transportation or work issues. Like Community First, Pharmacy Over the Rhine serves anyone and is able to put profits on some medications toward lower costs for Americans who are struggling with their prescription bills.
I’m glad that these pharmacies are offering low-cost medication to those who need it most, and, in the case of Pharmacy Over the Rhine, providing accessibility to those who need it. Local pharmacies are struggling to stay afloat these days, and perhaps the non-profit model will be the wave of the future that lets them compete and serve their communities.
by Gabriel Levitt, Vice President, PharmacyChecker.com and Sam Werbalowsky, Pharmacychecker.com | Apr 18, 2014 | Drug Prices
The International Federation of Health Plans released data yesterday that compares the costs of healthcare around the world. Thankfully, The Huffington Post and Vox.com chose to cover this. While the Huffington Post article merely adds more proof that America has high drug prices, the Vox article points out something that we’ve been talking about for a long time: the U.S. pays more for the same exact products found in other countries. Sarah Kliff writes, “There’s nothing different about the Nexium that we buy in the United States and the pill that the Dutch buy – except that, in the United States, we’re terrible at negotiating a good deal on pretty much any medical service.”
Interestingly, there is sometimes a difference in various countries’ versions of Nexium: it is often sold as a tablet in Europe compared to a capsule in the U.S. Both products are made by drug giant AstraZeneca. There are many instances where the exact same drug, made in the United States, is astronomically more expensive domestically than internationally. To show you, just hop on the time machine to our series Made in America; Cheaper Abroad.
Tagged with: American Made Prescriptions Are Cheaper Abroad, Huffington Post, Nexium, Vox.com
