Lower Drug Costs for Seniors

Families USA publishes an annual report analyzing prices of the 50 top selling drugs used by seniors. The latest survey claims that these drugs' prices rose about 30 percent over the past five years – or 2.5 times the rise in the consumer price index.

However, seniors can significantly lower their costs for these prescription drugs using prudent shopping techniques highlighted in the recent NCPA study "Shopping for Drugs." In fact, the cost of some drug therapies can be reduced by 75 percent to 90 percent using buying techniques consumers normally use to shop for other goods. [See the Figure.] Lower Drug Costs for Seniors

Pill Splitting. Patients can often purchase medications in doses double the prescribed amount and split them in half. Often, the pharmacist will split the pills for them. This saves money because many medications are sold for about the same price regardless of the size of the pill. For example, seniors can save an average of 39 percent on about half of the 50 most common drugs they use by pill splitting. Candidates for pill splitting include such cholesterol-lowering drugs as Lipitor, Zocor and Pravachol, and such antidepressants as Paxil, Celexa and Zoloft, among others.

Over-the-Counter Options. Self-medication with over-the-counter drugs (OTC) is the most frequent way patients treat health conditions. Americans buy more than five billion OTC drug products each year – accounting for 60 percent of drugs used. Today consumers have access to a market with more than 100,000 different OTC drug products. More than 600 OTC drugs were previously available only by prescription. There are OTC options from the same drug class for about five of the 50 drugs most widely used by seniors.

For instance, Claritin, (for allergies) is the 48th most commonly used drug by seniors in 2002, costs about $283 per 100 tablets if purchased by prescription, but only $28.23 per 100 tablets if purchased OTC at Wal-Mart – a savings of 90 percent.

The fifth most commonly used drug among seniors, Prilosec, is a proton pump inhibitor (PPI) used for serious cases of heartburn; three other PPIs (Prevacid, Protonix and Nexium) also made the list of top 50 drugs. Prilosec will be available OTC beginning September 2003, and the Internet pharmacy Drugstore.com is taking advance orders at $29.99 for a box of 42 tablets – allowing seniors to save about 80 percent.

Shopping for the Best Deal. Seniors can frequently save by comparing prices on the Internet. Moreover, purchasing larger sizes can often reduce the average price. By combining these techniques for branded medications, shoppers can save an average of 12 percent. For generics, the average savings is 52 percent. For example:

Some Internet pharmacies sell many generic drugs used for heart problems – including potassium chloride, diuretics, vasodialators and beta blockers – for only a few dollars more in large quantities (100 to 200 tablets) than in smaller quantities of, say, 30.
Buying larger quantities can save an average of about 51 percent on about one-third of the 50 most common drugs.

Therapeutic Substitutes. Many drugs have therapeutic substitutes that are far cheaper. These may be generic equivalents or other drugs from the same class. Although there are many examples of therapeutic substitutes, two of the top 50 drugs are especially good candidates for substitution:

Seniors opting for generic Metoprolol tartrate (50mg) in quantity instead of Toprol XL would save 81 percent.
Similarly, seniors with diabetes buying generic Glipizide instead of Glucotrol XL would save about 74 percent.

Not all therapeutic substitutes will work equally well for all people. But in many cases, a physician can help find a drug that works well for less money.

Other Options. The drug Celebrex is part a new generation of "super-aspirins" – called COX-2 Inhibitors – that are increasingly popular with seniors. They are popular because they relieve pain and inflammation without the stomach irritation sometimes experienced by taking daily doses of aspirin, ibuprofen or naproxen. Unfortunately, they are rather expensive – costing about $2.35 per tablet or capsule.

However, there are other pain relievers besides COX-2 Inhibitors without the gastrointestinal irritation of aspirin. Seniors may get relief from such pain relievers as ibuprofen or naproxen tablets, costing 11 cents to 13 cents each, rather than buying Celebrex for 20 times as much. If taken in combination with a common heartburn medication – such as OTC generic Prilosec, Zantac, Pepcid or Tagamet – seniors may find they would get the same effect as taking a nonstomach-irritating COX-2 inhibitor alone.

This is a case where combining two older pills may be much cheaper than taking one new one.

Drug Assistance Programs. Many states have programs to assist low-income seniors with their drugs costs. In addition, many drug companies have discount card programs for low-income or elderly patients. For example, Together RX, a joint program run by several drug companies, offers savings of up to 40 percent on more than 150 different drugs. Medicare beneficiaries earning up to $38,000 per couple qualify. [See the "Checklist for Saving on Drugs" .]

Conclusion. Conclusion. Seniors can realize significant savings on about 43 of the top 50 most often used drugs. Thirty-five of these are higher-priced brand drugs. There are already generic equivalents for some of these drugs and there will be many more within a few years. A few prescription drugs will even become available OTC. [For detailed information on savings, See Table 1 and Table 2.]

Devon M. Herrick is research manager for the National Center for Policy Analysis.

