Don’t accept the face value price of a drug

Everybody knows that some medications can cost a lot of money.  I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it.  When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication.  They are much cheaper and work just as well as the brand name (almost always).

Imagine my surprise when a patient recently presented me with a receipt, along with a request to change medication because the one I gave her was too expensive.

Dont accept the face value price of a drug

The medication was diltiazem ER, the generic form of Cardizem CD.  The patient pay portion was $0.  However, this patient is on Medicare, and the cost of every drug inches her closer to the “donut hole.”  Basically, when the cost of drugs gets up to a certain amount (around $2,700), the patient enters a coverage gap and must pay 100% of medication costs.  If you look in the upper right hand corner of the receipt, you will see that the cost of this drug was $536.84.

To say I was stunned is putting it mildly.  So much so that I was convinced it was a mistake.  After, the cost of brand name Cardizem CD is $288.99.  How could a generic be more expensive?  Cardizem went generic in 2010 — that’s plenty of time for the price to come down.

I called Walmart to see what the story was.  I spoke to the pharmacy tech and asked her how much diltizem ER costs.  Her answer was that there was one that was $54 and another that was $84.   I then gave her my patient’s information and asked her why she was charged $536.84.  After a lot of hemming and hawing, she said that that was the cost for one particular pill made by one particular manufacturer.  I then asked her why my patient was given this one, instead of the one that was 10x cheaper.  She couldn’t answer the question, so I got the pharmacist on the phone.

I wish I could say I got a good, reasonable explanation.  I did not.  She told me that there are several versions of generic diltiazem ER.  They are all basically the same, but range in price from $53 to $536, depending on the manufacturer.  She had no idea why my patient was given the most expensive one.  I have some ideas, but I’m not going to speculate here, since I was always taught that if you can’t say anything nice, then don’t say anything at all.   I clarified to her that my patient was to only get the cheap one.  However, the damage is already done and she has edged an extra $500 closer to the donut hole.

So, what’s the moral of the story?  Don’t just accept that the price of a drug is what it is.  If something seems much more expensive than it should be, talk to the pharmacist or your doctor.  Shop around and bring your business elsewhere if a pharmacy is not willing to assist you.

Marni Nicholas is an internal medicine physician who blogs at Patients, Patience, and Paces.

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  • James Matthew Weber

    The Walmart business model is ‘interesting’. In places you expect the pharmacy to be low cost, it often is in fact very high cost.
    I wish I could say that this was a unique experience, however my experience with Walmart Pharmacies is that your prescription has to fall into one of 3 categories for Walmart prices to be competitive. If you have insurance, it is the copay,no problem. If your prescription is covered under the $4 or $10 programs, no problem. If you are using a Walmart Co-Branded product such as Humulin insulin, you are ok. Otherwise my experience is that Walmart’s generic prices are often very high. They seem to select high cost generic suppliers outside the $10 and $4 products. I found a mail order pharmacy on the West Coast that charges less than half the Walmart price on my generic prescriptions, and in some cases, less than 1/3rd.

  • Diane Fonner

    I’ll put in my 2 cents for independent pharmacies. They may not always be the cheapest in town but we always try to work with patients. We can’t promise $4 or $10 but we try to be consistent and it is in OUR best interest to order consistently and from the same manufacturer when possible so the patient gets the same tablet each time. Therefore we keep our prices as even across the board as we can. Though with drug shortages being as crazy as they have been, some things have to change at times. Also, we can usually get meds the next day (not twice a week like most big stores do now). And service is number 1 for our customers. That’s how we stay in business.

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