Original Research5 November 2019
A National Cross-sectional Study
    Author, Article and Disclosure Information
    Visual Abstract. Variation in Prescription Drug Prices by Retail Pharmacy Type

    Studies suggest that drug prices vary widely across retail pharmacies. In this study, researchers used drug pricing data from GoodRx to describe cash prices across categories of retail pharmacies throughout the United States for commonly used generic and brand-name drugs.

    Background:

    Cash prices for prescription drugs vary widely in the United States.

    Objective:

    To describe cash price variation by retail pharmacy type for 10 generic and 6 brand-name drugs throughout the United States and stratified by ZIP code.

    Design:

    Cross-sectional study.

    Setting:

    Drug pricing data from GoodRx, an online tool for comparing drug prices, representing more than 60 000 U.S. pharmacies (fall 2015).

    Measurements:

    Cash prices for a 1-month supply of generic and brand-name drugs were ascertained. Stratified by ZIP code, relative cash prices for groups of generic and brand-name drugs were estimated for big box, grocery-based, small chain, and independent pharmacies compared with a reference group of large chain pharmacies.

    Results:

    Across 16 325 ZIP codes, 68 353 unique pharmacy stores contributed cash prices. When stratified by 5-digit ZIP code, the relative cash prices for generic drugs at big box, grocery-based, small chain, and independent pharmacies compared with those at large chain pharmacies were 0.52 (95% CI, 0.51 to 0.53), 0.82 (CI, 0.81 to 0.83), 1.51 (CI, 1.45 to 1.56), and 1.61 (CI, 1.58 to 1.64), respectively. The relative cash prices for brand-name drugs were 0.97 (CI, 0.96 to 0.97), 1.00 (CI, 0.99 to 1.00), 1.06 (CI, 1.05 to 1.08), and 1.03 (CI, 1.02 to 1.04), respectively.

    Limitation:

    Results may not reflect current drug prices and do not account for point-of-sale discounts or price matching that may be offered by smaller pharmacies.

    Conclusion:

    Compared with large chains, independent pharmacies and small chains had the highest cash prices for generic drugs and big box pharmacies the lowest. Relative differences in cash prices for brand-name drugs were modest across types of retail pharmacies.

    Primary Funding Source:

    Arnold Ventures.

