GAO-02-280R Prescription Drug Prices

United States General Accounting Office

Washington, DC 20548

December 5, 2001

Congressional Requesters

Subject: Prescription Drugs: Prices Available Through Discount Cards and From

Other Sources

This letter responds to your request for information on how the prices for

prescription drugs purchased using drug discount cards compare with the prices

available at local pharmacies or over the Internet. Using a list of 17 drugs that are

among the most widely prescribed to the Medicare population, we have documented

prices from several sources. These included prices available from (1) five companies

that administer large drug discount card programs, (2) five Internet pharmacies, and

(3) several retail pharmacies in four different areas—Washington, D.C.; Chicago;

Seattle; and rural Georgia. (See encl. I for additional details on our scope and

methodology.) We did not independently verify the drug prices provided by these

sources. With this exception, we performed our work from September through

November 2001, in accordance with generally accepted government auditing

standards.

The drug prices we obtained from these sources are presented in enclosures II

through V.

As arranged with your offices, unless you release its contents earlier, we plan no

further distribution of this letter until 30 days after its issuance date. At that time, we

will send copies to interested parties. This letter will also be available on GAO’s

home page at http://www.gao.gov. If you or your staffs have any questions regarding

this letter, please contact me at (202) 512-7119 or John Hansen at (202) 512-7105.

Laura A. Dummit

Director, Health Care—Medicare Payment Issues

Enclosures – 5
2 GAO-02-280R Prescription Drug Prices

List of Requesters

The Honorable John D. Dingell

Ranking Minority Member

Committee on Energy and Commerce

House of Representatives

The Honorable Henry A. Waxman

Ranking Minority Member

Committee on Government Reform

House of Representatives

The Honorable Charles B. Rangel

Ranking Minority Member

Committee on Ways and Means

House of Representatives

The Honorable Sherrod Brown

Ranking Minority Member

Subcommittee on Health

Committee on Energy and Commerce

House of Representatives

The Honorable Fortney Pete Stark

Ranking Minority Member

Subcommittee on Health

Committee on Ways and Means

House of Representatives

The Honorable Mike Ross

House of Representatives
Enclosure I Enclosure I

3 GAO-02-280R Prescription Drug Prices

SCOPE AND METHODOLOGY

For our study, we identified 17 drugs that are frequently prescribed for participants in

AARP’s drug discount card program. For our analysis, we used the 10 most

frequently prescribed prescription drugs, and the 10 drugs whose price and utilization

made them the highest expenditure drugs purchased by participants in the AARP

program. The unduplicated drugs from both lists yielded the 17 drugs for which we

obtained prices.1

Four of the drug discount cards we examined are administered by four of the nation’s

largest pharmacy benefit management (PBM) companies—Merck-Medco Managed

Care, Advance PCS, Express Scripts, and Wellpoint Health. We asked each PBM to

provide us the prices that a participant in its largest drug card program would pay for

each of the 17 drugs if purchased at a retail pharmacy or through the mail. In some

cases, the PBMs provided us with prices averaged over several of the large drug

discount card programs they administered. The fifth drug card program we examined

is administered by Citizens Energy, a nonprofit company. The Citizens Health card

can be used to obtain discounts at participating pharmacies in Connecticut,

Massachusetts, and Rhode Island and through a mail service pharmacy administered

by Express Scripts. We also asked each drug card administrator for information on

enrollment fees and shipping charges for mail service prescriptions.

We also obtained prices for the 17 drugs from five retail pharmacies in Washington,

D.C., five in Seattle, four in Chicago, and five in rural Georgia. These included

pharmacies that were part of national or regional chains, part of national

supermarket chains, discount department stores, members-only price clubs, and

independent retail pharmacies. We asked each pharmacy to give us the price that

would be paid by a cash-paying customer. After obtaining the prices, we asked

whether the pharmacy offered a senior citizen discount on prescriptions. We reduced

the reported drug prices to reflect any available senior citizens discount. Finally, we

obtained prices and shipping costs from five Internet pharmacies.

