Price Comparison of Commonly Prescribed Pharmaceuticals ...

[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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