Saint Louis, MO—Prices for generic heart failure (HF) drugs vary widely at retail pharmacies in a two-state region surveyed in recent research.

The research, published online by JAMA Internal Medicine to coincide with its presentation at the American Heart Association’s Scientific Sessions 2016, was in response to recent increases in generic drug costs.

Background information in the article notes that the higher costs raise concerns about the effect on uninsured and underinsured patients—many of them among the estimated 7.3 million Americans with cardiovascular disease—who might be restricted to retail pharmacies within a specific geographic area.

The Saint Louis University School of Medicine—led study evaluated retail pharmacy pricing in a two-state region around St. Louis for generic HF drugs recommended in treatment guidelines. Overall, 153 chain and 22 independent pharmacies were contacted by phone and asked about the price—without insurance—for digoxin, lisinopril, and carvedilol for 30- and 90-day supplies.

Wide variations were detected. Results indicate that, for example, a 30-day supply of digoxin, plus higher-dose lisinopril and carvedilol, varied from $12 to almost $398, with a median price of almost $71. A handful of pharmacies charged less than $25 for 30-day supplies and less than $100 for 90-day supplies for all three drugs. Strangely enough, digoxin was the most expensive drug, even though it is the most venerable cardiovascular medication available.

No correlations of pricing were found based on the type of pharmacy, or whether the pharmacy was in Missouri or Illinois, or sorted by zip code, median annual income, or other income clusters. The research letter points out that the retail pharmacies themselves were the primary drivers of cost, not factors such as drug dose, therapy duration, pharmacy ownership, or location.

“In conclusion, generic drugs for HF show wide variability in pricing at the retail pharmacy level. The precise reasons for this, and the implications for adherence and subsequent clinical outcomes, require further study from both scientific and policy standpoints,” study authors suggest.

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