Price Comparison of Commonly Prescribed Pharmaceuticals in ...
Price Comparison of Commonly Prescribed
Pharmaceuticals in Alberta 2018
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2018
In Canada, prescription medications are the second most costly component
of health care, upwards of $29 billion per year.1 These costs largely reflect
the treatment of chronic medical conditions predominantly cared for by
family physicians,2 including heart disease, high cholesterol, hypertension,
diabetes and depression.1
Among OECD nations, Canada¡¯s drug spending per capita is lower than only
Switzerland and the United States.4 Canada also has the second highest
rate of cost related medicine non-adherence in the world, where one in 12
Canadians do not fill a prescription or skip doses due to medication costs.5
In Alberta, trade name medications account for 33% of prescriptions but
around 80% of prescription drug costs.6 On a national level, the top 100
most expensive prescription drugs (of ~3000 available products),7 account
for almost half of total prescription drug spending.8
Canada is currently the only country with a universal health insurance
system without a national pharmacare program.11 Adopting a national
pharmacare program would save approximately 7 billion dollars annually
in prescription drug costs.11
Many medications within a drug class are therapeutically interchangeable
with similar anticipated clinical outcomes. Newer medications within a
class are often derivatives of older products, frequently at a substantially
higher cost, and often not covered under provincial drug plans (see Table
1). In 2015, pharmaceutical companies spent over 500 million dollars on
journal advertisements and sales representative visits in Canada,9 with
over 90% of marketing aimed at medications with little or no therapeutic
gain over existing prodcuts.10
Most provincial governments are implementing cost control measures for
prescription medications. For instance, Alberta implemented a maximum
allowable cost pricing for proton pump inhibitors, where patients are
encouraged to use a covered lower cost alternative medication or
personally pay the cost difference between their higher and lower cost
alternative.12 We estimate that using lower cost PPIs could save over 200
million dollars annually in Canada without an appreciable change in most
patients symptoms or health.
Recently, the pan?
Canadian Pharmaceutical Alliance announced a new
pricing deal with generic pharmaceutical makers.13 While they negotiated
a 25-40% price reduction for the 70 most commonly prescribed generic
medications,14 Canadians will still be paying significantly more than other
countries for their generic medications.14 (see Table 2)
Medication costs information may influence prescribers to choose lower
cost alternative medications.15 With this in mind, we are pleased to publish
our 6th annual Price Comparison of Commonly Prescribed Pharmaceuticals
in Alberta. We encourage prescribers to consider costs (and medication
coverage) when treating chronic medical conditions and especially when
needing to choose between therapeutically similar medications.
In addition to considering least cost alternatives, other ways of decreasing
medication costs include:
?
Using combination products
?
Extending long term prescriptions to at least 90 days
?
Splitting medications
In this document, 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. 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). Medications that
are not covered (NC) are paid for entirely by your patients.
The prices, rounded to the nearest $5, represent the entire retail cost
of the prescription filled at a community pharmacy in Alberta, including
markups and dispensing fee. 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 to the health system. The reported price reflects the
maximum allowable dispensing fee charged under provincial regulations.
Some pharmacies may charge less than that, but this tool allows for relative
cost comparisons between medications in the same class or for treating
the same condition.
This list is not exhaustive, but is up to date as of February 3, 2018. We
encourage you to contact your local pharmacist for information on
medications not included that you routinely use in your practice.
Please forward any feedback, including cases where knowledge of
medication cost or coverage made a difference to your patients or practice
to: mkolber@ualberta.ca or tony.nickonchuk@ahs.ca.
Michael Kolber MD CCFP MSc, University of Alberta, Peace River
Jayson Lee BSc Pharm,Pharmacare Fulfillment Centre, Edmonton
G. Michael Allan MD CCFP, University of Alberta, Edmonton
Christina Korownyk MD CCFP, University of Alberta, Edmonton
Tony Nickonchuk BSc Pharm, Alberta Health Services, Peace River
3
What¡¯s New in 2018?
References:
Added: Acne medication and Testosterone replacement
1.
Table 1: Important Price Differences between Generic
and Trade Name or Therapeutically Similar Products
Prescription medication use by Canadians aged 6 to 79. Statistics Canada. 2014. Available
at: . Accessed
November 23, 2015.
2.
Stewart M, Ryan B. Ecology of health care in Canada. Can Fam Physician 2015; 61:449-53
Brand
Generic Name
90 Day
Cost
Cheaper Alternative
90 Day
Cost
90 Day
Savings
3.
Canadian Rx Atlas, 3rd ed. 2013. Available at: . Accessed November 25, 2014.
Brilinta 90mg
Ticagrelor
$315
Clopidogrel 75mg
$50
$265
4.
