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Marc Rodwin, "Pharmaceutical Price Transparency and Consumer Choice: An Empirical Test and Conceptual Choice"

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April 28, 2017

Transparency is a relatively new concept to the world of health and health care, considering that just a few short decades ago we were still in the throes of a “doctor-knows-best” model. Today, however, transparency is found on almost every short list of solutions to a variety of health policy problems, ranging from conflicts of interest to rising drug costs to promoting efficient use of health care resources, and more. Doctors are now expected to be transparent about patient diagnoses and treatment options, hospitals are expected to be transparent about error rates, insurers about policy limitations, companies about prices, researchers about data, and policymakers about priorities and rationales for health policy intervention. But a number of important legal and ethical questions remain. For example, what exactly does transparency mean in the context of health, who has a responsibility to be transparent and to whom, what legal mechanisms are there to promote transparency, and what legal protections are needed for things like privacy, intellectual property, and the like? More specifically, when can transparency improve health and health care, and when is it likely to be nothing more than platitude?

This conference aimed to: (1) identify the various thematic roles transparency has been called on to play in American health policy, and why it has emerged in these spaces; (2) understand when, where, how, and why transparency may be a useful policy tool in relation to health and health care, what it can realistically be expected to achieve, and when it is unlikely to be successful, including limits on how patients and consumers utilize information even when we have transparency; (3) assess the legal and ethical issues raised by transparency in health and health care, including obstacles and opportunities; (4) learn from comparative examples of transparency, both in other sectors and outside the United States. In sum, we hope to reach better understandings of this health policy buzzword so that transparency can be utilized as a solution to pressing health policy issues where appropriate, while recognizing its true limitations.

Learn more on our website: http://petrieflom.law.harvard.edu/events/details/2017-annual-conference

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Marc Rodwin, "Pharmaceutical Price Transparency and Consumer Choice: An Empirical Test and Conceptual Choice"

  1. 1. CAN TRANSPARENCY REDUCE RETAIL PHARMACEUTICAL PRICE DISPARITIES OR LOWER COSTS FOR CONSUMERS? Marc A Rodwin, J.D., Ph.D. Suffolk University Law School Transparency in Health and Health Care: Legal and Ethical Possibilities and Limits 2017 Harvard Law School Petrie-Flom Center April 28, 2017
  2. 2. 3 commonly asserted propositions re Rx transparency 1) Prescription drug prices lack transparency. 2) Lack of price transparency is new and contributes to wide price variations. 3) Increasing transparency is sufficient to reduce price variation and lower prices.
  3. 3. Better supported alternative propositions 1) There was little pharmaceutical price transparency in the 1960s due to restrictions on advertising and the lack of technology to facilitate learning prices. These obstacles have since been removed. 1) Variation in retail prescription drug prices in the U.S. has existed since the mid-1960s and persists despite recent increased price transparency. 1) Other factors explain wide prices variation and high prices:
  4. 4. Other factors explain wide prices variation and high prices: a) Retailers, Pharmaceutical Benefit Managers (PBMs) and manufacturers price discriminate to increase revenue. b) Insurance copayment policies result in some consumers paying more than others for identical medications. c) High transaction costs deter consumers from comparing prices effectively or purchasing medication based on price. d) Wide price variation is due to retailers, PBM and manufacturers marketing strategies and the absence of perfect competition.
  5. 5. 1967. Hastings, Glen E., and Richard Kunnes. "Predicting prescription prices." New England Journal of Medicine 277, no. 12 (1967): 625-628. 1970. What is the price of an Rx Drug? Consumer Reports 35 no. 5 279 (May 1970) 1973. Wertheimer, Albert I. "Pricing pharmaceutical service—art, science or whim." Journal of the American Pharmaceutical Association 13, no. 1 (1973): 11-12, at 11. 1975. Cady, John F., and Alan R. Andreasen. "Price levels, price practices and price discrimination in a retail market for prescription drugs." The Journal of Consumer Affairs (1975): 33-48. 1977. Berki, S. E., J. W. Richard, and H. A. Weeks. "The mysteries of prescription pricing in retail pharmacies." Medical care 15, no. 3 (1977): 241-250. Wertheimer, Albert I. "Pricing pharmaceutical service—art, science or whim." Journal of the American Pharmaceutical Association 13, no. 1 (1973): 11-12, at 11. 1986. Bloom, Bernard S., David J. Wierz, and Mark V. Pauly. "Cost and price of comparable branded and generic pharmaceuticals." JAMA 256, no. 18 (1986): 2523-2530.