We did not independently verify the drug prices provided by these sources. With this

exception, we performed our work from September through November 2001, in

accordance with generally accepted government auditing standards.

 1

The drug information provided by AARP included a specific dosage form, strength and package size.

With one exception, the drugs were in packages of 30 tablets or capsules. Fosamax was in a package

of four tablets.
Enclosure II Enclosure II

4 GAO-02-280R Prescription Drug Prices

Drug Discount Card Retail Prices Compared to

Drugstore Prices in Four Geographic Areas

Drug discount card

Drug descriptiona 1b 2c 3d 4 5e

Washington,

D.C.,

average

priceg

Chicago

average

priceh

Seattle

average

priceg

Rural

Georgia

average

priceg

Generic drugs

Atenolol 50 mg $5.69 $5.55 $4.57 $6.32 $4.90 $8.55 $9.09 $9.72 $18.33

Digoxin/Digitek .25 mg 7.03 8.72 8.36 7.70 n/af 8.35 10.52 9.19 9.41

Furosemide 40 mg 4.81 5.30 4.08 5.04 5.04 7.83 8.67 7.71 9.50

Hydrochlorothiazide 25 mg 4.42 4.61 5.82 4.97 4.09 7.13 8.34 7.27 7.91

Metoprolol 50 mg 5.53 6.13 5.08 5.32 5.32 9.13 9.42 14.15 15.62

Brand name drugs

Celebrex 200 mg 74.92 69.09 68.44 75.28 76.18 80.34 79.89 78.94 82.29

Evista 60 mg 63.62 64.10 63.43 64.05 64.87 72.30 71.49 72.96 75.62

Fosamax 70 mg 59.24 59.71 59.09 59.84 60.49 65.02 67.07 64.48 67.58

Glucophage 500 mg 22.91 23.82 23.17 23.93 24.16 29.77 28.07 29.46 28.53

Klor-Con 10 mEq 6.20 9.50 5.82 6.34 6.34 9.51 10.02 8.79 12.05

Lipitor 10 mg 55.94 56.37 56.34 56.48 57.20 61.81 58.92 57.90 65.52

Lipitor 20 mg 85.26 85.42 86.87 85.45 86.51 93.25 90.67 91.20 100.17

Norvasc 5 mg 39.44 39.85 39.16 40.25 40.70 44.18 41.52 43.01 44.87

Plavix 75 mg 96.06 96.13 95.49 96.16 97.31 106.43 107.49 106.48 112.59

Premarin .625 mg 22.19 21.02 20.40 23.22 22.73 24.84 25.12 25.07 25.98

Prilosec 20 mg 115.79 115.41 115.00 115.73 117.04 121.64 124.02 119.98 127.89

Zocor 20 mg 112.16 111.77 111.41 112.08 113.41 122.25 116.67 118.31 123.43

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets.

b

This drug card program has an annual enrollment fee of $25 for individuals and $40 for families.

c

Prices are the average prices paid by customers of several different card programs.

d

This drug card program has an enrollment fee of $11.95 per month for individuals and $19.95 for

families.

e

This drug card program has an annual membership fee of $12 for individuals and $28 for families.

f

This company did not have a price for digoxin/digitek for the dosage we requested.

g

Reflects the average of the prices obtained from five area drugstores.

h

Reflects the average of the prices obtained from four area drugstores.
Enclosure III Enclosure III

