It seems like a simple question—how much does a drug cost? The answer turns out to be far from simple. As you may have noticed, we routinely include the approximate cost of drug therapy in tables on treatment. The difficulty starts in deciding which source to use for drug pricing. In the past, we generally used the Red Book for average wholesale price. The problem with this approach was that it did not take into account the many variables that affect what a patient pays for a drug, including: (1) copayments, (2) drug insurance programs, (3) drug formularies, and (4) retail chain discounting. When trying to affix prices for one month of treatment, we have found that they vary considerably, depending on the source used.
We heard from an ever-vigilant physician reader who challenged what he thought were misrepresentative drug prices. He found instances of generic drug prices in American Family Physician that were sevenfold higher than those at the sources he had checked.
Given the difficulties of arriving at the cost of a course of therapy or a one-month prescription, and the wide range of prices possible, we wondered whether it was worth the trouble. So, we did what we regularly do when faced with questions like this—we surveyed our readers. The answer was loud and clear: you want representative prices listed, for generic and brand name drugs. You also prefer an actual dollar amount, or range, rather than using symbols such as $–$$$$$, as some drug formularies do. And, you found this information helpful when deciding among drugs or when counseling patients.
After looking into this issue, we developed the following process to represent drug pricing. We use drugstore.com as the primary source for basic pricing (the source that Epocrates uses). If needed, we check other online sources, such as pillbot.com, or retail chains, such as CVS and Walgreens. We also check to see if super discounts are available at national retail chains, such as Walmart and Target (e.g., $4 for a 30-day supply and $10 for a 90-day supply). Finally, if all else fails—and it sometimes does—we call pharmacies and ask what it would cost to buy a nondiscounted prescription.
In addition to providing representative prices for drug therapy, we also use the following principles, based on feedback, to help readers when they are comparing drug treatments. We list the generic names of drugs first, followed in most cases by the original brand name, so that readers will readily recognize what drug is being referred to. Our surveys show that many readers are more familiar with a drug by its brand name, and prefer to have this information included. Once the original brand is no longer available, or after its patent expires, we typically list just the generic name. With the generic pricing, we mark the drugs that are available in super discount programs at national retail chains. This format helps highlight drugs that are available for relatively low cost, which is especially helpful for patients who do not have prescription drug insurance. We also use online sources that are available without a subscription or access controls, so that physicians and readers can compare pricing themselves if they want to, especially if they are reading an article that does not have current pricing listed.
As always, we welcome suggestions from readers about making our information more helpful to them and their patients. Send your comments to firstname.lastname@example.org.
editor's note: Dr. Siwek is editor of American Family Physician.
editor's note: AFP no longer uses drugstore.com as a source of drug pricing.