M (2018)
[Pages:26]PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA
(2018)
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 2
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA
Prescription Drug Costs
Medication prices are in a constant state of flux. This can make it difficult for prescribers to get a handle on the cost of medications. A survey of this
issue suggested that 80% of physicians felt unaware of the actual cost of the medications they prescribe.1 A systematic review concluded that physi-
cians consistently overestimate costs of inexpensive prescriptions and underestimate costs of expensive medications.2 Price may not be the most im-
portant factor in selecting a prescription medication but patient-borne costs are an important barrier to optimal outpatient medication use and adherence.3,4 Formulary coverage and prescriber selection directly influence out-of-pocket costs for patients.
Recognizing the limitations of physicians' knowledge regarding medication costs, the Alberta College of Family Physicians began producing an annual
pricing document for comInmtroondlyucptrieosncribed medications starting in 2011.5 Since each province has its own formulary and costing system, such a pricing
document would only apply to the province in which it is produced. Following in the footsteps of Alberta, the "Price Comparison of Commonly Pre-
scribed Medications in Manitoba 2016" document was created and launched at the Medication, Evidence and Decision Support (MEDS) Conference in
January 2016.
The third edition, "Price Comparison of Commonly Prescribed Medications in Manitoba 2018" was released at the MEDS conference on January 27th,
2018. Key changes include the part 1 coverage of PPIs, and the part 1 coverage and introduction of generic pregabalin at a reduced price. Duloxetine
also now has part 1 coverage. Diclectin? is now available in generic form at less than ? the cost of the brand name. It still may not work very well (PLoS
One 2017;13(1):e0189978) but at least it is a cheaper. The introduction of Basaglar? (glargine) insulin is interesting. A biosimilar to Lantus? sold for
approximately $30 less than the originator product. The ARB-diuretic combination are now generic and essentially the same price as the ARB alone.
They might be a good choice if your patient needs the combination. It is hoped that this document will enhance the understanding of medication pricing and coverage so that clinically effective medications that are also affordable and cost-effective are preferentially selected.3,6
Methods
The prices represent only the medication cost to the nearest dollar for a 90-day supply unless otherwise indicated. The cost per unit/tablet has also been
provided. Coverage under the Manitoba Pharmacare program (PC) and the Non-Insured Health Benefits (NIHB) has also been listed. These prices do not
indicate the full amount paid by patients. In Manitoba dispensing fees are not regulated and may vary between pharmacies. This makes it impossible to
calculate the final total price for a given prescription; however, the ranking of relative prices in a particular drug class is unlikely to be altered. For drugs
listed on the Manitoba Drug Interchangeability Formulary, the lowest formulary price was used to calculate the cost for a given drug. For all other medi-
cations, wholesale prices were used as the source of pricing. The prices listed in this guide were current as of January 2018 (including Pharmacare Bulletin #96 ? January 25th, 2018) and may be subject to change.
This is our third edition of this pricing document. We have tried to incorporate as many as the suggestions we received over the past year into this edi-
tion. We hope you continue to find this document of use in your practice and encourage you to forward your suggestions so we can continue to make
the document better. Suggestions can be made at the MEDS website () or send an email directly to Shawn Bugden at
Shawn.Bugden@umanitoba.ca or Jamie Falk at Jamison.Falk@umanitoba.ca
Contributors
Cody Magnusson B.Sc. (Pharm), PharmD (candidate)
Kevin Friesen B.Sc. (Pharm), M.Sc. PhD (candidate)
Jared Fridfinnson B.Sc. (Pharm) (candidate)
Juliano Amador da Silva B.Sc. (Pharm), M.Sc. (candidate)
Olena Serwylo B.Sc. (Pharm), PharmD
Jamie Falk B.Sc. (Pharm), PharmD
Phillip Chung B.Sc. (Pharm), PharmD (candidate)
Shawn Bugden B.Sc. (Pharm), M.Sc., PharmD
References:
1. Reichert S, Simon T, Halm EA. Physicians' attitudes about prescribing and knowledge of the costs of common medications. Arch Intern Med 2000;160:2799-2803. 2. Allan GM, Lexchin J, Wiebe N. Physician awareness of drug cost: A systematic review. PLoS Medicine 2007;4:e283. 3. Tang KL, Ghali WA, Manns BJ. Addressing cost-related barriers to prescription drug use in Canada. CMAJ 2014;186:276-280. 4. Cogdill B, Nappi JM. Assessment of prescribers' knowledge of the cost of medications. The Annals of Pharmacotherapy 2012;46:200-207. 5. Nickonchuk T, Lee J, Kolber M. Price comparison of commonly prescribed pharmaceuticals in Alberta. 6. Patel MS, Volpp KG. Leveraging insights from behavioural economics to increase the value of health-care service provision. J Gen Intern med2012;27:1544-1547.