    References

    • 1. Aitken MBerndt ERCutler Det alHas the era of slow growth for prescription drug spending ended? Health Aff (Millwood)2016;35:1595-603. [PMID: 27605638] doi:10.1377/hlthaff.2015.1636 CrossrefMedlineGoogle Scholar
    • 2. Martin ABHartman MBenson Jet alNational Health Expenditure Accounts TeamNational health spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Aff (Millwood)2016;35:150-60. [PMID: 26631494] doi:10.1377/hlthaff.2015.1194 CrossrefMedlineGoogle Scholar
    • 3. Chhatwal JKanwal FRoberts MSet alCost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States. Ann Intern Med2015;162:397-406. [PMID: 25775312]. doi:10.7326/M14-1336 LinkGoogle Scholar
    • 4. Kesselheim ASAvorn JSarpatwari AThe high cost of prescription drugs in the United States: origins and prospects for reform. JAMA2016;316:858-71. [PMID: 27552619] doi:10.1001/jama.2016.11237 CrossrefMedlineGoogle Scholar
    • 5. Schumock GTLi ECWiest MDet alNational trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm2017;74:1158-73. [PMID: 28533252] doi:10.2146/ajhp170164 CrossrefMedlineGoogle Scholar
    • 6. Frank RGPrescription drug prices: why do some pay more than others do? Health Aff (Millwood)2001;20:115-28. [PMID: 11260933] CrossrefMedlineGoogle Scholar
    • 7. Gellad WFDonohue JMZhao Xet alBrand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison. Ann Intern Med2013;159:105-14. [PMID: 23752663]. doi:10.7326/0003-4819-159-2-201307160-00664 LinkGoogle Scholar
    • 8. Zhang YBaicker KNewhouse JPGeographic variation in Medicare drug spending. N Engl J Med2010;363:405-9. [PMID: 20538621] doi:10.1056/NEJMp1004872 CrossrefMedlineGoogle Scholar
    • 9. Cox ERMotheral BRHenderson RRet alGeographic variation in the prevalence of stimulant medication use among children 5 to 14 years old: results from a commercially insured US sample. Pediatrics2003;111:237-43. [PMID: 12563045] CrossrefMedlineGoogle Scholar
    • 10. Donohue JMMorden NEGellad WFet alSources of regional variation in Medicare Part D drug spending. N Engl J Med2012;366:530-8. [PMID: 22316446] doi:10.1056/NEJMsa1104816 CrossrefMedlineGoogle Scholar
    • 11. Zhang YBaik SHFendrick AMet alComparing local and regional variation in health care spending. N Engl J Med2012;367:1724-31. [PMID: 23113483] doi:10.1056/NEJMsa1203980 CrossrefMedlineGoogle Scholar
    • 12. Augustine NRMadhavan GNass SJedsMaking Medicines Affordable: A National Imperative. Washington, DC: National Academies Pr; 2017. Google Scholar
    • 13. Fendrick AMSmith DGChernew MEet alA benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost. Am J Manag Care2001;7:861-7. [PMID: 11570020] MedlineGoogle Scholar
    • 14. Huskamp HADeverka PAEpstein AMet alThe effect of incentive-based formularies on prescription-drug utilization and spending. N Engl J Med2003;349:2224-32. [PMID: 14657430] CrossrefMedlineGoogle Scholar
    • 15. Robinson JCWhaley CMBrown TTAssociation of reference pricing with drug selection and spending. N Engl J Med2017;377:658-65. [PMID: 28813219] doi:10.1056/NEJMsa1700087 CrossrefMedlineGoogle Scholar
    • 16. Baicker KTaubman SLAllen HLet alOregon Health Study GroupThe Oregon experiment—effects of Medicaid on clinical outcomes. N Engl J Med2013;368:1713-22. [PMID: 23635051] doi:10.1056/NEJMsa1212321 CrossrefMedlineGoogle Scholar
    • 17. Kesselheim ASHuybrechts KFChoudhry NKet alPrescription drug insurance coverage and patient health outcomes: a systematic review. Am J Public Health2015;105:e17-30. [PMID: 25521879] doi:10.2105/AJPH.2014.302240 CrossrefMedlineGoogle Scholar
    • 18. Consumer Reports. Consumer reports drugstore survey finds substantial price differences for commonly prescribed drugs. 1 December 2015. Accessed at www.consumerreports.org/media-room/press-releases/2015/12/consumer-reports-drugstore-survey-finds-substantial-price-differences-for-commonly-prescribed-drugs on 15 February 2018. Google Scholar
    • 19. Hauptman PJGoff ZDVidic Aet alVariability in retail pricing of generic drugs for heart failure [Letter]. JAMA Intern Med2017;177:126-8. [PMID: 27846638] doi:10.1001/jamainternmed.2016.6955 CrossrefMedlineGoogle Scholar
    • 20. Kullgren JTSegel JEPeterson TAet alAvailability and variation of publicly reported prescription drug prices. Am J Manag Care2017;23:444-8. [PMID: 28817781] MedlineGoogle Scholar
    • 21. Mathew R, Kilpatrick L, Garber A. The real price of medications: a survey of variations in prescription drug prices. U.S. PIRG Education Fund; 2019. Accessed at https://uspirg.org/sites/pirg/files/reports/WEB_USP_Real-Price-Medications_030519.pdf on 12 March 2019. Google Scholar
    • 22. IMS Institute for Healthcare InformaticsMedicine use and shifting costs of healthcare: a review of the use of medicines in the United States in 2013. Parsippanay, NJ: IMS Health; 2014. Google Scholar
    • 23. Arora SSood NTerp Set alThe price may not be right: the value of comparison shopping for prescription drugs. Am J Manag Care2017;23:410-5. [PMID: 28817779] MedlineGoogle Scholar
    • 24. JPMorgan Chase. Rewards category FAQs. 2018. Accessed at www.chase.com/index.jsp?pg_name=ccpmapp/shared/assets/page/Online_Rewards_FAQ on 15 February 2018. Google Scholar
    • 25. Tungol AStarner CIGunderson BWet alGeneric drug discount programs: are prescriptions being submitted for pharmacy benefit adjudication? J Manag Care Pharm2012;18:690-700. [PMID: 23206212] CrossrefMedlineGoogle Scholar
    • 26. Pauly NJBrown JDPrevalence of low-cost generic program use in a nationally representative cohort of privately insured adults. J Manag Care Spec Pharm2015;21:1162-70. [PMID: 26679965] MedlineGoogle Scholar
    • 27. Spooner JJA bleak future for independent community pharmacy under Medicare Part D. J Manag Care Pharm2008;14:878-81. [PMID: 19006444] CrossrefMedlineGoogle Scholar
    • 28. Orstein C, Thomas K. When buying prescription drugs, some pay more with insurance than without it. ProPublica. 9 December 2017. Accessed at www.propublica.org/article/when-buying-prescription-drugs-some-pay-more-with-insurance-than-without-it on 15 February 2018. Google Scholar