Drug Prices in Boston Soar Above WHO Benchmarks.
Prices in the Boston area for generic prescription medicines were 38 times higher than the international reference prices used as benchmarks by the World Health Organization (WHO), and 158 times higher for brand-name prescriptions, a new study by School of Public Health researchers shows.
The first-of-its-kind study, published in the Journal of Pharmaceutical Policy and Practice, also found that consumers in Boston pay 11 to 21 times the international reference prices for over-the-counter medicines. That overpricing remains even in pharmacy discount programs.
While drug prices are not regulated, the WHO has set as a target for countries that consumers should pay no more than four times the international reference prices (IRPs), and that governments should procure medicines at close to those benchmark prices. The target makes allowances for additional costs in the pharmaceutical supply chain.
The research team, primarily MPH students from the Department of Global Health, analyzed the availability and prices of 25 essential medicines in a representative sample of private retail pharmacies in the Boston area. They looked at drugs such as Bactrim, Zocor, and Amoxil, as well as over-the-counter medications such as Tylenol and Benadryl.
Overall, they found, “the prices of prescription medicines were particularly high” for both brand name and generic versions. In fact, for 14 of the medications, Boston patient prices were higher than those in some other high-income countries, such as Bahrain, and in the Tatarstan Province in Russia.
The study results were consistent with prior findings by Consumer Reports, which have shown substantial variations in pricing across pharmacies, and that savings are realized when patients purchase certain generic medicines at so-called “big-box” stores such as Walmart and Target and pharmacy discount programs.
“Our analysis highlights how US patients, especially those who are uninsured or pay out-of-pocket, pay extremely high prices even for off-patent (originator and generic) medicines, when compared to international reference prices,” said Richard Laing, professor of global health, who led the study.
“Consumers should shop around, as medicine inclusion and prices vary across discount programs,” said co-author Abhishek Sharma, an SPH alumnus in global health. He argued for a “transparent system . . . that allows consumers to easily check prescription medicine prices at different pharmacies, in order to identify potential savings.”
On over-the-counter drugs, one interesting finding was that medicines were cheaper in independent pharmacies than in chain pharmacies. Brand-name prescriptions, however, were higher priced in independent pharmacies. Generic drugs, meanwhile, were higher priced in chain pharmacies.
In terms of discount programs, Walmart/Sam’s Club and Target’s $4/10 discount program had the lowest overall median price ratio (calculated by comparing the median consumer price with the respective IRP) for a limited number of available medicines of the discount programs reviewed.
“Prescribers in the US should encourage consumers to consider the pharmacy discount programs, which offer generic medicines at lower prices,” said co-author Lindsey Rorden, an SPH alumna in global health. Unlike in retail stores, “the prices of medicines in the pharmacy discount programs were much closer to WHO’s target of four times the IRPs.”
While most consumers have insurance, the authors note that the US has seen a shift toward high-deductible insurance plans in the last decade. Patients who are uninsured, elderly, low income, or with high co-pays are “disproportionately unlikely to fill their prescriptions,” the researchers said.
The study arose out of field work by students taking an SPH class—Analyzing Pharmaceutical Systems—led by Laing. Sharma and Rorden collaborated with Margaret Ewen, a researcher at Health Action International in Amsterdam.
Ewen said this is the first time that the WHO/Health Action International medicine price survey tool has been used in the US. “It has shed much-needed light on the excessive prices of some commonly used medicines,” she said.
Laing plans to conduct future surveys with students to gauge trends in medicine availability and price over time.