How Much Is That Prescription???

This week, my regular physical coincided with a symptom of something that required medicine to treat. My doctor gave me a prescription, which she noted would not be that expensive. She was all set to call it in to CVS (my pharmacy on record, which I chose when I moved here based on its proximity). I had some time to kill, so I asked for it on paper instead, so that I could do some price comparison. Her staff informed me that I was lucky – in one month, all prescriptions were going electronic, per some sort of government mandate.

Since the doctor’s office was close to Costco, I started there. That pharmacist told me the cash price (based on having no insurance, since I haven’t yet met my deductible) of the generic was $39.38. Just curious, I asked and was told the price of the brand drug - $432.50! Are the two drugs equivalent, and if so, what accounts for the price differential? If they are equivalent, why would someone choose the brand drug? 

With no real answers (other than an assurance of equivalence), I trundled off to Wegmans. I was shocked when the clerk there told me their cash prices - $607.19 for the brand and $278.72 for the generic! I hadn’t expected such a differential, and she explained that it depended on who the pharmacy’s wholesaler was, and what price they negotiated and when. This led me to believe that the quotes I was getting were variable not just by store, but by date – I might come back with the same prescription in several months and get totally different prices. Leaving Wegmans empty-handed, and with Walgreens and Rite Aid not on my radar, my last stop was CVS – which would have filled the prescription by default. Cash price of the brand - $464.99 and of the generic - $229.99. Less than Wegmans, but an order of magnitude greater than Costco. In fact, the savings on just this one prescription would pay for our Costco membership for a couple of years. So back to Costco to have the prescription filled. As it turned out, the generic at each pharmacy was manufactured in India (had one been made in a Western country, that might have factored into a decision to pay more, but that might be an unfair bias).

I had no other information on which to base my purchasing decision, so it came down to price, and I chose the most affordable option, but not without some hesitation. The adage “you get what you pay for” may not be true, but it's ingrained. And I certainly regretted those years of putting cheap no-name gas in my car when my fuel injectors needed replacing prematurely. Would I regret buying the cheapest generic, if it had some nasty side-effect? But is the costlier brand drug more effective than a generic? Is it safer? Is Wegmans’ generic “better” than Costco’s? There's no way to know. And soon, there will be no easy way even to decide based on price, thanks to the move to the more efficient electronic prescription submission. How are we ever going to get health care costs under control if those costs are so variable, and yet they remain hidden until it’s time to pay them?