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Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014 What would your patients do with extra cash? Perhaps buy new running The prices represent the entire retail cost of the prescription filled at a shoes and a gym membership, or take a trip to escape the Canadian winter? We community pharmacy in Alberta, including markup and dispensing fees. This could be saving our patients and the health care system substantial money if does not reflect what a patient would pay if covered under a drug plan, but prescribers chose lower cost (often equivalent) medications, instead of higher rather the cost to an individual without coverage, or the cost to the health care cost medications, which may not be covered by provincial drug plans. Choosing system. Prices have been rounded to the nearest $5. Although prices may differ sitagliptin (Januvia) over metformin for diabetes, perindopril (Coversyl) over between wholesalers and pharmacies (especially for oral contraceptives and thiazides for hypertension and pregabalin (Lyrica) over amitriptyline (Elavil) for insulins), this tool allows for relative cost comparisons between medications in the same class or for treating the same disease. This list is not exhaustive and we encourage you to contact your neighborhood pharmacist for information on Physicians have limited knowledge and poor access to information about medications not included that you use in your practice. drug plans.1 With this in mind, we endeavored to create a document listing the price of medications commonly prescribed by Albertan primary care health This document is up to date as of January 1, 2014. Since the 2013 edition,
providers. Although medication choice should be based on clinical situations, generic prices have changed substantially, dropping in price in most cases. many medications are therapeutically interchangeable and using this reference For 2014, we have added a section on hormone replacement therapy and allows prescribers to consider costs when prescribing. Other cost savings Alzheimer’s disease medications. Please forward any feedback, including prices methods to be considered include: increasing prescription lengths for long-term that surprised you or cases where knowledge of prices made a difference in your medications, using combination products, and pill splitting where possible.
practice to [email protected].
Costs listed are primarily for the generic product (with generic name Michael Kolber BSc, MD, CCFP, MSc
bolded) as provincial drug plans will generally only pay for the lowest cost formulation available. Brand name prices (with brand name bolded) are for Department of Family Medicine, University of Alberta products still under patent protection. We also provide information on coverage by Alberta Blue Cross (BC) and Indian Affairs (IA) formularies and which Jayson Lee BSc Pharm
products require Special Authorization (SA). Clinical Pharmacist, Pharmacare Specialty Pharmacy #2 Tony Nickonchuk BSc Pharm CDE APA
Manager, Walmart Pharmacy
Peace River, Alberta
Medication costs were calculated by adding the wholesale cost of the medication plus mark up dispensing fee. Alberta Health & Wellness determines the maximum markup and dispensing fee that can be charged based on the acquisition cost of the medication and is illustrated in the table below.
This table is accurate for all medications except oral contraceptives, insulins, and injectables, where the total charge can be as high as 2/3 of the acquisition cost to a maximum of $100 per prescription. Acquisition Cost
Dispensing Fee
Total Fee
AcknowledgementsWe wish to thank Stacy Jardine, BSc. Pharm, Jamie Hoy, BSc. Pharm, Mike Allan MD, CCFP and Tina Korownyk MD, CCFP for their contributions to this project.
Reference1. Allan GM, Lexchin J, Wiebe N. Physician Awareness of Drug Cost: A Systematic Review PLoS Med. 2007 Sep;4(9):e283.
Lipid Lowering Agents, Beta Blockers, Calcium Channel Blockers .5Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blockers (ARBs), Diuretics .6Anti-platelet, Anti-coagulant .7 PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 5 Lipid Lowering Agents
Atorvastatin
Rosuvastatin
Atorvastatin
Rosuvastatin
Atorvastatin
Pravastatin
Simvastatin
Beta Blockers
Bisoprolol
Metoprolol
Metoprolol-SR
Bisoprolol
Atenolol
Metoprolol-SR
Atenolol
Calcium Channel Blockers
Amlodipine
Diltiazem-T
Amlodipine
Adalat XL
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 6 Angiotensin Converting Enzyme Inhibitors (ACEIs)
Ramipril
Ramipril/HCT
Fosinopril
Lisinopril
Ramipril
Ramipril/HCT
Enalapril
Coversyl
Coversyl Plus
Coversyl
Angiotensin Receptor Blockers (ARBs) (All have HCTZ combo products that are similar in price to the single entity product) Telmisartan
Candesartan
Irbesartan
Losartan
Valsartan
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 7 Chlorthalidone
Hydrochlorothiazide
Furosemide
Indapamide
Spironolactone
Spironolactone
Clopidogrel
Brilinta
Warfarin
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 8 Metformin
Glyburide
Gliclazide
Repaglinide
Trajenta
Insulin (Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 15 mL of penfill insulin) Humulin N
Novolin NPH
Humulin R
Novolin Toronto
Novorapid
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 9 RESPIRATORYPuffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device.
