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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