Standard Mischief

The Scene: K-mart-Sears, or Sears-K-mart, or whatever that store is down the street that sells everything from kitchen stoves to snack food, and has redecorated to add a “internet cafe” – sans any coffee – and to remove the pizza! pizza! cheezy snack bar. Your host, Standard Mischief, walks in. He’s on a mission. He walks up to the pharmacy counter and waits politely. He has timed this just right, it’s early in the morning and there are no other customers. A pharmacist is taking a personal call on the phone.

Standard Mischief: “I’m not in a hurry, I was just looking for a price check.”

Pharmacist: “What can I help you with?”

SM: “Well, I was looking for some prices on proton pump inhibitors.”

Pharmacist: “Well, what is your co-pay?”

SM: “No, no. I’m paying cash. I’m looking for a price on Nexium, once per day, 20 milligrams, 30 day supply”.

Pharmacist: “If you are paying cash, you definitely do not want that. I think you should try this” He pulls out a package of Prilosec OTC.

SM: “Yes, but that’s over-the-counter, I can price check that myself.”

Pharmacist: “With Nexium, you will pay through the nose.”

SM: “I was willing to bet that’s the case, but I wanted to get a check on the full range of options before I go into the Doctor’s office. You see, he only gives me fifteen minutes of his time and I need to have my ducks in a row. Also, I only get those fifteen minutes if I’m lucky and one of those drug company sales reps isn’t trying to take up some of my time.”

Pharmacist: “It’s very expensive.”

SM: “Is it really that hard to look up? I thought you had a computer? Don’t you do that all day long?”

Pharmacist: (begrudgingly) “Well, let’s see. The 30-day supply is $175.”

SM: “Thank you very much, I suppose I’ve taken up far too much of your time to get any more prices, I appreciate it.”

Standard Mischief exits stage left. On the way out, he price checks OTC ranitdine (Zantac), and picks up one bottle of brand name saline nasal spray. It’s a pricey $3.29 for something that is essentially sterile salt water, but he needs it and it’s far, far cheaper that that still-under-patent prescription steroid nasal spray he used to use, and it isn’t habit-forming like the OTC stuff he was using before that. Oddly enough, here at K-sears, the generic brand saline is actually more expensive. He decides to stock up on the cheap generic stuff next time he sees a sale.

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Scene two: Our hero walks up to the pharmacy counter inside Shoppers Food Warehouse. It’s still early, so there’s only the Pharmacist on duty. He’s putting that four to six year degree to good use by counting out pills from a bulk package and sticking labels on little vials. Upon seeing a customer, he immediately puts down his busy-work. Standard Mischief smiles. Good service is such a rarity nowadays.

SM: “Hi, I’m looking for a quote on Nexium.”

Pharmacist: “Well, what strength do you need?”

SM: “20 mg, let’s say once a day and a 30-day supply if that’s a convenient way for you.”

Pharmacist: “Well, that’s $154.95. But we’ll price match any competing store in the greater Bowie area.

SM: “Oh, that’s interesting, do you do that with all your prescriptions?”

Pharmacist: “Yes, oh, and let me see what the price is on the other strength.

SM: “Ah, that should be 40 mg, right?”

Pharmacist: “Yes. (pause) Well, the other strength is the exact same price.”

SM: “That’s interesting, and if I remember correctly that’s a capsule, not a pill, so I could not use my pill splitter, right?”

Pharmacist: “That’s correct.”

SM: “Could I get one more please? Say Prevacid at 30mg, once per day?” Obviously, that research with his copy of 2001 Current Medical Diagnosis and Treatment was paying off. “I of course need to talk to my doctor first, but I wanted to check first.”

Pharmacist: “Sure, no problem. OK, that’s going to be $163.95 for 30 days.”

SM: “Thanks for your help today.”

–

I originally was going to gather a few prices on common heartburn or acid reflux drugs and make a chart, but I decided that this exchange, all of it true, was a far better example. I’ve cleaned up the dialogue a bit, but that’s it. From this short exchange anyone can draw out a number of important points.

By price shopping only two stores, I’ve manages to save a hypothetical $20.05. That’s only considering the fact that I was shopping for one drug. Furthermore, the Pharmacist at the second store offered to match prices. Clearly even the most left-leaning soul on the planet can see the Free Marketâ„¢ at play here, doing exactly what it is suppose to do.

