Price Comparison of Commonly Prescribed Pharmaceuticals in ...
[Pages:20]Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014
What would your patients do with extra cash? Perhaps buy new running shoes and a gym membership, or take a trip to escape the Canadian winter? We could be saving our patients and the health care system substantial money if prescribers chose lower cost (often equivalent) medications, instead of higher cost medications, which may not be covered by provincial drug plans. Choosing sitagliptin (Januvia) over metformin for diabetes, perindopril (Coversyl) over thiazides for hypertension and pregabalin (Lyrica) over amitriptyline (Elavil) for chronic pain can add up quickly.
Physicians have limited knowledge and poor access to information about drug plans.1 With this in mind, we endeavored to create a document listing the price of medications commonly prescribed by Albertan primary care health providers. Although medication choice should be based on clinical situations, many medications are therapeutically interchangeable and using this reference allows prescribers to consider costs when prescribing. Other cost savings methods to be considered include: increasing prescription lengths for long-term medications, using combination products, and pill splitting where possible.
The prices represent the entire retail cost of the prescription filled at a community pharmacy in Alberta, including markup and dispensing fees. This does not reflect what a patient would pay if covered under a drug plan, but rather the cost to an individual without coverage, or the cost to the health care system. Prices have been rounded to the nearest $5. Although prices may differ between wholesalers and pharmacies (especially for oral contraceptives and insulins), this tool allows for relative cost comparisons between medications in the same class or for treating the same disease. This list is not exhaustive and we encourage you to contact your neighborhood pharmacist for information on medications not included that you use in your practice.
This document is up to date as of January 1, 2014. Since the 2013 edition, generic prices have changed substantially, dropping in price in most cases. For 2014, we have added a section on hormone replacement therapy and Alzheimer's disease medications. Please forward any feedback, including prices that surprised you or cases where knowledge of prices made a difference in your practice to nickonchuks@.
Costs listed are primarily for the generic product (with generic name bolded) as provincial drug plans will generally only pay for the lowest cost formulation available. Brand name prices (with brand name bolded) are for products still under patent protection. We also provide information on coverage by Alberta Blue Cross (BC) and Indian Affairs (IA) formularies and which products require Special Authorization (SA).
Michael Kolber BSc, MD, CCFP, MSc Associate Clinical Professor Department of Family Medicine, University of Alberta
Jayson Lee BSc Pharm Clinical Pharmacist, Pharmacare Specialty Pharmacy #2 Edmonton, Alberta
Calculating medication costs
Tony Nickonchuk BSc Pharm CDE APA Manager, Walmart Pharmacy Peace River, Alberta
Medication costs were calculated by adding the wholesale cost of the medication plus mark up dispensing fee. Alberta Health & Wellness determines the maximum markup and dispensing fee that can be charged based on the acquisition cost of the medication and is illustrated in the table below.
This table is accurate for all medications except oral contraceptives, insulins, and injectables, where the total charge can be as high as 2/3 of the acquisition cost to a maximum of $100 per prescription.
Acquisition Cost $0-74.99 $75-149.99 $150+
Dispensing Fee $10.22 $15.53 $20.94
Markup $1.71 $2.00 $5.03
Total Fee $11.93 $17.53 $25.97
Acknowledgements
We wish to thank Stacy Jardine, BSc. Pharm, Jamie Hoy, BSc. Pharm, Mike Allan MD, CCFP and Tina Korownyk MD, CCFP for their contributions to this project.
Reference
1. Allan GM, Lexchin J, Wiebe N. Physician Awareness of Drug Cost: A Systematic Review PLoS Med. 2007 Sep;4(9):e283.
Table of Contents
CARDIOVASCULAR.........................................................................................................................................................5
Lipid Lowering Agents, Beta Blockers, Calcium Channel Blockers.........................................................................................................................5 Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blockers (ARBs), Diuretics................................................6 Anti-platelet, Anti-coagulant..................................................................................................................................................................................................7