  6. 6. Uninsured 1) Low cost generics sold at for $4 to $10 for a 30 day supply. • Low cost list varies with pharmacy. 2) Other generics branded drugs sold at many prices by each pharmacy. • In Boston 6 chains, 1 mail order retailer; many independent. Pharmacies. A) List price; B) Membership discount; C) Discounts through phone apps vary with pharmacy and phone app. • Good RX • Well Rx • Rx Price Quotes • Easy Drug 3) Pet med web sites sell human drugs sometimes at lower price than pharmacies. Insured 1)Co-payments vary with market segment and insurer. 2) Copayments vary with which of 3 to 5 copayment tiers the drug is placed. 3) Purchasing drug without insurance from low-price drug list or with discount coupon is sometimes less expensive paying the insurance copayment. 4) Pet med web sites sometimes charge lower prices than standard pharmacies.
  7. 7. PRICES List Price Member Discount Good Rx Well Rx Price Quotes Easy Drug RETAILER CVS Rite Aid Wallgreens Costco Walmart Health Warehouse Table 4: Summary of Prices Compared in Survey for each medication
  8. 8. PRESCRIPTION DRUG HIGHEST FIRM LOWEST FIRM 2ND LOWEST FIRM PRICE DIFFERENCE MEAN PRICE Aripiprazole; Abilify Walgreens: $944.09 Costco: $90.47 CVS: $158.81 $68.34 $522.35 Fluticasone: Advair Rite Aid: $330.39 Costco: $150.39 Walmart: $153.16 $2.77 $232.52 Albendazole: Albenza CVS: 5511.92 Costco: $5005.55 Walmart $5253.81 $248.26 $5,380.04 Captopril: Capoten CVS: $81.14 Costco/Walmart: $8.54 Rite Aid: $9.99 $1.45 $26.35 Clomipramine: Anafranil H Warehouse: $333.0 Walgreens: $10 CVS: $106.06 $91.06 $197.20 Duloxetine: Cymbalta Walgreens: $231.99 H Warehouse: $15.75 Walmart: $25.74 $9.99 $109.36 Digoxin: Lanoxin Walmart/ Costco: $69.15 Walgreens: $5 Rite Aid: $10 $4.99 $34.02 Table 5: Summary of Retail Price Variation for 21 Drugs: Highest price, lowest price, 2nd-lowest price, $ difference between lowest and 2nd lowest price, and mean price (Part 1)
  9. 9. Prescription Drug HIGHEST FIRM LOWEST FIRM 2ND LOWEST FIRM PRICE DIFFERENCE MEAN PRICE Doxycycline: Monohydrate Monodox Walmart: $124.54 H Warehouse: $14.98 Walgreens: $15 $0.02 $56.02 Doxycycline Hyclate: Vibramycin CVS: $182.81 Rite Aid: $9.99 Walgreens:$15 $5.25 $69.67 Erythromycin: Erythrocin H Warehouse: $660.90 Costco: $61.19 CVS: $183.29 $122.10 $431.94 Atorvastatin: Lipitor Rite Aid: $149.99 H Warehouse: $6.30 Costco: $9.95 $3.65 $64.12 Metformin: Glucophage Walmart: $29.06 Walmart: $4 Walgreens/ H Warehouse:$5 $1 $10.33 Methazolamid e: Neptazane CVS: $185.78 CVS: $31.36 Walgreens: $47.34 $15.98 $95.55 Clopidogrel: Plavix Rite Aid: $152.99 H Warehouse: $7.90 Walmart: $18.48 $10.58 $73.86 Table 5: Summary of Retail Price Variation for 21 Drugs: Highest price, lowest price, 2nd-lowest price, $ difference between lowest and 2nd lowest price, and mean price (Part 2)