5 GAO-02-280R Prescription Drug Prices

Drug Discount Card Mail Order Prices Compared to Internet Pharmacy Prices

Drug discount card

Drug descriptiona 1b 2c 3d 4 5e

Internet

pharmacy

average price

Generic drugs

Atenolol 50 mg $14.17 $2.22 $12.67 $3.57 $0.80 $7.02

Digoxin/Digitek .25 mg 5.78 3.74 5.57 4.85 n/af 7.80

Furosemide 40 mg 5.51 1.86 5.21 3.08 2.04 7.07

Hydrochlorothiazide 25 mg 4.14 1.48 3.97 3.08 0.34 7.12

Metoprolol 50 mg 10.74 2.63 10.39 2.57 8.33 7.27

Brand name drugs

Celebrex 200 mg 70.79 62.67 62.91 70.88 67.72 72.33

Evista 60 mg 60.26 57.89 58.29 59.91 57.19 66.42

Fosamax 70 mg 56.18 53.75 54.31 55.80 53.10 62.24

Glucophage 500 mg 22.32 19.48 21.28 20.71 19.25 22.54

Klor-Con 10 mEq 7.18 6.68 7.26 3.59 3.84 8.41

Lipitor 10 mg 53.11 50.64 51.78 52.52 50.04 56.86

Lipitor 20 mg 80.43 78.30 79.85 80.82 77.35 86.35

Norvasc 5 mg 37.73 34.38 35.98 36.65 34.66 38.45

Plavix 75 mg 90.48 88.48 87.78 91.28 87.41 95.94

Premarin .625 mg 21.65 16.32 18.73 20.01 17.92 19.59

Prilosec 20 mg 108.87 107.09 105.72 110.40 105.80 114.65

Zocor 20 mg 105.49 103.67 102.42 106.83 102.42 110.28

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets.

b

This drug card program has an annual enrollment fee of $25 for individuals and $40 for families.

c

Prices provided by the drug card administrator are estimates for a 30-day supply based on average

prices for a 90-day supply available to customers of several different drug card programs.

d

This drug card program has an enrollment fee of $11.95 per month for individuals and $19.95 for

families.

e

This drug card program has an annual membership fee of $12 for individuals and $28 for families.

f

This company does not have a price for digoxin/digitek for the dosage we requested.

g

Reflects the average of the prices obtained from five Internet pharmacies.
Enclosure IV Enclosure IV

6 GAO-02-280R Prescription Drug Prices

Internet Pharmacy Drug Prices

Internet pharmacy

Drug descriptiona

12345b Average

Generic drugs

Atenolol 50 mg $6.99 $9.99 $5.01 $6.87 $6.23 $7.02

Digoxin/Digitek .25 mg 7.99 9.99 5.01 6.87 9.15 7.80

Furosemide 40 mg 6.99 9.99 5.01 6.87 6.48 7.07

Hydrochlorothiazide 25 mg 6.99 9.99 5.01 6.87 6.75 7.12

Metoprolol 50 mg 7.99 9.99 5.01 6.87 6.48 7.27

Brand name drugs

Celebrex 200 mg 69.46 73.99 65.92 79.87 72.40 72.33

Evista 60 mg 65.36 69.59 63.87 69.87 63.41 66.42

Fosamax 70 mg 63.94 63.59 62.72 63.87 57.07 62.24

Glucophage 500 mg 21.04 23.69 20.52 23.87 23.58 22.54

Klor-Con 10 mEq 7.99 9.99 5.01 11.87 7.17 8.41

Lipitor 10 mg 54.61 57.99 53.75 61.87 56.10 56.86

Lipitor 20 mg 84.43 86.59 79.85 95.87 85.00 86.35

Norvasc 5 mg 37.62 40.99 33.78 40.87 38.98 38.45

Plavix 75 mg 96.22 93.99 86.71 107.87 94.91 95.94

Premarin .625 mg 18.68 20.69 16.48 19.87 22.22 19.59

Prilosec 20 mg 108.03 109.99 108.30 130.87 116.06 114.65

Zocor 20 mg 107.22 109.99 104.92 120.87 108.42 110.28

Note: mg = milligrams; mEq = milliequivalents

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4

tablets.

b

This Internet pharmacy lists more than one price for Atenolol, Furosemide, and

Hydrochlorothiazide. The prices presented for these drugs are the median prices. Also, this

Internet pharmacy has a mailing charge that varies depending on package weight.
Enclosure V Enclosure V

