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Electronic letters published:
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U.S. Pharmaceutical Options Improving
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John M. Hayes, MD Milwaukee VA Medical Center and Denver VA Medical Center, Allan V. Prochazka, M.D., M.Sc.
Send rapid response to journal:
john.hayes3{at}va.gov John M. Hayes, et al.
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To the editor: The recent article by Kesselheim and Choudry highlight important considerations in assessing the international market for lower cost pharmaceuticals. Soon after Medicare Part D was initiated, there was a clear cost benefit to patients in aggressively searching for non-Part D sources of brand name cardiovascular medicines.(1) The brand name regimen we have examined (Toprol XL 100 mg daily, Altace 10 mg daily, Lipitor 10 mg daily) went from $933 in 2005 at the best Canadian on-line price to $1048 in 2007.(2) The median price for the US Part D plans in the Denver 80220 zip code for this regimen went from $1731 to $1133 in the same time period. For comparison, a generic equipotent regimen (metoprolol 100 mg bid, lisinopril 20 mg qd, lovastatin 20 mg qd) dropped from a median of $744 in 2005 to $555 in 2007. In 2005 only one Part D plan had annual costs less than the best Canadian price whereas in 2007 many Part D plans (36.5%) now provide brand name medications at better prices than the best Canadian on-line source.(3) In the two years since Part D inception, annual patient costs have fallen significantly for a typical brand name cardiovascular regimen while the lowest Canadian annual costs available have increased. Although in our studied regimen Toprol XL now has an approved generic equivalent which may contribute to lower costs for the brand name medication, we do not believe this alone can account for the decline. The recent fall in the US dollar relative to the Canadian dollar, certainly contributes to the lesser cost advantage of seeking brand name medications outside the US. In addition, generic equivalent regimens both inside and outside Part D plans continue to fall in price. Given the shrinking cost advantage and the other difficulties of international drug purchase outlined by Kesselheim and Choudry, physicians should encourage Medicare patients to seek the Part D plans that cover their needs at the lowest cost and should prescribe generic alternatives whenever possible. 1) Hayes JM, Walczak, H, Prochazka A. Comparison of drug regimen costs between the Medicare prescription discount program and other purchasing systems. JAMA. 2005 Jul 27;294(4):427-8. PMID: 16046648 2) Information accessed December 2005 and Decmber 2007 at http://www.pharmacychecker.com 3) Information accessed December 2005 and Decmber 2007 at http://www.medicare.gov/ Conflict of Interest:None declared |
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