Zorba Paster: The Anger About Drug Pricing Is Well Warranted

Talking To Your Pharmacist May Help You Navigate The Complex Structure Of Drug Prices

Chris Potter (CC-BY)

Dear Doc: You were right! Again! I took my prescriptions to several local pharmacies and none of them, not one of them, would tell me prices unless I let them run prescriptions through. I couldn’t get the price without having them filled.

Is this fair? I don’t think so. I compare prices for groceries, for cars, for restaurants; why can’t I do this for drugs, too? It ticks me off. — LK

Dear LK: You are right to be ticked. This is dead wrong! But I have some solutions. First of all, sign up for goodrx.com. They’ll show the prices in your area. It’s an easy way to check things out.

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Make sure you sign in with your ZIP code so the information you get is accurate for where you live. New York prices might be different than small-town Wisconsin prices, for example, which surprisingly are often more expensive.

Next, if you go to a pharmacy and find out that the prescription is too expensive, don’t take it. That’s right — don’t even touch the prescription bottle or the bag, and I mean this advice literally.

You don’t have to accept that prescription until you touch it and they run it through. Don’t worry, they won’t throw out those pills. They’ll just put them back on the shelf and dispense them to someone else.

Now, you may think, “Hey, they went to the bother of putting my name on it and counting out the pills. I should just suck it up and buy it.” Nah, don’t do that. If they’re playing a game with you, then you can play it right back.

While we’re on the subject of drugs, including the generic thing, I want to talk a bit about Viagra. I’ve had some comments about this since I last wrote about buying this drug in Canada (illegal, by the way, if you’re worried about that).

Viagra, or sildenafil, is sold only as a name-brand. It costs — now get this — $43.50 a pill. That’s really, really costly. But when the drug company Pfizer first developed this, they did so for a disease called pulmonary hypertension. They marketed this in a different size (i.e. milligram) tablet under the name Revatio.

That form of sildenafil is now generic. It’s a lot cheaper. It only comes in a 20 milligram generic tablet, though, so we’re going to have to do some math. Put on your thinking caps, and here goes.

Five 20 milligram generic Revatio pills costs $6.75. One name-brand Viagra costs $43.50 (the typical Viagra dose is 50 milligrams for most men). Which one is cheaper? Aha. That fourth-grade math teacher was right. You did it.

So why buy the name-brand when you can get the exact same drug as a generic? Beats me.

Because of the differences in milligram size and indication, or drug usage, the pharmacy cannot recommend this to you. Your doctor can prescribe Revatio, but if it is for an off-label use, it would not be paid for by your insurance unless you have pulmonary hypertension.

But if you’re going to pay for it yourself anyway (and few insurance companies pay for Viagra), ask your doctor for the Revatio generic. You’ll be getting the same drug for a fraction of the price.

Now, before you stop reading this, I want to broaden this generic issue a bit more. There are many drugs that are similar to each other but not exactly the same. They may have the same effect but are slightly different.

If you end up with a prescription you think is over the top in price, talk to your pharmacist and ask them their advice. They are a fountain of knowledge and may steer you to calling your doctor for one of the similar drugs that are less costly. You can do this and you should. Stay well.

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