Although it was tough slogging to get an actual price from the first Pharmacist, he wasn’t trying to push snake oil on me. According to this Wikipedia entry, AstraZeneca, the manufacture of Nexium, used to push Prilosec as their star acid-reflux drug. According to this other page:

“…So she’s among the many who hail the miracle powers of the original Purple Pill, Prilosec. That drug stripped misery from the lives of millions and became the world’s best-selling prescription drug – and the number one medication prescribed for seniors – taking in $6 billion a year. Prilosec is so good, and patients so attached to it, that doctors jokingly call it “purple crack.”

But that was then, and this is now, and the world’s former best selling prescription drug suffered a timely fate, it’s patent expired. AstraZeneca didn’t let it’s most profitable drug slip away so easily, however:

The main patent on Prilosec expired more than a year ago. Under normal circumstances, that would have triggered the arrival of a generic version on the market, followed by a host of generic rivals. With so much low-cost competition, we would all be enjoying lower drug costs. But that didn’t happen. Through lawsuits, the makers of Prilosec have managed to keep the generics at bay while unleashing a half-a-billion-dollar marketing blitz to move people off Prilosec and onto Nexium, their costly, patent-protected new Purple Pill, which even their own studies show to be barely more effective than the original.

The article that I’m linking to is somewhat dated. but after Prilosec’s patent expired, AstraZeneca pensioned to move the drug over to OTC. Perhaps at one time, over the counter drugs were a class of medication that was supposed to be safe enough for just laypeople to be able to dose themselves on, but nowadays it’s all about the marketing. There’s tremendous pressure on doctors to write scrip for prescription drugs, instead of telling patents to try something OTC. By moving Prilosec to OTC, I’m sure that they also managed to cut into the projected profits of the manufactures of generic Prilosec.

It also seems that Nexium really isn’t all that more effective that the now cheaper Prilosec:

Dr. Doug Levine, AstraZeneca’s executive director for gastrointestinal clinical research, says Nexium represents a clear improvement over Prilosec. But in most of the company’s trials, the effects of 40 milligrams of Nexium were compared against 20 milligrams of Prilosec. In the two instances where they were compared at equal strength, only one showed a statistical difference, and that was a 3 percent shorter healing time.

So as long as some other entity was picking up the majority of the cost of Nexium, The first Pharmacist was more than happy to sell it to me. That brings me to our next point: Almost no one price shops for pharmaceuticals. Is it any wonder that drug prices are sky high? If your prescription cost you a $20 co-pay, are you really going to shop around or are you going to go to the pharmacy that’s most convenient to you? Furthermore, if OTC Prilosec is priced at $19.29 for a 30 day supply (darn right I price-checked it), but the prescription purple pill is just a $20 co-pay  with the majority of the actual cost taken up by your insurance provider, which one are you going to choose? Now is it clear why pharmaceuticals prices are out of control?

You will also notice that I was price shopping for saline spray. I’ll tell you the truth, after I started paying the full real price for medicine, and that very real cash was coming out of my pocket, I was more than willing to try other therapies to get some relief. I know this will not work for everyone, but the simple saline spray once or twice a day works better for me than an expensive steroid spray like Flonase, Nasacort or Nasonex. By doing a better job at keeping my sinuses clear, I’ve drastically reduced the number of times I have had to seek professional care for an antibiotic scrip to fight off a sinus infection, saving both myself a co-pay and also saving my insurance company from having to come up with the balance of the doctor’s payment.

Update: There’s just one more point I need to make, It’s a pain in the ass to price prescriptions drugs. I’m convince that this is the case because there’s no market forces demanding prices (short of seedy no-prescription-needed gray-market ‘net pharmacies, none of which I’m willing to quote in my blog). Why should there be, when all drugs cost the same, the price of your co-pay. Most times a good doctor will have a feel for what’s expensive, but if I’m going in expecting to get a certain kind of scrip, I try very hard to control my out-of-pocket costs myself. This means bugging pharmacists, unless I can find another online pharmacy with open prices (sadly,an old online source I use to use is now defunct).

About the Author: Standard Mischief is the pseudonym of a person without any “piled higher and deeper” letters behind his name. He is in no way qualified to dispense medical advice, and is in fact explicitly not doing so. He has classified this blog post into the “not intended to diagnose, treat, cure or prevent any disease” blog category for that very reason. Please seek medical advice before acting on any non-advice contained in this blog. While you are waiting in the waiting room, please ponder living in a world where this type of incantation – meant to try to ward off a frivolous lawsuit – would not be needed. Think of a world where our legal system, suppose to be “of, by, and for the people”, would dismiss such suits with prejudice before even incurring a single billable hour by a several hundred dollar per hour lawyer.