BOISE -- In this 7 Investigation, KTVB looked at how prescriptions are priced and how you can look for the best deals in town. In looking at cash prices, which is what uninsured patients would pay, the prices can vary pretty wildly pharmacy-to-pharmacy. The cost differences KTVB found were up to hundreds of dollars per month.
The pharmaceutical industry doesn't readily disclose actual drug costs or markups, but several local pharmacies and a couple of big chains were willing to explain price variations and gave advice on saving money.
Idahoans spend millions of dollars each year on prescriptions
Prescription drug spending has been one of the fastest growing components of health care in the last decade. Just in our state, the Kaiser Family Foundation reports Idahoans spent more than $877 million dollars filling more than 15 million prescriptions in 2010. The average Idahoan fills around 10 prescriptions each year.
Prices have been going up for drugs across the country. From 2000 to 2010, the National Association of Chain Drug Stores tells KTVB the average cost of prescriptions (including brand-name and generic) has risen from $45.79 to $79.43.
Idaho's House Minority Leader Representative John Rusche (D-Lewiston) is a retired physician and medical director of a health insurance company. He says prescription costs are a factor for everyone in the medical field.
"The prices of medications are really a concern," Rusche said. "There's a lot of patients that get a prescription, go to the pharmacy, see what it costs and get half of the prescription or even choose not to take it at all if it's too expensive."
Uninsured adults are twice as likely as insured patients to not fill a prescription or cut pills and skip doses, according a Kaiser Family Foundation report. Because of cost, that report shows roughly a quarter of Americans have decided not to fill a prescription.
Figuring costs for insured vs. uninsured
With so much money being spent on prescription drugs each year in Idaho, KTVB wanted to see how those prices are set, and how to save money.
Insurance is a big factor for how drugs are priced. Most Idahoans are insured in some way (48% employer, 8% individual, 13% Medicaid, 12% Medicare, 1% other public programs).
"The insurance company negotiates a contract with the manufacturer and it will agree to pay a price for the ingredient, for the pill itself, and they also negotiate a contract with a pharmacy or a chain of pharmacies for what's called a filling fee. So the price that people see or the insurance company sees is a combination with those two," Rusche explained.
"People that have don't insurance, they don't have any protection from a pharmacy that may want to charge $314 or whatever," Rusche said, referencing prices KTVB was quoted.
Comparing cash costs at local pharmacies
A local pharmacist says the best way to find out what you'll pay out-of-pocket is to first ask around.
"When looking for costs, you can always call around to different pharmacies, just ask them what medication you're looking for, how many tablets you're looking for, and they can really quickly give you a price over the phone of what that medication will cost," Lyle Trone, Medicap Pharmacist, said.
Just like any consumer can do, KTVB called more than a dozen pharmacies and asked for prices on five popular drugs. The following price comparisons are the cash quotes given over the phone; they are factored by a computer the pharmacist or technician looks at. NOTE: The following prices do NOT factor in insurance, co-pays, discounts, price-matching or a pharmacist's personal discretion.
Anastrozole (a generic for Arimidex, a popular cancer drug) 1 mg, 30 days
Atoravastatin (the only generic currently available for the cholesterol-lowering Lipitor) 20 mg, 30 days
Adderall (price quotes are for the cheapest available generic version) 20 mg, 30 days
Ethinyl Estradiol and Norgestimate (generic name for popular birth control Ortho Tri-Cyclen) 1 package
Levothyroxine Sodium (generic name for Levoxyl, a thyroid medication) 100mcg, 30 days
Why pharmacy prices can vary
Local pharmacists say they price off of how much they're paying for medications. Sometimes those prices can even fluctuate day to day. Adderall is a good example of that and shows why prescriptions can sometimes be more expensive at the end of the year.
"Just like any consumer product you're taking, depending on what that demand is and how much supply there is, those prices can fluctuate," Trone said. "With a lot of medications, there's only a certain amount that can be made each year, so if all that medication is used up before the end of the year and they're able to make more, then that limited quantity is going to skyrocket in price."
At Medicap, the price of the cheapest generic Adderall went down $15 from the time KTVB gathered information for the above charts.
Trone also explains larger pharmacies have more buying power and can purchase more of a medication at one time. While that can make the prescriptions less expensive for those stores, he says it's not always the case because of competition.
"It comes down to what pharmacies are able to get those prices for. So, say they're trying to be competitive with another pharmacy, they actually may be losing money on selling a drug, just so they can be competitive. So, a way they can make up money is they'll increase the price of a different medication that maybe they can get a little bit cheaper, to kind of offset those prices," Trone said.
More discounts, programs and ways to save
With discounts and pharmacy programs, you can get the drugs for cheaper than you see listed in the above graphics. Many stores offer discount savings cards, like K-Mart and Walgreens. You pay an annual fee, but by comparing costs, KTVB found on these medications, you'd save more than $100 a year.
Walgreens' program is $20 per year for individuals, $35 a year for families (including pets). As an example, the cancer drug, Anastrozole (Arimidex generic) is cash priced at $314.99 for 30 days, but by buying a card, the cost drops significantly. Walgreens then offers a 90 day supply for less than the original price, figuring out to be $100.32 per month with the card.
Costco is a membership store where you'll get discounts on prescriptions for being a member, but even without being a member you can use the pharmacy and often see some of the lowest prices. A Costco spokesperson explained the store sets prices on all goods food to electronics to prescriptions based on their cost to buy. Generally, they don't mark up more than 15% on anything, including medication.
Some stores offer price matching. Both SkopKo and Target offered those options on especially expensive price quotes. A Target pharmacy technician suggested we get a quote from another retailer and bring that price in for a match.
Independent stores also offer low prices
Smaller, local stores might not have big buying power, but like Ladd Family Pharmacy explained to us over the phone, they also don't have corporate policies to stop individual price adjustments.
"With going to an independent pharmacy (not just us), you are getting better service, individualized service. Usually it is a smaller store where the staff gets to know the patient. It's not the fast food mentality," Elaine Ladd said. "With independents, there is no fixed pricing, you have real people on the other end of that telephone or the other end of the counter that are willing to work with you."
Ladd even has a foundation set up to help patients with certain financial needs.
Trone says his pharmacy uses a service to let them know what other pharmacies, like big chain stores, are charging. They use that information to stay competitive.
"With independent pharmacies, people sometimes think that they're not going to have the same prices, prices are going to be higher. Really a lot of the times, we're going to be right around the same price, if not even lower, because again, we're trying to get more customers into our store," Trone said.
Shop around, but pick your favorite
If your findings are like what KTVB found, you'll see different pharmacies will be cheaper on different drugs, so you might be tempted to use several pharmacies. But to safeguard from potentially deadly drug interactions, every pharmacy said just pick one.
"In the long run, as far as patient safety, it definitely is better to fill at one pharmacy, even if one or two of the medications might be more expensive," Trone said.
"In regards to safety: Using one pharmacy allows pharmacists to better monitor patients' medications and avoid potential drug interactions," Walgreens spokesman Robert Elfinger said. "As far as pricing, we urge people to find one pharmacy that offers the best value in terms of pricing, convenience, service and accessibility."