When St. Louis cardiologist Paul Hauptman got a call from a 25-year-old patient who couldn’t afford to buy his prescription for a generic drug to treat heart problems, he knew something was wrong.
“It was $100 at a local pharmacy. I thought surely, it was a mistake,” Hauptman said. “Most of the medications, we’re presuming at most pharmacies will be something like $4, $5, $6.”
So Hauptman and his research team at St. Louis University started calling 200 pharmacies in the St. Louis region. They asked for the sticker prices of three common drugs used to treat heart failure — digoxin, lisinopril and carvedilol — and the results were all over the board.
“Carvedilol costs $4 or $140 for a 30-day supply. Digoxin, that costs $4 or $300. This type of range was completely unexpected,” Hauptman said. “We’re concerned that patients are going to the pharmacy, having sticker shock, and going home.”
About 7.3 million people in the United States are uninsured and living with cardiovascular disease, according to the American Heart Association.
The problem with the varied costs of drugs, Hauptman said, is that the pricing appears to be completely random throughout the St. Louis region. A color-coded pricing map published with the study had the air of a well-populated dart board after a few rounds.
“There was no clear association or predictors of pricing. Rural, suburban, urban, Missouri versus Illinois. High median income, low median income,” Hauptman said. “Even within the same chain, if you go to two different stores you might get two different prices.”
The disparity in drug problems is a real problem without a clear solution, said Herb Patterson, a University of North Carolina pharmacist and board member for the Heart Failure Society of America.
“Consumer Reports has addressed this recently and they strongly encourage consumers to ‘shop around’ for the best price.," Patterson wrote in an email. "Unfortunately, this then leads to (patients) going to multiple pharmacies to get different medications and it tends to negate having a single pharmacist who can oversee all their medications for interactions.”
“Not optimal health care in my opinion,” he wrote.
Hauptman's research appears as a research letter in JAMA Internal Medicine.
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