  10. 10. PRESCRIPTI ON DRUG HIGHEST FIRM LOWEST FIRM 2ND LOWEST FIRM PRICE DIFFERENCE MEAN PRICE Pioglitazone: Actos Rite Aid: $347.99 H Warehouse: $6.95 Costco: $14.57 $7.62 $131.85 Piroxicam: Feldene Rite Aid: $123.34 Walmart: $48.04 CVS: $51.16 $3.12 $72.40 Pravastatin: Pravachol CVS: $65.31 Walgreens: $5 Rite Aid: $9.99 $4.99 $23.75 Amitriptyline: Ranexa Walgreens: $508.47 Costco : $154.01 Walmart: $154.06 $0.05 $279.60 Risperidone: Risperdal Rite Aid: $119.99 Costco: $8.80 Walgreens: $15 $6.20 $53.21 Montelukast: Singulair Rite Aid: $169.99 H Warehouse: $8 Costco: $11.27 $3.27 $66.97 Olanzapine: Zyprexa CVS: $436.99 H Warehouse: $11.85 Costco: $12.40 $0.55 $189.06 Table 5: Summary of Retail Price Variation for 21 Drugs: Highest price, lowest price, 2nd-lowest price, $ difference between lowest and 2nd lowest price, and mean price (Part 3)
  11. 11. PHARMACY Lowest $ amount between highest and lowest price for a single medication Highest $ amount between highest and lowest price for a single medication $ amount between lowest and highest price difference Mean savings when purchasing at lowest price* Health Warehouse $0 (Aripiprazole Digoxin, Erythromycin, Piroxicam, Risperidone. No price difference $14.12 (Doxycycline) $14.12 $3.47 Costco $1.85 (Metformin) $590.11 (Aripiprazole) $588.26 $150.98 CVS $12.11 (Metformin) $731.18 (Aripiprazole) $719.07 $172.18 Rite Aid $6.03 (Metformin) $507.06 (Aripiprazole) $501.03 $145.11 Walgreens $10.07 (Metformin) $674.93 (Aripiprazole) $664.86 $149.64 Walmart $10.92 (Methazolamide) $232.70 (Olanzapine) $221.78 $91.58 Table 6: Range of prices offered within a single pharmacy: Lowest $ difference between high and low price; highest $ difference between high and low price; Mean saving by purchasing drug at lowest price.
  12. 12. Price Variation within one Pharmacy
  13. 13. Table 7A CVS Generic Drug Pricing Pharmacy/Plan Name Dose Listed Price Generic GoodRX Coupon Well Rx Rx Price Quotes Easy Drug Caremark Price (Generic) Caremark Price (Brand) - Mail service Price Difference (High to Low) Mean All generics Abilify (Aripiprazole) 2mg $ 889.99 $ 158.81 $ 681.82 $ 844.85 $ 584.49 $ 299.44 $ 295.77 $ 731.18 $ 522.35 Advair 100/50mcg N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. Albenza (Albendazole) 400mg N.A. N.A N.A N.A N.A N.A. N.A. N.A N.A. Capoten (Captopril) 12.5mg $ 27.19 $ 19.91 $ 27.19 $ 11.92 $ 34.55 $ 81.14 $ 72.56 $ 69.22 $ 26.35 Anafranil