Minneapolis, MN—A new research letter raises an intriguing question: Why are the retail prices of human medications about 5.5 times higher than pet medications, even if they have the same ingredients at common human-equivalent doses?

The report in JAMA Internal Medicine compared the prices of 120 medications commonly used in humans and pets. University of Minnesota—led researchers point out that, on average, discounted prices for humans were higher than pet prices for more than 60% of medications. They add that, on average, discounted prices were 1.5 times higher for human medications than for pet medications.

"A 10-day supply of the same medication costs $2 for a pet dog, $10 for a person with a discount coupon, and $100 for a person without a coupon," says Arjun Gupta, MBBS, assistant professor at the University of Minnesota Medical School and oncologist with Minnesota Health Fairview. "With many humans and pets uninsured or underinsured, it is important that cash prices for medications are affordable, and that pricing is not exploitative."

Study authors note that in 2021 the marketing of about 20,000 medications for human use and 1,600 for veterinary use was overseen by the FDA. "Some medications are common to both pets and humans, and price differences can be extreme," the authors point out.

The article provided the example of levamisole, which was introduced in the 1960s as a veterinary antiparasitic medication but in 1991 showed efficacy in treating human colon cancer. The introductory human price of Janssen's Ergamisol, the brand name of levamisole, was $5 per 50-mg tablet. That was 100 times the then-veterinary price of about $0.05 for an equivalent amount. "In 2021, demand for ivermectin for treatment of COVID-19, fueled by misinformation, led to people seeking veterinary formulations of the drug, increasing the price 15-fold over a month ($6 to $92 for three tubes)," the authors add.

For the study, researchers identified the 200 human medications with the most prescription fills using the ClinCalc database. For those medications where the same ingredients are also used in pets, the study team collected the price per unit (e.g., per tablet) in humans and pets.

For human prices, GoodRx, a national-level price-comparison website, was used to calculate the average retail price (ARP) and a discounted price at Costco Pharmacy for a typical fill of the most common human dosage. Pet (dog) prices were obtained from online pharmacies, such as Chewy.com, via Google. Generic medications and human equivalent doses were used when possible. The primary outcome was the human-to-pet price ratio.

Of the 200 human medications identified, 120 (60.0%) with unique active ingredients and a pet formulation were studied. All medications except insulin detemir had generic human formulations. Results indicate that the human ARP and discounted price were higher than the pet price for 112 (93.3%) and 77 (64.2%) medications, respectively.

"The median (IQR) human ARP-to-pet price ratio was 5.5 (2.9-10.7), and the human discounted price-to-pet price ratio was 1.4 (0.7-2.5)," the authors stated. "The human ARP-to-pet price ratio was more than 10 for 35 (29.1%) medications. The human discounted price-to-pet price ratio was more than 3 for 20 (16.7%) medications."

About 12.5% of the drugs studied were antimicrobials, with the human ARP-to-pet price ratio of more than 1 for all of them and a median of 4.4. The human discounted price-to-pet price ratio was more than 1 for eight (53.3%) antimicrobials, with a median of 1.3.

"In this cross-sectional study, we found that prices of most medications were higher for humans than for pets," the researchers concluded. "Even discounted prices for humans, a best-case scenario of out-of-pocket costs for patients without prescription drug coverage, were higher than pet prices for two-thirds of medications."

Reasons for price differences with the mostly generic medications, they noted, are manufacturing, regulatory standards, and distribution, as well as different prices in different markets with the same costs. "Online pet pharmacies face less overhead in storage, and veterinary formulations may contain harmful (to humans) additives," the report stated. "Additionally, higher prices for humans may reflect pharmaceutical company investment, as well as differences in effectiveness and willingness to pay."

Still, the price differences between human and pet prices for a 30-day supply were sometimes dramatic, even with discounts. The authors note that in 2018 a 5-mg tablet of phytonadione (oral vitamin K) for humans cost $70.51, compared with a 50-mg veterinary-grade tablet costing $0.61.

"The human ARP of antimicrobials was four times the pet price. When antimicrobial access is appropriately limited through human sources by requiring a prescription, patients may turn to more accessible—and cheaper—pet antimicrobials," the study cautions.

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