Salbutamol
Atrovent (200)
Spiriva (30)
Qvar (200)
Alvesco (120)
Pulmicort (200)
Flovent (120)
Flovent (120)
Long-acting beta agonist/Corticosteroid Combinations Symbicort (120)
Advair MDI (120)
Advair MDI (120)
Advair Diskus
Montelukast
Nasal Corticosteroids (Brackets next to brand name indicate number of doses per device) Beclomethasone
Fluticasone Propionate
Nasonex (140)
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 10 SMOKING CESSATION (COST QUOTED FOR 12 WEEKS OF STATED DOSING FREQUENCY) Nortriptyline
Bupropion
*0.5mg qd x 3 days, 0.5mg bid x 4 days, 1mg bid thereafter Nicoderm
**21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily) Nicorette
Nicorette
Nicorette
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 11 Rabeprazole
Omeprazole
Lansoprazole
Pantoprazole
Esomeprazole
Ranitidine
Helicobacter Pylori Eradication
HP-PAC (7 days of prepacked medications listed below)
Amoxicillin
Clarithromycin
prescriptions; All 3 covered by BC and IA Lansoprazole
Antiemetics (Cost for 15 tablets)
Dimenhydrinate
Metoclopramide
Diclectin
Ondansetron
Psyllium Fiber
Lactulose
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 12 Selective Serotonin Reuptake Inhibitors (SSRIs) Citalopram
Sertraline
Paroxetine
Fluoxetine
Cipralex
Serotonin/Norepinehprine Reuptake Inhibitors (SNRIs) Venlafaxine
Cymbalta
Noradrenergic and Specific Serotenergic Antidepressant (NaSSA) Mirtazapine
Quetiapine
Risperidone
Quetiapine
Olanzapine
Olanzapine
Seroquel XR
Lorazepam
Clonazepam
Oxazepam
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 13 Cost for 12 week supply unless otherwise stated, and 21 or 28 products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
Synphasic
Levonorgestrel
Levonorgestrel
Triquilar
Desogestrel
Tri-Cyclen Lo
Tri-Cyclen
Drosperinone
Nuvaring
*Provides contraception for up to 30 months. Upfront cost is high but divided over 30 months, cost is $20 per 84 days.
Mirena**
**Provides contraception for up to 5 years. Upfront cost is high but divided over 5 years, cost is $15 per 84 days.
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 14 Premarin
Medroxyprogesterone
Prometrium
Estradiol-17ß Patch
Estrogel
Premarin Vaginal
Vagifem-10
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 15 Non-Steroidal Antiinflammatory Drugs (NSAIDs) Naproxen
Diclofenac
Ketorolac
Arthrotec
Celebrex
Miscellaneous
Tramadol/
Acetaminophen
Rizatriptan
quantity limitsSA req’d BC, IA covered with Zolmitriptan
quantity limitsSA req’d BC, IA covered with Sumatriptan
Neuropathic or Chronic Pain
Amitriptyline
Amitriptyline
Gabapentin
Pregabalin
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 16 Allopurinol
Colchicine
Erectile Dysfunction (Cost for 4 tablets) Tamsulosin CR
Terazosin
Finasteride
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 17 Sulfameth/Trimeth
Doxycycline
Macrobid
Amoxicillin
BC / IA coveredIA covered, special restrictions Levofloxacin
Ciprofloxacin
Azithromycin
Amoxicillin/Clavulanate Clavulin
Cephalexin
Clarithromycin
BC / IA coveredIA covered, special restrictions Vitamin D
Calcium Carbonate
Etidronate/Calcium
Alendronate
Risedronate
Galantamine ER
Rivastigmine
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services In the summer of 2011, Jayson worked as a pharmacy student with Tony. One day Dr. Kolber stopped by for a visit. He mentioned, in passing, “Boy, it would be great to have a list of common drugs and what they cost.” As pharmacists, Tony and Jayson couldn’t agree more. They don’t mind calling busy, hard working doctors with deep clinical questions but always feel like bothers if it is about coverage limitations or price concerns. So, as preceptors so often do to students, Tony told Jayson to do all the grunt work. Then Tony took all the credit for the work and presented it as his own to Dr. Kolber. Dr. Kolber forgot he mentioned the idea but loved it nonetheless and proposed making it even bigger and bringing it to the ACFP. Thus began their tripartite collaboration. Jayson has since become a fully licensed pharmacist so Tony does the grunt work and, as recompense, lists Jayson as a co-author. In sincerity, lots of consideration, research, and extensive editing goes into this document by all three, their professional colleagues, and the great team at ACFP. They sincerely hope you find it of value in your practice.
Michael R. Kolber, BSc, MD, CCFP, MSc
Family Physician
Dr. Kolber is an Associate Professor in the Department of Family Medicine at the University of Alberta. He practices in Peace River and belongs to the University of Alberta Department of Family Medicine Evidence Based Medicine group. Dr. Kolber contributes to Tools for Practice, presents at the ACFP’s CPD Roadshows, and is the Planning Committee Chair for the Practical Evidence for Informed Practice conference. He has presented at local, provincial, national, and international educational events.
Jayson Lee, BSc. Pharm.
Clinical Pharmacist
Jayson graduated from University of Alberta in 2013 and now works as a clinical pharmacist at Pharmacare Specialty Pharmacy #2 in Edmonton. His main areas of clinical focus are in psychiatry and drug addiction. Jayson has authorization to administer injections and orders and monitors lab values for his patients. Tony Nickonchuk, BSc. Pharm., RPh. APA
Pharmacy Manager
Tony practices pharmacy in Peace River as pharmacy manager at Walmart Pharmacy. Since obtaining his additional prescribing authorization, he provides advanced patient care including prescribing and laboratory value monitoring. His focuses include diabetes, hypertension, and dyslipidemia, mostly in the context of three clinical trials.
Tel: 780-488-2395 | Toll: 1-800-361-0607 (Alberta only) FROM THE TEAM
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Source: http://acfp.ca/Portals/0/docs/ACFPPricingDoc2014.pdf