HYPOGLYCEMIC AGENTS............................................................................................................................................8 RESPIRATORY.................................................................................................................................................................. 9 SMOKING CESSATION.................................................................................................................................................10 GASTROINTESTINAL..................................................................................................................................................... 11 PSYCHIATRY.................................................................................................................................................................... 12 contraceptives....................................................................................................................................................... 13 HORMONE REPLACEMENT THERAPY.................................................................................................................14 ANALGESICS.................................................................................................................................................................... 15 UROLOGY.......................................................................................................................................................................... 16 Miscellaneous.......................................................................................................................................................... 17
Antibiotics, Osteoporosis, Alzheimer's
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014 | 5
Generic Name CARDIOVASCULAR
Brand name
Strength
Dosing
90 Day Cost (unless otherwise noted)
Coverage
Lipid Lowering Agents
Atorvastatin
Lipitor
Rosuvastatin
Crestor
Atorvastatin
Lipitor
Rosuvastatin
Crestor
Atorvastatin
Lipitor
Pravastatin
Pravachol
Simvastatin
Zocor
Ezetimibe
Ezetrol
10mg
QD
10mg
QD
20mg
QD
20mg
QD
40mg, 80mg QD
20mg
QD
10mg
QD
10mg
QD
$40 $45 $45 $50 $50 $55 $55 $200
BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered SA req'd for BC and IA
Beta Blockers Bisoprolol Metoprolol Metoprolol-SR Bisoprolol Atenolol Metoprolol-SR Atenolol
Monocor Lopresor Lopresor SR Monocor Tenormin Lopresor SR Tenormin
5mg
QD
25mg, 50mg BID
100mg
QD
10mg
QD
50mg
QD
200mg
QD
100mg
QD
$20 $25 $25 $25 $25 $35 $35
BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered
Calcium Channel Blockers
Amlodipine
Norvasc
5mg
QD
$35
BC / IA covered
Diltiazem-T
Tiazac
240mg
QD
$45
BC / IA covered
Amlodipine
Norvasc
10mg
QD
$45
BC / IA covered
Nifedipine
Adalat XL
30mg
QD
$65
BC / IA covered
LEGEND:
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014 | 6
Generic Name
Brand name
Strength
Angiotensin Converting Enzyme Inhibitors (ACEIs)
Ramipril
Altace
5mg
Ramipril/HCT
Altace/HCT
5mg/12.5mg
Fosinopril
Monopril
10mg
Lisinopril
Zestril
20mg
Ramipril
Altace
10mg
Ramipril/HCT
Altace/HCT
10mg/25mg
Enalapril
Vasotec
10mg
Dosing
90 Day Cost (unless otherwise noted)
Coverage
QD
$25
QD
$30
QD
$30
QD
$30
QD
$30
QD
$35
QD
$35
BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered BC / IA covered
Perindopril
Coversyl
4mg
QD
$95
BC / IA covered
Perindopril/Indapamide Coversyl Plus
4mg/1.25mg QD
$115
BC / IA covered
Perindopril
Coversyl
8mg
QD
$130
BC / IA covered
Angiotensin Receptor Blockers (ARBs) (All have HCTZ combo products that are similar in price to the single entity product)
Telmisartan
Micardis
80mg
QD
$35
BC / IA covered
Candesartan
Atacand
8mg
QD
$40
BC / IA covered
Irbesartan
Avapro
150mg
QD
$40
BC / IA covered
Losartan
Cozaar
50mg
QD
$40
BC / IA covered
Valsartan
Diovan
80, 160mg
QD
$50
BC / IA covered
LEGEND:
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014 | 7
Generic Name
Brand name
Strength
Dosing
90 Day Cost (unless otherwise noted)
Coverage
Diuretics
Chlorthalidone
Hygroton
50mg
1/4 QD
$15
BC / IA covered
Hydrochlorothiazide
Hydrodiuril
12.5, 25 mg
QD
$15
BC / IA covered
Furosemide
Lasix
20, 40 mg
QD
$15
BC / IA covered
Indapamide
Lozide
1.25mg
QD
$20
BC / IA covered
Spironolactone
Aldactone
25mg
QD
$25
BC / IA covered
Spironolactone
Aldactone
100mg
QD
$35
BC / IA covered
Anti-platelet
ASA
Aspirin
81mg, 325mg QD
$5
OTC, IA covered but NC BC
Clopidogrel
Plavix
75mg
QD
$70
SA req'd BC, IA covered
Prasugrel
Effient
10mg
QD
$280
NC by BC or IA
Ticagrelor
Brilinta
90mg
BID
$310
SA req'd for BC, NC by IA
Anti-coagulant
Warfarin
Coumadin
5mg
QD
$20
BC / IA covered
Rivaroxaban
Xarelto
10, 15, 20mg
QD
$300
SA req'd for BC, NC by IA
Dabigatran
Pradax
110mg
BID
$335
SA req'd for BC, NC by IA
Dabigatran
Pradax
150mg
BID
$335
SA req'd for BC, NC by IA
Apixaban
Eliquis
5mg
BID
$425
SA req'd for IA, NC by BC
LEGEND:
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014 | 8
Generic Name
Brand name
Strength
Dosing
90 Day Cost (unless otherwise noted)
Coverage
HYPOGLYCEMIC AGENTS
Biguanides
Metformin
Glucophage
500mg
2 BID
$35
BC / IA covered
Metformin SR
Glumetza SR
1000mg
1 BID
$250
NC by BC or IA
Sulfonylureas
Glyburide
Diabeta
5mg
BID
$20
BC / IA covered
Gliclazide
Diamicron
80mg
BID
$30
BC / IA covered
Meglitinides
Repaglinide
Gluconorm
1mg
TID
$40
BC / IA covered
Dipeptidylpeptidase-4 Inhibitors (DPP-4)
Linagliptin
Trajenta
5mg
QD
$270
SA req'd for BC and IA
Saxagliptin
Onglyza
5mg
QD
$295
SA req'd for BC and IA
Sitagliptin
Januvia
100mg
QD
$310
SA req'd for BC and IA
Glucagon-like Peptide 1 Agonist (GLP-1)
Liraglutide
Victoza
1.2mg SQ
QD
$595
NC by BC or IA
Insulin (Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 15 mL of penfill insulin)
Long-acting insulin
Humulin N
100U/mL
As dir
$45
BC / IA covered
Long-acting insulin
Novolin NPH
100U/mL
As dir
$45
BC / IA covered
Regular insulin
Humulin R
100U/mL
As dir
$45
BC / IA covered
Regular insulin
Novolin Toronto 100U/mL
As dir
$45
BC / IA covered
Rapid-acting insulin
Humalog
100U/mL
As dir
$60
BC / IA covered
Rapid-acting insulin
Novorapid
100U/mL
As dir
$65
BC / IA covered
Basal insulin
Lantus
100U/mL
As dir
$100
BC / IA covered
Basal insulin
Levemir
100U/mL
As dir
$110
BC / IA covered
LEGEND:
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
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