capsules (Clomipramine) 50mg $ 266.99 $ 106.06 $ 243.58 $ 121.00 $ 208.85 $ 281.25 N.A. $ 175.19 $ 197.20 Cymbalta DR capsule (duloxetine) 20mg $ 195.99 $ 41.85 $ 96.45 $ 189.41 $ 132.47 $ 71.88 $ 63.10 $ 154.14 $ 109.36 Lanoxin (Digoxin) .125mg $ 39.39 $ 10.97 $ 33.49 $ 12.14 $ 47.90 $ 49.30 $ 29.47 $ 38.33 $ 34.02 Monodox (Doxycycline) 100mg $ 56.59 $ 33.27 $ 73.32 $ 44.14 $ 95.07 $ 36.91 $ 28.00 $ 67.07 $ 56.02 Doryx (Doxycycline hyclate) 100mg $ 89.59 $ 45.70 $ 76.80 $ 46.42 $ 106.08 $ 182.81 $ 80.87 $ 137.11 $ 69.67 Ery-Tab (Erythromycin) 500mg N.A. $ 289.64 $ 497.99 $ 183.29 $ 444.40 $ 327.24 $ 439.50 $ 314.70 $ 431.94 Lipitor (atorvastatin) 20mg $ 134.99 $ 19.11 $ 69.98 $ 90.08 $ 110.31 $ 60.96 $ 51.99 $ 91.20 $ 64.12 Glucophage (Metformin) 500mg $ 11.99 $ 12.81 $ 11.33 $ 13.05 $ 19.19 $ 17.10 $ 7.08 $ 12.11 $ 10.33
  14. 14. Table 7A CVS Generic Drug Pricing continued Pharmacy/Plan Name Dose Listed Price Generic GoodRX Coupon Price Well Rx Rx Price Quotes Easy Drug Caremark Price (Generic) Caremark Price (Brand) - Mail service Price Difference (High to Low) Mean All generics Neptazane (Methazolamide) 25mg $ 105.99 **48.49 (50mg) $ 87.95 $ 31.36 $ 75.46 $ 185.78 $ 179.55 $ 154.42 $ 95.55 Plavix (clopidogrel) 75mg $ 141.99 $ 85.15 $ 80.11 $ 112.01 $ 131.80 $ 73.11 $ 64.35 $ 77.64 $ 73.86 Actos (Pioglitazone) 45 mg $ 305.99 $ 25.92 $ 251.46 $ 182.78 $ 215.67 $ 115.03 $ 107.22 $ 280.07 $ 131.85 Feldene (Piroxicam) 20mg $ 79.99 $ 51.30 $ 51.16 $ 53.86 $ 87.25 $ 75.10 $ 66.39 $ 36.09 $ 72.40 Pravachol (Pravastatin) 20mg $ 33.99 $ 22.59 $ 25.93 $ 36.87 $ 65.31 $ 37.49 $ 27.93 $ 42.72 $ 24.46 Ranexa (ER 12 h) 500mg $ 424.79 $ 364.53 $ 359.53 $ 188.26 $ 155.63 N.A. N.A. $ 60.26 $ 279.60 Risperdal (Risperidone) 1mg $ 93.59 $ 19.14 $ 48.91 $ 76.73 $ 88.40 $ 79.84 $ 71.24 $ 74.45 $ 53.21 Singulair (Montelukast) 10mg $ 128.99 $ 22.48 $ 68.13 $ 95.26 $ 108.33 $ 69.88 $ 61.05 $ 106.51 $ 66.97 Zyprexa (Olanzapine) 10mg $ 436.99 $ 27.35 $ 96.30 $ 309.14 $ 364.98 $ 189.65 $ 183.51 $ 409.64 $ 189.06 average: $ 159.58
  15. 15. Table 7B RiteAid Generic Drug Pricing Pharmacy/ Plan Name Dose Listed Price Generic GoodRX Coupon Price Well Rx Rx Price Quotes Easy Drug Membership price (Generic) High Phone App Price Low Phone App Price Difference high to low Abilify (Aripiprazole) 2mg $ 899.99 $ 944.07 $ 437.01 $ 844.35 $ 439.99 N.A. $ 944.07 $ 437.01 $ 507.06 Advair 100/50mcg N.A N.A N.A N.A N.A N.A. N.A. N.A. N.A. Albenza (Albendazole) 400mg N.A N.A N.A N.A N.A N.A. N.A. N.A. N.A. Capoten (Captopril) 12.5mg $ 44.99 $ 9.99 $ 25.05 $ 28.44 $ 27.54 $ 9.99 $ 44.99 $ 9.99 $ 35.00 Anafranil capsules (Clomipramine) 