1 in 5 Most Costly Generics Not Available Through National Direct-to-Consumer Pharmacies

A new analysis revealed that 1 in 5 of the most expensive generic drugs was not available at any of the 5 national direct-to-consumer (DTC) pharmacies in 2020: Amazon, Walmart, Costco, Health Warehouse, and the Mark Cuban Cost Plus Drugs Company.

This discovery stems from a cross-sectional study examining the accessibility and affordability of 100 of the most expensive generic drugs with the highest cost per patient and 50 of the most frequently used generics with the highest number of patients at the 5 prominent DTC pharmacies, which were included based on the fact they sell generic prescription drugs at publicly available prices without health insurance. The researchers assessed availability of these drugs and their lowest prices at DTC pharmacies based on a standardized drug strength and supply—typically 30 pills—and compared against prices at GoodRx retail pharmacies.

Drugs on pharmacy shelf | Image credit: I Viewfinder – stock.adobe.com

Published in the Journal of General Internal Medicine, the study revealed that almost all commonly used medications were accessible at 1 or more of these pharmacies for patients on Medicare Part D plans. Of 118 expensive generic dosage forms, 94 (80%) were available at 1 or more DTC pharmacies, with Amazon (n = 85) and Health Warehouse (n = 73) having the most available and none on the Walmart $4 list. Meanwhile, 51 of the 52 common generic dosage forms were available, with Costco selling all 51, Amazon and Health Warehouse each selling 50, the Mark Cuban Cost Plus Drugs Company selling 45, and Walmart only selling 18.

For expensive generics, the median cost savings at DTC pharmacies compared with GoodRx retail pharmacy prices were substantial, amounting to $231 (95% CI, $129-$792) or 76% (IQR, 53%-91%) in savings. Similarly, for common generics, the savings were $19 (95% CI, $10-$34) or 75% (IQR, 67%-83%) lower than the retail price.

However, there were notable variations in drug prices across different pharmacies, with certain pharmacies offering lower costs for specific medications. Among the 88 expensive generics available in similar quantities and strengths across various DTC pharmacies, 42 (47%) were found to have the lowest cost at Amazon, followed by 23 (26%) at the Mark Cuban Cost Plus Drug Company, 13 (14%) at Health Warehouse, and 12 (13%) at Costco. For the 51 common generic formulations, 16 (31%) had the lowest cost at Costco, 14 (27%) at Amazon, 10 (20%) at Walmart, 6 (12%) at Health Warehouse, and 5 (10%) at Mark Cuban Cost Plus Drug Company.

“This variation in the availability and cost of generics at DTC pharmacies requires patients and prescribers to shop around to find the best deal, which is a time-consuming process with financial tradeoffs,” the researchers said. “To our knowledge, there are no simple, accurate, and comprehensive tools to help patients identify the lowest-cost generic drug across all retail, community, and DTC pharmacies in real time. Such a tool could greatly assist patients and clinicians.”

Yet, for patients managing chronic conditions such as hypertension, diabetes, and heart failure with multiple medications, needing to navigate various pharmacies for each prescription would be complicated and impractical. Additionally, many health care providers are unaware of the costs associated with the drugs they prescribe, and only a small fraction engage in discussions with their patients about costs during the prescribing process.

“Differences in the availability and costs of generic prescription drugs sold by direct-to-consumer pharmacies provide a glimpse into the challenges patients may face trying to find inexpensive options for their essential medicines,” the researchers said. “Physicians can use this information to help guide patients trying to access generic drugs at affordable prices, and policymakers can use this information to guide more rational policies to ensure that all patients are able to access generic drugs at low prices.”

Reference

Lalani HS, Tessema FA, Kesselheim AS, Rome BN. Availability and cost of expensive and common generic prescription drugs: a cross‐sectional analysis of direct‐to‐consumer pharmacies. J Gen Intern Med. Published online February 7, 2024. 10.1007/s11606-024-08623-y