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Table I: All 50 Drugs

Savings From Smart Shopping

Cost Per Pill Theraputic Generic OTC Shopping

Rank Drug Dose 100 Doses Splitting¹ Substitution Substitution Substitution Savings

1 Lipitor 10mg $194.43 23% 9%

2 Norvasc 5mg $126.66 26% 6%

3 Fosamax 70mg $1,585.10 n/a 6%

4 Plavix 75mg $322.94 16%

5 Prilosec 20mg $380.88 18% 81% 7%

6 Celebrex 200mg $235.54 5%

7 Furosemide 40mg $5.90 78%

8 Zocor 20mg $362.00 49% 18% 8%

9 Prevacid 30mg $366.00 15% 80% 9%

10 Norvasc 10mg $186.66 n/a 3%

11 Lipitor 20mg $297.77 50% 9%

12 Klor-Con M20 20mg $20.19 n/a 58%

13 Toprol XL 50mg $60.15 81% 9%

14 Xalatan 0.005mg $50.99 7%

15 Vioxx 25mg $235.54 27% 10%

16 Lanoxin 0.125mg $16.17 48% 13% 27%

17 Synthroid 0.100mg $34.41 40% 37% 22%

18 Synthroid 0.050mg $30.74 44% 32% 16%

19 Metoprolol 50mg $11.50 n/a 37%

20 isosrbide mononitrate 30mg $39.60 n/a 40%

21 Digitek 0.125mg $14.00 50% 31%

22 isosrbide mononitrate 60mg $34.99 n/a 52%

23 Metoprolol 50mg $11.50 n/a 37%

24 Synthroid 0.075mg $34.43 42% 39% 32%

25 Zoloft 50mg $219.99 50% 14%

26 Protonix 40mg $299.99 76% 11%

27 Cozaar 50mg $128.02 29% 23%

28 Atenolol 25mg $7.60 56%

29 Premarin 0.625mg $20.19 24%

30 Furosemide 20mg $5.90 68%

31 Zocor 40mg $372.21 51% 19% 9%

32 Evista 60mg $218.30 15%

33 Nexium 40mg $373.30 16% 81% 6%

34 Zocor 10mg $217.77 17% 11% 9%

35 Combivent 01mg $48.89 12%

36 Miacalcin 200IU/act $68.99 4%

37 Atenolol 50mg $8.69 50%

38 Pravachol 20mg $252.21 27% 11%

39 Paxil 20mg $243.37 44% 2%

40 Toprol XL 100mg $90.27 n/a 75% 9%

41 Celexa 20mg $208.86 48% 12%

42 Hydrochlorothiazide 25mg $5.90 50% 34%

43 Glucotrol 10mg $70.50 74% 20%

44 Klor-Con M10 10mg $14.10 n/a 54%

45 Furosemide 40mg $5.90 78%

46 Potassiumn chloride 10mg $11.50 n/a 34%

47 Lanoxin 0.25mg $16.79 28% 17% 24%

48 Claritin 10mg $280.25 90%

49 Diovan 80mg $127.87 44% 18%

50 HCTZ/triamterene 25-37.5mg $10.89 64%

Number of Medications 20 5 9 5 49

Average Potential Savings 39% 29% 36% 82% 24%

¹Note: Many medications may not be split including capsules, tablets not available in double doses or controlled release formulations.

Table II: Information Used for Pie Chart

Savings From Smart Shopping

Cost Per Pill Theraputic OTC Shopping Other

Rank Drug Dose 100 Doses Splitting¹ Substitution Substitution Savings Options

1 Lipitor 10mg $194.43 23%

2 Norvasc 5mg $126.66 26%

3 Fosamax 70mg $1,585.10 n/a 6%

4 Plavix 75mg $322.94 16%

5 Prilosec 20mg $380.88 81%

6 Celebrex 200mg $235.54 5%

7 Furosemide 40mg $5.90 78%

8 Zocor 20mg $362.00 49%

9 Prevacid 30mg $366.00 80%

10 Norvasc 10mg $186.66 n/a 3%

11 Lipitor 20mg $297.77 50%

12 Klor-Con M20 20mg $20.19 n/a 58%

13 Toprol XL 50mg $60.15 81%

14 Xalatan 0.005mg $50.99 7%

15 Vioxx 25mg $235.54 27%

16 Lanoxin 0.125mg $16.17 48%

17 Synthroid 0.100mg $34.41 40%

18 Synthroid 0.050mg $30.74 44%

19 Metoprolol 50mg $11.50 n/a 37%

20 isosrbide mononitrate 30mg $39.60 n/a 40%

21 Digitek 0.125mg $14.00 50%

22 isosrbide mononitrate 60mg $34.99 n/a 52%

23 Metoprolol 50mg $11.50 n/a 37%

24 Synthroid 0.075mg $34.43 42%

25 Zoloft 50mg $219.99 50%

26 Protonix 40mg $299.99 76%

27 Cozaar 50mg $128.02 29%

28 Atenolol 25mg $7.60 56%

29 Premarin 0.625mg $20.19 24%

30 Furosemide 20mg $5.90 68%

31 Zocor 40mg $372.21 51%

32 Evista 60mg $218.30 15%

33 Nexium 40mg $373.30 81%

34 Zocor 10mg $217.77 17%

35 Combivent 01mg $48.89 12%

36 Miacalcin 200IU/act $68.99 4%

37 Atenolol 50mg $8.69 50%

38 Pravachol 20mg $252.21 27%

39 Paxil 20mg $243.37 44%

40 Toprol XL 100mg $90.27 n/a 75%

41 Celexa 20mg $208.86 48%

42 Hydrochlorothiazide 25mg $5.90 50%

43 Glucotrol 10mg $70.50 74%

44 Klor-Con M10 10mg $14.10 n/a 54%

45 Furosemide 40mg $5.90 78%

46 Potassiumn chloride 10mg $11.50 n/a 34%

47 Lanoxin 0.25mg $16.79 28%

48 Claritin 10mg $280.25 90%

49 Diovan 80mg $127.87 44%

50 HCTZ/triamterene 25-37.5mg $10.89 64%

20 2 5 16 7

Average Potential Savings 39% 78% 82% 51% 9%

¹Note: Many medications may not be split including capsules, tablets not available in double doses or controlled release formulations.