In the Hunt for Cheaper Drugs, Bulk Buying Is Good–Usually

Graphic: Purchasing decision tree for drugs

It pays to shop around, even when it comes to prescription drugs.

With ever-rising costs of co-payments and cutbacks in insurance coverage, an increasing number of Americans — and not just the 41 million who are uninsured — are facing sticker shock on medicines. The trick is learning how to become a savvier shopper without jeopardizing quality or consistency.

Personal Journal looked at several strategies for saving money and found some surprises.

While going with generics is cheaper than taking a brand-name drug, we were surprised how much variation there can be with the prices for generic drugs, depending on where you bought them.

We also learned not to make assumptions. Canadian Internet pharmacies, which can offer substantial savings on brand-name drugs, sometimes don’t offer any savings at all on generics.

Chain drugstores, meanwhile, aren’t always cheaper than independent Main Street pharmacies.

Take, for example, the generic form of antidepressant Prozac, known as fluoxetine. In our search, prices ranged from as high as $2 a pill at various chain and independent pharmacies in the greater New York City area, to as low as 15 cents a pill at Costco. The Costco price — available through its Web shop or in its actual warehouseclubs — was lower than some co-payments under company-sponsored insurance plans.

Online Comparison Shopping

Internet pharmacies can seem intimidating for those who aren’t regular Web shoppers, but the potential savings can be worth the trouble of getting familiar with cyberspace. It is easier and more convenient to do comparison shopping online rather than calling around to pharmacies.

Important drug information — instructions, side effects and potentially dangerous interactions with other drugs — is generally just a mouse click away. Most of the major Internet pharmacies, such as drugstore.com, also have a pharmacist available 24 hours a day to answer questions over the phone. Ordering online also means that medications will be delivered to your door.

As with all online pharmacies, processing and shipping can take as long as three weeks, so buying medications online that are needed immediately, such as antibiotics, isn’t practical.

Shopping at Canadian online pharmacies has become a popular way for people in the U.S. — especially the elderly — to reduce their drug costs. Because of Canadian price controls and the weak Canadian dollar, you can generally save between 50% and 70% on brand-name drugs. But for generics we found that the savings weren’t as great, and in some cases U.S. online pharmacies had lower prices than those north of the border.

Shopping in Canada may also become more difficult because some of the major drug makers are trying to shut down cross-border sales. In January, GlaxoSmithKline PLC stopped shipping its drugs, including the antidepressant Paxil, to Canadian pharmacies until they stop filling U.S. prescriptions. (In the U.S., only drug manufacturers are permitted to import drugs, although the Food and Drug Administration generally allows individuals to import small amounts for personal use and hasn’t clamped down on Internet shipments.)

Buying in Bulk

Internet purchases and buying in bulk — say, getting a threemonth-supply at a time — often go hand in hand. As the graphic shows, bulk purchases are generally economical, but that isn’t always the case. There are also other considerations beyond the cost per pill. For example, your doctor needs to write a multimonth prescription.

This isn’t always possible with some drugs — such as bloodpressure and thyroid medications — because your doctor may have to tweak the dosage until it is right for you. Also, if you are on a fixed income, buying in bulk may not be financially feasible no matter how great the savings.

Your doctor should be your first stop in your bargain hunt, because he or she may have a stash of free samples that could be a big help even if only for a week or two.

Both doctors and pharmacists also will know if a generic version exists for a particular drug. Such versions of brand-name drugs by far the biggest overall money saver.

Doctors and pharmacists can suggest a cheaper branded alternative made by a rival drug maker when appropriate. Cholesterol drugs, for instance, can range from $100 a month for Pfizer Inc.’s Lipitor to less than $50 for Novartis AG’s Lescol.

Splitting Pills

Pharmacists, in addition, can tell you whether it is possible to buy a higher dosage and save money by splitting the tablet, though that tactic requires some familiarity between druggist and customer. “If I felt that certain of my customers are capable, I would suggest they split tablets,” says Tony Welder, a pharmacist in Bismarck, N.D.

Some tablets, like antidepressant Zoloft, made by Pfizer, can be split fairly easily because they’re already indented with a dividing line. Thesavings can be tremendous. In the case of Zoloft, 30 tablets of a 50-milligram dose costs $69.99 at drugstore.com, while the same number of 100-milligram Zoloft tablets costs $70.99. Cut the larger dose in half, and you have a 50% savings.

Of course, not all tablets can or should be split, Mr. Welder warns. Some are too hard or have special coatings, and some drugs, especially heart medications, have critical dosages that shouldn’t be tampered with. There is also the worry that perhaps an elderly patient may not do it properly.

Another warning: Don’t sacrifice consistency of care to cut costs on prescription drugs, no matter how great the savings. Pharmacists and doctors need to know all of the medicines you are taking, and tracking can get complicated when making purchases from multiple sources.

“A la carte shopping for your drugs is a bad idea” because that makes it hard for a pharmacist to guard against dangerous drug interactions, says Todd Andrews, a representative for drugstore chain CVS Corp.

Originally published in the Wall Street Journal.

• Much DNA really is junk, say drug developers (0)