OECD Data: Per capita Pharmaceutical Spending. Available at:
healthres/pharmaceutical-spending.htm#indicator-chart. Accessed February 14, 2018.
Trintellix 20mg
Vortioxetine
$320
Fluoxetine 20mg
$60
$260
5.
Pristiq 50mg
Desvenlafaxine
$285
Venlafaxine 75mg
$45
$240
Morgan SG, Lee A. Cost-related non-adherence to prescribed medicines among older
adults: a cross-sectional analysis of a survey in 11 developed countries. BMJ Open 2017;
7:e014287. doi:10.1136/bmjopen-2016- 014287
6.
Alberta prescription drug market. 2016. Available at: . Accessed February 5, 2018.
7.
Author calculation based on: Alberta Drug Benefit List, Alberta Human Services and the
Palliative Coverage Drug Benefit Supplements Price File January 1, 2016. Available at:
Accessed December 23, 2015
$255
Metformin 1g BID
$30
$225
Glumetza SR
2000mg QD
Metformin SR
Advair Diskus
250/50
Fluticasone/
Salmeterol
$340
Symbicort 200/6
(Budesonide/
Formoterol)
$155
$185
8.
Paquette A. Top drugs of 2013. 2014 Feb 18. Pharmacy Practice Plus. Available at:
Accessed December 3, 2015.
Nexium 40mg
Esomeprazole
$200
Pantoprazole 40mg
$30
$170
9.
Coversyl 4mg
Perindopril
$95
Ramipril 5mg
$30
$65
Lexchin J. Drug prices: How do we get to a better place? CMAJ 2017 June 12;189:E792-3.
doi: 10.1503
10.
Lexchin J. The relation between promotional spending on drugs and their therapeutic
gain: a cohort analysis. CMAJ Open 2017. DOI:10.9778/cmajo.20170089
11.
Morgan SG, Law M, Daw JR, Abraham L, Martin D. Estimated cost of universal public
coverage of prescription drugs in Canada. CMAJ 2015. DOI:10.1503 /cmaj.141564
12.
Alberta Health Pharmacy Benefact Number 639. September 2016. Available at: https://
ab.bluecross.ca/pdfs/pharmacy-benefacts/pharmacy-benefact-639.pd
13.
Zafar A. CBC News January 29, 2017. Generic drug industry agrees to cut prices up to
40% in 5?year deal with provinces Available at: . Accessed Feb 1, 2017.
14.
Adhopia V. Big Pharma Blinked. But Why? Available at:
second-opinion-february-3-2018-1.4517468. Accessed February 3, 2018.
15.
Gorfinkel I, Lexchin J. We need to mandate drug cost transparency in electronic medical
records. CMAJ 2017 December 18;189:E1541-2. doi: 10.1503
Table 2: Comparison of Newly Negotiated Canadian
Generic and New Zealand Generic Medication Prices
4
Drug
Frequency
New Canadian Price
Per 3 Month Supply
($CAD)
New Zealand
Price Per 3 Month
Supply ($CAD)
Difference
Atorvastatin 80mg
Daily
$21
$6
-$15
Amlodipine 5mg
Daily
$12
$1
-$11
Metformin 850mg
TID
$9
$4
-$5
Candesartan 32mg
Daily
$21
$10
-$11
Olanzapine 10mg
Daily
$64
$5
-$59
Finasteride 5mg
Daily
$37
$4
-$33
Table of Contents
CARDIOVASCULAR........................................................................................................................................................ 6
Lipid Lowering Agents, Beta Blockers, Calcium Channel Blockers, Angiotensin Converting Enzyme Inhibitors (ACEIs)................6
Angiotensin Receptor Blockers (ARBs).............................................................................................................................................................................7
Diuretics, Anti-platelet, Anti-coagulant..............................................................................................................................................................................7
HYPOGLYCEMIC AGENTS............................................................................................................................................8
OBESITY...............................................................................................................................................................................8
SMOKING CESSATION.................................................................................................................................................. 9
RESPIRATORY.................................................................................................................................................................10
GASTROINTESTINAL..................................................................................................................................................... 11
PSYCHIATRY.................................................................................................................................................................... 12
CONTRACEPTIVES....................................................................................................................................................... 13
HORMONE REPLACEMENT THERAPY.................................................................................................................14
UROLOGY..........................................................................................................................................................................14
ANALGESICS.................................................................................................................................................................... 15
MISCELLANEOUS.......................................................................................................................................................... 16
Antibiotics, Osteoporosis, Dementia................................................................................................................................................................................. 16
Topical steroids and other preparations.......................................................................................................................................................................... 17
Lice treatments........................................................................................................................................................................................................................... 18
Oral iron therapy........................................................................................................................................................................................................................ 18
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