Friday, August 3, 2012

Shopping around: variations in price for generic clopidogrel

In May of this year, the patent for brand-name clopidogrel (Plavix®) finally expired, an event that was heralded as a breakthrough in the management of coronary artery disease. As with all newly available generic medications, months may pass before generic clopidogrel becomes considerably less expensive than its brand name counterpart. As generic manufacturers scramble to ramp up production, significant differences in price and availability are likely.

These differences were recently highlighted in the September issue of Consumer Reports, where a variety of pharmacies across the US were surveyed on the price of a 30-day supply of clopidogrel.  The prices ranged anywhere from $15 to $200 -- notably, independent pharmacies consistently quoted a price of around $50, which was often markedly lower than many of their chain and supermarket competitors.

The article also mentions the Plavix® Choice program, which allows patients to obtain brand-name Plavix® through the manufacturer at a significantly reduced cost -- $37 in most cases.  Significant restrictions apply, of course; for example, only commercially-insured and cash-paying patients (i.e., no Medicare or Medicaid enrollees) are eligible for the program.  Although the article goes on to claim that the manufacturer picks up the difference, it is not clear from the Bristol-Myers Squibb website that this is the case.  When the patent for brand-name atorvastatin (Lipitor®) expired in the fall of last year, Pfizer was widely criticized for several controversial financial arrangements with pharmacy benefit managers (PBMs), including a prescription discount program aimed at retaining market share.  Although the program provided some cost-savings for patients, insurers and health-systems were often stuck paying the bill.

In the end, the editors of Consumer Reports recommend that patients "shop around" for generic clopidogrel.  However, as most health care professionals will say, shopping around is rarely the right answer in the long run.  Patients should obtain all of their medications at a single community pharmacy (or pharmacy chain/franchise), as this allows the pharmacist to maintain a complete and accurate medication record, which is critical for evaluating drug-food and drug-drug interactions (see here for an example), responding to requests for medication information from other health care providers, assisting in medication reconciliation when patients are hospitalized, and more. Besides, most pharmacies already offer competitor price-matching programs, so no one should need to obtain their clopidogrel prescription anywhere other than their home pharmacy.

So while it is appropriate to recommend that patients ask around for the lowest price of generic clopidogrel, they should still be encouraged to shop in only one place.

4 comments:

Mike Dorsch said...

Great post! There are some interesting things going on with clopidogrel generic pricing. Costco.com has a relatively cheap price ( $13.87 for 30 tabs). I hear it is only by mail order and doesn't require a membership. I think this is the cheapest I have seen. Anyone else see cheap clopidogrel?

Brent N Reed said...

I believe Costco was also the pharmacy that the article in Consumer Reports said offered the lowest price for 30 days of clopidogrel. It varies pretty widely here in central North Carolina -- anywhere from $25 to over $150.

Jill said...

I think it's great that plavix is generic, but the problem is that now we plavix genotype everyone and a significant amount of pts are switched to prasugrel or ticagrelor and they don't benefit from plavix being generic...

Brent N Reed said...

@Jill: I see your point. I guess it would be my hope that, given how many of our patients have difficulty affording their medications, the genotype assay would help us identify those patients who we should feel compelled to treat with a more expensive P2Y12 inhibitor (prasugrel or ticagrelor) over clopidogrel following their index event. We should only be genotyping those patients who would require 12 months of dual antiplatelet therapy, so even if they are found to be clopidogrel responders, the cost of the test plus a year of generic clopidogrel is still less than what they would pay for 12 months of brand-name prasugrel or ticagrelor (which is what they would probably get upfront at many other institutions). I think it helps us identify those patients who we think would probably benefit from clopidogrel as much as they would one of the newer agents... but whether this is truly the case, I think only time will tell.