50mg $ 308.99 $ 142.40 $ 155.76 $ 299.67 $ 158.26 N.A. $ 308.99 $ 142.40 $ 166.59 Cymbalta DR capsule (duloxetine) 20mg $ 199.99 $ 91.40 $ 98.48 $ 188.91 $ 100.98 N.A. $ 199.99 $ 91.40 $ 108.59 Lanoxin (Digoxin) .125mg $ 9.99 $ 9.99 $ 35.05 $ 57.41 $ 37.55 $ 9.99 $ 57.41 $ 9.99 $ 47.42 Monodox (Doxycycline) 100mg $ 99.99 $ 81.26 $ 70.43 $ 46.17 $ 72.93 N.A. $ 99.99 $ 46.17 $ 53.82 Doryx (Doxycycline Hyclate) 100mg $ 110.09 $ 81.26 $ 78.68 $ 41.31 $ 81.18 $ 9.99 $ 110.09 $ 9.99 $ 100.10 Ery-Tab (Erythromycin) 500mg N.A. $ 236.71 $ 516.99 $ 504.78 $ 439.57 N.A. $ 516.99 $ 236.71 $ 280.28 Lipitor (Atorvastatin) 20mg $ 149.99 $ 36.09 $ 81.94 $ 111.56 $ 84.36 N.A. $ 149.99 $ 36.09 $ 113.90 Glucophage (Metformin) 500mg $ 9.99 $ 9.99 $ 13.50 $ 10.33 $ 16.02 $ 9.99 $ 16.02 $ 9.99 $ 6.03
  16. 16. Table 7 B RiteAid Generic Drug Pricing continued Pharmacy/ Plan Name Dose Listed Price Generic GoodRX Coupon Price Well Rx Rx Price Quotes Easy Drug Members hip price (Generic) High Phone App Price Low Phone App Price Difference high to low Neptazane (Methazolami de) 25mg $ 114.99 $ 130.09 $ 55.72 $ 83.38 $ 58.22 N.A. $ 130.09 $ 55.72 $ 74.37 Plavix (Clopidogrel) 75mg $ 152.99 $ 21.16 $ 97.97 $ 91.76 $ 100.47 N.A. $ 152.99 $ 91.03 $ 61.96 Actos (Pioglitazone) 45 mg $ 347.99 $ 146.91 $ 155.88 $ 21.16 $ 163.38 N.A. $ 347.99 $ 21.16 $ 326.83 Feldene (Piroxicam) 20mg $ 85.99 $ 61.34 $ 64.57 $ 123.34 $ 67.07 N.A. $ 123.34 $ 61.34 $ 62.00 Pravachol (Pravastatin) 20mg $ 9.99 $ 9.99 $ 48.10 $ 20.78 $ 50.61 $ 30.00 $ 50.61 $ 9.99 $ 40.62 Ranexa (ER 12 h) 500m g $ 439.99 $ 358.03 $ 363.53 $ 187.51 $ 154.76 N.A. $ 439.99 $ 154.76 $ 285.23 Risperdal (Risperidone) 1mg $ 119.99 $ 62.12 $ 65.45 $ 25.69 $ 67.93 N.A. $ 119.99 $ 25.69 $ 94.30 Singulair (Montelukast) 10mg $ 169.99 $ 75.39 $ 80.28 $ 39.88 $ 82.87 N.A. $ 169.99 $ 39.88 $ 130.11 Zyprexa (Olanzapine) 10mg $ 306.53 $ 246.48 $ 272.86 $ 19.13 $ 275.36 N.A. $ 306.53 $ 19.13 $ 287.40
  17. 17. Table 7 C: Walgreens Generic Drug Pricing Pharmacy/Plan Name Dose Listed Price Generic GoodRX Well Rx Rx Price Quotes Easy Drug Membership price High Phone App Price Low Phone App Price Price Difference (High to Low) Mean All generics Abilify (Aripiprazole) 2mg $ 944.09 $ 317.25 $ 269.16 $ 844.10 $ 396.64 N.A. $ 944.09 $ 269.16 $ 674.93 $ 522.35 Advair 100/50m cg N.A N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A. Albenza (Albendazole) 400mg N.A N.A. N.A. N.A. N.A. N.A. N.A. N.A. N.A N.A. Capoten (Captopril) 12.5mg $ 29.89 $ 15.35 $ 29.36 $ 13.22 $ 25.43 $10.00 $ 29.89 $10.00 $ 19.89 $ 26.35 Anafranil capsules (Clomipramine) 50mg $ 259.69 $ 32.36 $ 234.05 $ 32.92 $ 143.09 $15.00 $ 259.69 $ 147.31 $ 112.38 $ 197.20 Cymbalta DR capsule (Duloxetine) 20mg $ 231.99 $ 76.18 $ 74.94 $ 188.66 $ 91.53 N.A. $ 231.99 $ 74.94 $ 157.05 $ 109.36 Lanoxin (Digoxin) .125mg $ 42.95 $ 15.64 $ 31.22 $ 14.58 $ 34.45 $5.00 $ 42.95 $5.00 $ 37.95 $ 34.02 Monodox (Doxycycline) 100mg $ 58.79 $ 32.90 $ 57.45 $ 50.94 $ 66.28 $15.00 $ 66.28 $15.00 $ 51.28 $ 56.02 Doryx (Doxycycline Hyclate) 100mg $ 95.99 $ 52.23 $ 51.13 $ 57.83 $ 73.72 $15.00 $ 95.99 $15.00 $ 80.99 $ 69.67 Ery-Tab (Erythromycin) 500mg $531.53 N.A. $ 513.99 $ 504.53 $ 443.19 N.A. $531.53 $ 443.19 $ 88.34 $ 431.94 Lipitor (Atorvastatin) 20mg $ 134.99 $ 58.00 $ 36.60 $ 138.32 $ 76.57 N.A. $ 138.32 $ 36.60 $ 101.72 $ 64.12 Glucophage (Metformin) 500mg $5.00 $5.00 $ 7.32 $ 10.28 $ 15.07 $5.00 $ 15.07 $5.00 $ 10.07 $ 10.33
  18. 18. Table 7C Walgreens Generic Drug Pricing continued Pharmacy/ Plan Name Dose Listed Price Generic GoodRX Coupon Well Rx Rx Price Quotes Easy Drug Members hip price (Generic) High Phone App Price Low Phone App Price Price Difference (High to Low) Mean All generics Neptazane (Methazolami de) 25mg N.A $58.04 $ 104.49 $ 47.34 $ 53.05 N.A. $ 104.49 $ 47.34 $ 57.15 $ 95.55 Plavix (Clopidogrel) 75mg $144.99 $75.82 $ 39.36 $ 149.20 $ 91.08 N.A. $ 149.20 $ 39.36 $ 109.84 $ 73.86 Actos (Pioglitazone) 45 mg $ 310.97 $ 77.33 $ 79.85 $ 14.61 $ 147.69 N.A. $ 310.97 $ 14.61 $ 296.36 $ 131.85 Feldene (Piroxicam) 20mg $ 93.69 $ 52.07 $ 60.82 $ 91.51 $ 61.01 N.A. $ 93.69 $ 52.07 $ 41.62 $ 72.40 Pravachol (Pravastatin) 20mg $ 10.00 $ 10.00 $ 16.60 $ 28.10 $ 46.20 $5.00 $ 46.20 $5.00 $ 41.20 $ 24.46 Ranexa (ER 12 h) 500mg $508.47 $365.53 $ 360.53 $ 187.51 $ 156.00 N.A. $508.47 $ 156.00 $ 352.47 $ 279.60 Risperdal (Risperidone) 1mg $ 105.10 $ 34.41 $ 29.58 $ 34.60 $ 61.78 $15.00 $ 105.10 $15.00 $ 90.10 $ 53.21 Singulair (Montelukast) 10mg $132.99 $63.31 $ 31.87 $ 142.01 $ 75.24 N.A. $ 142.01 $ 31.87 $ 110.14 $ 66.97 Zyprexa (Olanzapine) 10mg $ 324.99 $ 90.02 $ 120.01 $ 424.47 $ 248.47 N.A. $ 424.47 $ 90.02 $ 334.45 $ 189.06
  19. 19. Copayments
  20. 20. Table 9B: HEALTH CONNECTOR Rx DRUG COPAYMENTS AFTER DEDUCTIBLE DRUG TIER: Tier 1 Generic Drugs Tier 2 Preferred Brands Tier 3 Non-Preferred Brands Tier 4 Specialty Drugs TYPE OF PLAN: Bronze $25 $75 $100 $100 Silver $20 $60 $90 $90 Gold $20 $30 $50 $50 Platinum $15 $30 $50 $50
  21. 21. Table 9C: CONNECTORCARE COPAYMENTS Generics Preferred Brands Non- Preferred Brands Specialty Drugs PLAN TYPE: Type 1 $1 $3.65 $3.65 $3.65 Types 2A & 2B $10 $20 $40 $40 Types 3A & 3B $12.50 $25 $50 $50 Connector Care Plans are available for those household incomes at or below 300%FPL .