TABLE OF CONTENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 3
Therapeutic Class
CARDIOVASCULAR AGENTS
HYPOGLYCEMIC AGENTS
RESPIRATORY AGENTS
SMOKING CESSATION PSYCHIATRY
Drug Class
Lipid Lowering Agents -Blockers Calcium Channel Blockers Angiotensin Converting Enzyme Inhibitors (ACEIs) Angiotensin II Receptor Blockers (ARBs) Diuretics Antiplatelet Agents Anticoagulants
Biguanides Sulfonylureas Meglitinides Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Glucagon-like Peptide-1 (GLP-1) Agonists Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors Insulin
Short-acting 2-Agonists Long-acting 2-Agonists Anticholinergics Inhaled Corticosteroids Long-acting 2-Agonists + Anticholinergics Long-acting 2-Agonists + Corticosteroids Short-acting 2-Agonists + Anticholinergics Leukotriene Receptor Antagonists Phosphodiesterase-4 Enzyme Inhibitor Nasal Corticosteroids
Smoking Cessation Agents Nicotine Replacement Therapy
Antidepressants Antipsychotics Benzodiazepines
Page Number
5 5 5 5 6 6 7 7 7 8 8 8 8 8 8 8 9 10 10 10 10 10 11 11 11 11 11 11 12 12 12 13 13 14 14
TABLE OF CONTENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 4
Therapeutic Class
CONTRACEPTIVES
Drug Class
1st Generation Progestins
2nd Generation Progestins
3rd Generation Progestins
Anti-androgenic Progestins
Transdermal & Vaginal Contraceptives
Intrauterine Devices (IUDs)
HORMONE REPLACEMENT THERAPY
ANALGESICS
MIGRAINES and GOUT ANTIMICROBIALS ALZHEIMER'S DISEASE OSTEOPOROSIS UROLOGY
GASTROINTESTINAL AGENTS
IRON PREPARATIONS
Oral Agents Transdermal Agents Vaginal Agents
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) COX-2 Inhibitors Combination Analgesics Neuropathic and Chronic Pain Agents
Antimigraine agents Gout
Erectile Dysfunction Benign Prostatic Hyperplasia (BPH) Overactive Bladder
Proton Pump Inhibitors (PPIs) Histamine H2-Receptor Antagonists (H2RAs) Antiemetics Laxatives Antidiarrheals Helicobacter Pylori Eradication
Page Number
15 15
15
15
15
15
15
16 16 16 16 17 17 17 17 17 18 18 18 19 20 21 22 22 22 23 24 24 24 24 24 24 25 26
CARDIOVASCULAR AGENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 5
Generic Name Lipid Lowering Agents
Rosuvastatin Atorvastatin Rosuvastatin Simvastatin Ezetimibe Atorvastatin Atorvastatin Rosuvastatin Simvastatin Pravastatin Pravastatin
-Blockers
Bisoprolol Metoprolol Metoprolol Atenolol Bisoprolol Metoprolol SR Atenolol Metoprolol Metoprolol SR
Brand Name
Crestor Lipitor Crestor Zocor Ezetrol Lipitor Lipitor Crestor Zocor Pravachol Pravachol
Monocor Lopressor Lopressor Tenormin Monocor Lopressor SR Tenormin Lopressor Lopressor SR
Carvedilol
Coreg
Calcium Channel Blockers
Amlodipine Amlodipine Diltiazem CD Verapamil SR Nifedipine XL Diltiazem CD Verapamil SR Diltiazem CD Verapamil Nifedipine XL Verapamil
Norvasc Norvasc Cardizem CD Isoptin SR Adalat XL Cardizem CD Isoptin SR Cardizem CD Isoptin Adalat XL Isoptin
Strength
