Variability in Retail Pricing of Generic Drugs for Heart Failure

Abstract

Generic medications may lessen patients' financial burden and improve adherence. 1 Recent increases in generic drug costs 2 raise concerns about the effect on uninsured and underinsured patients whose options may be restricted to retail pharmacies within a limited geographic area. An estimated 7.3 million Americans with cardiovascular disease are in the uninsured group. 3 Therefore, we evaluated US retail pharmacy pricing for generic guideline-directed heart failure (HF) drugs in a metropolitan area as a function of dose, supply, pharmacy type and zip code, and zip code median annual income.Methods | Pharmacies were identified across 55 zip codes in a 2-state region using a government website. 4 In zip codes with more than 4 pharmacies, the nonrandomized convenience sample included at least half of these stores. Pharmacies were queried by phone during a 3-week period in May 2016 regarding cost, without insurance, of digoxin (0.125 mg/d and 0.25 mg/d), lisinopril (10 mg/d and 40 mg/d), and carvedilol (6.25 mg and 25 mg twice daily) for 30-and 90-day supplies. Median annual income by zip code was determined from US Census Bureau data. Pricing between groups was compared using Kruskal-Wallis and Mann-Whitney tests; associations were assessed with Spearman ρ correlations. Cluster analysis was used to create groups based on zip code and zip code-based median annual income. The TwoStep cluster procedure was used to determine the optimal number of natural groupings based on a set of variables such that similarity of cases within a cluster and differences between clusters were maximized. Figure. Map Showing Locations of Retail Pharmacies in the Study<20 Generic drug price, $ 20-50 51-100 101-150 >150 Color coding corresponds to retail prices of the combination of digoxin, 0.25 mg/d; lisinopril, 40 mg/d; and carvedilol, 25 mg twice daily.

Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study

“…Drastic price differences for comparable generics are not an exclusively German phenomenon. Thus a few recent US studies – likewise for pharmacies in close proximity and even for different indications (heart failure, erectile dysfunction, benign prostatic hyperplasia) – in some cases revealed considerably more drastic price differences for comparable generic preparations 56-59…”

Questionable utility of digoxin in left-ventricular assist device recipients: A multicenter, retrospective analysis

“…Additionally, LVAD patients have been demonstrated to have variable medication adherence, and therefore attention to simplifying their regimen would be of importance [5]. Complicating this further is the highly variable pricing of digoxin and, as one recent multi-state analysis demonstrated, that it is the most expensive agent of a generic HF regimen [14]. Finally, digoxin is known to have many drug-drug interactions, including carvedilol and loop diuretics, has a relatively narrow therapeutic range, and can result in significant gastrointestinal and central nervous system adverse effects [15] Therefore, the discontinuation of digoxin in selected patients appears attractive.…”

The Gap to Fill: Rationale for Rapid Initiation and Optimal Titration of Comprehensive Disease-modifying Medical Therapy for Heart Failure with Reduced Ejection Fraction

“…[ 39 ] Use in the US is uniquely hindered by large variability in pharmaceutical pricing, as well as high out-of-pocket costs and the need for prior authorisations for the more novel ARNI and SGLT2i. [ 12 , 40 – 42 ] A call for reform of the utilisation management requirements and prior authorisation process signed by 17 medical organisations, including the ACC and the AMA, hopes to curb the negative impact felt by patients. [ 43 ] Whether this will improve timely and affordable access to optimal care remains to be seen.…”