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$4 generic prescriptions: a bargain or just sleight of hand?

Wal-Mart started it. The $4 generic prescription deal. Saves hundreds of dollars for millions of patients. Or does it?

Recently my supermarket pharmacy joined the $4 prescription parade so I’m finally going to get an up-close look at all the hoopla. Until now, convenience has trumped price shopping, and I haven’t been willing to drive to Wal-Mart for my scripts.

When I picked up my refills last week at my supermarket’s pharmacy, the first thing I noticed was that I was charged exactly $4 for the least expensive refill. Curious, I checked my old receipts when I got home and, sure enough, previously I’d only paid $1.52 for the same drug.

Having recently changed insurance plans, such comparisons are going to be a bit complicated for me. But however it shakes out, it got me thinking. Retailers of all kinds are in business to make a profit. They don’t give you something for nothing. So, Thought #1: A lot of old generic drugs have cost less than $4 for a long time. Have their prices now been raised to the magic $4? And Thought #2: How much have the prices of higher cost drugs — generics not on the list and brand name drugs — been raised to offset any actual losses with the $4 drugs?

I picked up a slick little brochure listing all the drugs on my pharmacy’s $4 list. It made interesting reading. The first thing I noticed were the non-prescription drugs that have been available over-the-counter (OTC; without a prescription) for years. Guaifenesin DM (guaifenesin with dextromethorphan), an expectorant/cough syrup combo, is available OTC as Robitussin DM, Musinex DM, and a generic. I don’t know if it’s cheaper from the pharmacy or off the store shelf, or if the strength is the same. Certainly that should be checked out. On the other hand, the last time the doctor gave me a prescription for Musinex DM and I presented it to the pharmacist, she referred me to the boxes out on the store shelf.

Another drug on the list is ibuprofen, in three different strength tablets and a liquid. The name is as ubiquitous as aspirin for most adults, because it has been available OTC as Advil and in generic form for many years. If the dosages don’t match the strength your doctor recommends, adjust accordingly by taking more or less. Unless, of course, the pharmacy’s $4 is a cheaper way to go; but won’t that require a prescription from your doctor? Is it worth it to you to get a prescription?

Naproxen (aka Aleve), another pain reliever and anti-inflammatory, also appears on the list. It, too, is an OTC drug, available generically. The same is true with ranitidine (Zantac), a stomach acid reducer.

Loratadine is on the $4 list. It’s sold OTC as Claritin or Alavert, an antihistamine. Recently it has become available OTC as a generic, too. So which is cheaper, off the shelf or from the pharmacy? And if you get an actual prescription, is the pharmacist going to fill it from her stock, or direct you out to the open store shelf? If you then buy it off the open shelf, will you pay $4 because you had a script, or will you end up paying more (or less)?

Further complicating the picture is the issue of generics vs. brand names. In the past there has been great concern that generics were less effective than brand names, or perhaps of lesser or varying quality. I shared that concern for a long time, perhaps because I was so close to the world of medicine and Big Pharma. Without question, it was to Big Pharma’s advantage to promote this thinking and keep us buying their brand names. Today, though, with my budget being as big a concern as my health, I’ve taken a wider view; generics, after all, are regulated by the FDA (for whatever that fallible agency’s regs are worth).

Bottom line, I don’t believe Big Pharma is sitting idly by while $4 price plans reduce their profits. And pharmacies still have to buy their stock somewhere. And they all want to make a profit. So call me crazy (it wouldn’t be the first time), but I have my doubts about how much the pharmacies are actually saving us with these $4 drug programs.

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