10mg 10mg 20mg 10mg 10mg 20mg 40mg, 80mg 40mg 20mg, 40mg 10mg 20mg
Usual 90 Day Per Unit
Dosing Cost
Cost
Daily
$22
Daily
$24
Daily
$27
Daily
$27
Daily
$29
Daily
$29
Daily
$32
Daily
$32
Daily
$34
Daily
$37
Daily
$43
$0.24 $0.26 $0.30 $0.30 $0.33 $0.33 $0.35 $0.36 $0.38 $0.41 $0.48
5mg
Daily
$9
50mg 25mg 50mg 10mg 100mg 100mg 100mg 200mg
BID
$12
BID
$12
Daily
$13
Daily
$13
Daily
$18
Daily
$21
BID
$25
Daily
$33
3.125mg, 6.25mg, 12.5mg, 25mg
BID
$85
$0.10 $0.06 $0.06 $0.14 $0.15 $0.20 $0.24 $0.14 $0.37
$0.47
5mg 10mg 120mg 240mg 30mg 180mg 120mg 240mg 80mg 60mg 120mg
Daily Daily Daily Daily Daily Daily Daily Daily TID Daily TID
$18 $27 $44 $51 $56 $59 $68 $78 $81 $93 $126
$0.20 $0.30 $0.49 $0.57 $0.62 $0.66 $0.76 $0.87 $0.30 $1.03 $0.47
Coverage
Pharmacare
NIHB
Y
Y
Y
Y
Y
Y
Y
Y
Y-EDS
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
LEGEND: NIHB = Non-Insured Health Benefits; EDS = Exception Drug Status, prior approval required; PA= Prior approval required; Part 2 = Covered for certain indications (prior approval not required); SR = Sustained release; CD = Controlled delivery.; XL = Extended release.
CARDIOVASCULAR AGENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 6
Coverage
Generic Name
Brand Name Strength
Angiotensin Converting Enzyme Inhibitors (ACEIs)
Ramipril
Altace
2.5mg, 5mg
Ramipril
Altace
10mg
Fosinopril
Monopril
20mg
Lisinopril
Zestril
20mg
Enalapril
Vasotec
10mg
Perindopril
Coversyl
4mg
Perindopril
Coversyl
8mg
Combination ACEI + Diuretic
Ramipril/ Hydrochlorothiazide
Altace HCT
10mg/12.5mg, 10mg/25mg
Perindopril/ Indapamide
Coversyl Plus
4mg/1.25mg
Perindopril/ Indapamide
Coversyl Plus HD 8mg/2.5mg
Angiotensin II Receptor Blockers (ARBs)
Losartan
Cozaar
25mg, 50mg, 100mg
Telmisartan
Micardis
40mg, 80mg
Candesartan
Atacand
Valsartan
Diovan
Irbesartan
Avapro
Combination ARB + Diuretic
8mg, 16mg, 32mg 80mg, 160mg 75mg, 150mg, 300mg
Telmisartan/ Hydrochlorothiazide
Candesartan/ Hydrochlorothiazide
Irbesartan/ Hydrochlorothiazide
Losartan/ Hydrochlorothiazide
Micardis Plus Atacand Plus Avalide Hyzaar
80mg/12.5mg, 80mg/25mg
16mg/12.5mg
150mg/12.5mg, 300mg/12.5mg, 300mg/25mg
100mg/12.5mg
Losartan/ Hydrochlorothiazide
Hyzaar
50mg/12.5mg, 100mg/25mg
Usual Dosing 90 Day Cost Per Unit Cost Pharmacare NIHB
Daily Daily Daily Daily Daily Daily Daily
$11 $14 $48 $63 $69 $83 $116
$0.12 $0.16 $0.53 $0.70 $0.76 $0.92 $1.29
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Daily Daily Daily
$32 $100 $108
$0.36 $1.11 $1.20
N
Y
Y
Y
Y
Y
Daily Daily Daily Daily Daily
$18
$0.20
$25
$0.28
$26
$0.29
$27
$0.30
$27
$0.30
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Daily Daily Daily Daily Daily
$25
$0.28
$27
$0.30
$27
$0.30
$28
$0.31
$28
$0.31
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
LEGEND: NIHB = Non-Insured Health Benefits; EDS = Exception Drug Status, prior approval required; PA= Prior approval required;
Part 2 = Covered for certain indications (prior approval not required).