  22. 22. PET PET MED WEB SITES
  23. 23. Pet web sites compared with standard pharmacies DRUGS Highest Firm Price Highest Lowest Firm Price Lowest Lowest Firm Price Lowest Generic Generic all non-pet non-pet Amitriptyline Walmart $ 12.00 Walmart $ 4.00 Walmart $ 4.00 Cefpodoxime Proxetil H Warehouse $225.80 1800petsupplies $ 40.20 Walgreens $ 88.35 Digoxin Costco/Walmart $ 69.15 CVS $ 10.97 CVS $ 10.97 Doxycycline Hyclate Costco $137.61 Costco $ 15.24 Costco $ 15.24 Enalaprilll CVS $ 41.49 petsupplies4less $ 5.70 Costco $ 10.76 Fluoxetine CVS $151.60 Walmart $ 4.00 Walmart $ 4.00 Furosemide CVS $ 14.22 PetcareRx $ 3.60 Walmart $ 4.00 Hydroxyzine HCL 1800 PetMeds $ 24.30 H Warehouse $ 5.00 H Warehouse $ 5.00 Lactulose Solution Walmart $ 30.55 Walmart $ 8.02 Walmart $ 8.02 Levothyroxine H Warehouse $ 23.40 1800 PetMeds $ 3.30 Walmart $ 4.00 Methimazole RiteAid $ 25.99 petsupplies4less $ 8.70 Costco $ 12.03 Methocarbamol CVS $ 15.70 H Warehouse $ 5.00 H Warehouse $ 5.00 Metronidazole Costco $ 36.12 H Warehouse $ 10.08 H Warehouse $ 10.08 Piroxicam RiteAid $123.34 Walmart $ 48.04 Walmart $ 48.04 Prednisone petsupplies4less $ 14.70 H Warehouse $ 5.00 H Warehouse $ 5.00 Spironolactone RiteAid $ 14.85 Walmart $ 4.00 Walmart $ 4.00 Theophylline RiteAid $ 41.69 H Warehouse $ 21.00 H Warehouse $ 21.00 Tramadol CVS $ 21.58 Walmart $ 4.90 Walmart $ 4.90
  24. 24. Transparency and Retail Rx Drug Price Variation 1) Tools that can reveal price information are often used to facilitate price discrimination. Phone apps facilitate comparing prices of competing retailers but sellers often use them to market drugs and offer different price discounts to various consumers. 2) Retail price variations are due price discrimination, marketing strategies and differences in insurance copayments rather than lack of price transparency.
  25. 25. 3) The promotion of price transparency is often necessary but insufficient to reduce retail price variation and anti- competitive practices. 4) Reducing the cost of obtaining price information could help lower prices for consumers if drugs were sold through a regulated exchange. Many proponents of transparency dislike regulation and will oppose a regulated exchange even though it would produce optimal price transparency.

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