Thursday, June 25, 2020

Price of Antipsychotics Varies Significantly Between Pharmacies, Study Finds

The price of antipsychotic medications varies significantly between pharmacies, sometimes by differences of over $1,000, according to a study published in Psychiatric Services in Advance.

Carrie R. Kriz, M.S., Leigh Anne Nelson, Pharm.D., B.C.P.P., and colleagues from the University of Missouri-Kansas City collected data by calling 281 pharmacies in the Kansas City area and requesting the cash price of a 30-day supply of six generically available antipsychotic medications. Each call included requests for the cash price of two medications at the specific strength and number of doses to “mimic a patient’s interaction and limit questions from the pharmacy,” the authors wrote. (Pharmacy students called each pharmacy three separate times to obtain prices for all six medications.)

The medications were the second-generation antipsychotics risperidone at 4 mg per day, olanzapine at 20 mg per day, quetiapine at 600 mg per day, ziprasidone at 160 mg per day, and aripiprazole at 20 mg per day and the first-generation antipsychotic haloperidol at 10 mg per day.

Of the pharmacies called, 265 responded to phone queries between April 25, 2017, and May 25, 2017. There were significant pricing variations between all types of pharmacies, including nationwide chains, grocery store pharmacies, and independent pharmacies. Haloperidol had the lowest price difference ($20-$102.99), while aripiprazole had the highest difference ($29.99-$1,345). There were also significant differences in price for olanzapine ($16-$1,314) and quetiapine ($20-$1,105.75).

Compared with independent pharmacies, chain pharmacies had the highest prices for most medications. Prices at grocery store pharmacies and independent pharmacies averaged $180 and $415 lower than those at chain pharmacies, respectively.

Some states have website databases meant to publicly report pharmacies’ medication prices, but these databases can be unreliable, the authors noted. Additionally, “[i]ndividuals with schizophrenia often have co-occurring cognitive deficits, and thus the utility of websites for price comparisons by these individuals remain questionable,” they wrote.

Prescription coupon websites may be a resource to save money on medications, but the authors pointed out that studies show individuals with severe mental illness are less likely to use the internet. Those individuals may also find it difficult to identify and contact multiple pharmacies to check prices. “Therefore, the best outcome for patients may be a combination of counseling patients on how to obtain low-priced medications and provision by health care providers of medication coupons to patients,” the authors wrote.

According to the authors, further research is necessary, particularly to determine if socioeconomic or neighborhood characteristics contribute to price variability. “By understanding where and how patients can access low-cost antipsychotic medications, providers may be able to provide patients with the best possible treatment option at the lowest cost,” the authors concluded.

(Image: iStock/LaylaBird)

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