CARDIOVASCULAR AGENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 7
Coverage
Generic Name Diuretics
Hydrochlorothiazide Chlorthalidone Furosemide Hydrochlorothiazide Furosemide Indapamide Spironolactone Spironolactone
Antiplatelet Agents
ASA-EC ASA-EC Clopidogrel Ticagrelor
Anticoagulants
Warfarin
Brand Name Strength Usual Dosing 90 Day Cost Per Unit Cost
HydroDiuril
12.5mg
Daily
$3
Hygroton
50mg
1/4 Daily
$3
Lasix
20mg
Daily
$4
HydroDiuril
25mg
Daily
$4
Lasix
40mg
Daily
$7
Lozide
2.5mg
Daily
$11
Aldactone
25mg
Daily
$12
Aldactone
100mg
Daily
$25
$0.03 $0.14 $0.04 $0.05 $0.07 $0.12 $0.13 $0.28
Aspirin Aspirin Plavix Brilinta
81mg 325mg 75mg 90mg
Daily Daily Daily BID
$5 $3 $36 $300
$0.051 $0.031 $0.40 $1.67
Coumadin
5mgdose variable
Daily
$15
$0.17
Pharmacare
Y Y Y Y Y Y Y Y
N N Y Y-Part 2
Y
NIHB
Y Y Y Y Y Y Y Y
Y Y Y Y2
Y
Rivaroxaban
Xarelto
15mg, 20mg Daily
$281
$3.12
Y-EDS
Y-PA
Apixaban Dabigatran
Eliquis Pradaxa
2.5mg, 5mg BID
110mg, 150mg
BID
$317 $326
$1.76 $1.81
Y-EDS
Y-PA
Y-EDS
Y-PA
1 Per unit cost for OTC products not covered by Pharmacare/not listed on the Manitoba Drug Interchangeability Formulary will vary due to price differences that exist among brands/manufacturers and pack sizes of a given product. 2 NIHB coverage is limited to 12 months. Continued coverage beyond one year may be granted upon receipt of rationale for continuation of therapy from the prescriber.
LEGEND: NIHB = Non-Insured Health Benefits; EDS = Exception Drug Status, prior approval required; PA= Prior approval required;
Part 2 = Covered for certain indications (prior approval not required); EC = Enteric coated.
HYPOGLYCEMIC AGENTS
PRICE COMPARISON OF COMMONLY PRESCRIBED MEDICATIONS IN MANITOBA 2018--PAGE 8
Generic Name Biguanides
Brand Name
Strength
90 Day Per Unit
Usual Dosing Cost
Cost
Metformin Metformin SR
Glucophage Glumetza
500mg 1000mg
1000mg BID Daily
$16 $121
$0.04 $1.34
Sulfonylureas
Gliclazide MR Gliclazide MR Glyburide Gliclazide
Meglitinides
Diamicron MR Diamicron MR Diabeta Diamicron
60mg 30mg 5mg 80mg
Daily Daily BID BID
$6
$0.06
$8
$0.09
$14
$0.08
$50
$0.28
Repaglinide
Gluconorm
1mg
TID
$23
$0.08
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
Linagliptin Saxagliptin Sitagliptin
Trajenta Onglyza Januvia
5mg 5mg 100mg
Daily Daily Daily
$223 $284 $294
$2.48 $3.16 $3.27
Glucagon-like Peptide-1 (GLP-1) Agonist (cost based on 1 box of two 18mg/3mL pens)
Liraglutide
Victoza
1.2-1.8mg
Daily (subcut)
$186
N/A
Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors
Empagliflozin
Jardiance
10mg, 25mg Daily
$259
$2.88
Dapagliflozin
Forxiga
5mg, 10mg Daily
$259
$2.88
Canagliflozin
Invokana
100mg,
Daily
$262
$2.91
1NIHB coverage may be considered on a case-by-case basis.
Coverage
Pharmacare
NIHB
Y
Y
N
N
Y
Y
Y
Y
Y
Y
Y
Y
Y-EDS
Y
Y-EDS
Y-PA
Y-EDS
Y-PA
Y-EDS
Y-PA
N
N
Y-EDS
Y-PA
Y-EDS
N1
Y-EDS
Y-PA
LEGEND: NIHB = Non-Insured Health Benefits; EDS = Exception Drug Status, prior approval required; PA= Prior approval required;
Part 2 = Covered for certain indications (prior approval not required); SR = Sustained release; MR = Modified release.
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