7 GAO-02-280R Prescription Drug Prices

Area Drug Prices

Table 1: Washington, D.C., Area Drug Prices

Washington, D.C., area drugstoreb

Drug descriptiona 1 2c 3c 4c 5c Average

Generic drugs

Atenolol 50 mg $10.68 $9.50 $4.50 $9.08 $8.99 $8.55

Digoxin/Digitek .25 mg 8.46 8.99 6.30 8.99 8.99 8.35

Furosemide 40 mg 9.46 8.99 4.50 8.99 7.19 7.83

Hydrochlorothiazide 25 mg 5.98 8.99 4.50 8.99 7.19 7.13

Metoprolol 50 mg 13.78 10.72 4.50 9.44 7.19 9.13

Brand name drugs

Celebrex 200 mg 82.98 82.03 86.40 84.59 65.69 80.34

Evista 60 mg 72.98 76.49 72.90 77.03 62.09 72.30

Fosamax 70 mg 66.46 65.69 68.22 64.43 60.29 65.02

Glucophage 500 mg 26.46 27.56 25.65 29.60 39.59 29.77

Klor-Con 10 mEq 10.68 8.99 8.10 8.99 10.79 9.51

Lipitor 10 mg 63.92 62.08 64.26 63.89 54.89 61.81

Lipitor 20 mg 98.84 91.66 99.36 94.49 81.89 93.25

Norvasc 5 mg 43.92 44.59 44.55 49.13 38.69 44.18

Plavix 75 mg 109.68 100.31 111.60 104.39 106.19 106.43

Premarin .625 mg 25.62 24.37 23.90 26.00 24.29 24.84

Prilosec 20 mg 127.62 118.79 135.00 116.09 110.69 121.64

Zocor 20 mg 127.98 117.89 131.40 127.79 106.19 122.25

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4

tablets.

b

These pharmacies include national chain drugstores, an independent drugstore, and a

national chain grocery store.

c

Prices for these drugstores reflect a 10-percent senior citizens discount
Enclosure V Enclosure V

8 GAO-02-280R Prescription Drug Prices

Table 2: Chicago Area Drug Prices

Chicago area drugstoreb, c

Drug descriptiona 1234 Average

Generic drugs

Atenolol 50 mg $8.99 $9.99 $7.69 $9.69 $9.09

Digoxin/Digitek .25 mg 8.99 9.99 13.39 9.69 10.52

Furosemide 40 mg 8.99 9.99 6.99 8.69 8.67

Hydrochlorothiazide 25 mg 8.99 9.99 6.39 7.99 8.34

Metoprolol 50 mg 9.69 9.99 6.99 10.99 9.42

Brand name drugs

Celebrex 200 mg 81.89 77.99 68.99 90.69 79.89

Evista 60 mg 69.99 71.59 67.39 76.99 71.49

Fosamax 70 mg 68.99 63.59 63.99 71.69 67.07

Glucophage 500 mg 29.49 27.39 22.69 32.69 28.07

Klor-Con 10 mEq 9.39 9.99 9.69 10.99 10.02

Lipitor 10 mg 60.99 58.99 52.69 62.99 58.92

Lipitor 20 mg 93.99 93.99 80.69 93.99 90.67

Norvasc 5 mg 42.99 42.39 36.99 43.69 41.52

Plavix 75 mg 114.99 105.99 107.99 100.99 107.49

Premarin .625 mg 26.89 22.89 21.69 28.99 25.12

Prilosec 20 mg 124.99 119.99 118.39 132.69 124.02

Zocor 20 mg 119.99 117.99 107.99 120.69 116.67

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4

tablets.

b

These pharmacies include national drugstore chains and a discount store.

c

None of the pharmacies provide senior citizens discounts.
Enclosure V Enclosure V

9 GAO-02-280R Prescription Drug Prices

Table 3: Seattle Area Drug Prices

Seattle area drugstoreb

Drug descriptiona 1c 2c 3d 4e 5f Average

Generic drugs

Atenolol 50 mg $8.54 $9.62 $11.19 $12.68 $6.57 $9.72

Digoxin/Digitek .25 mg 8.09 9.89 8.39 13.29 6.29 9.19

Furosemide 40 mg 6.29 8.09 9.19 9.88 5.09 7.71

Hydrochlorothiazide 25 mg 9.89 7.19 6.79 8.41 4.09 7.27

Metoprolol 50 mg 21.32 15.29 12.79 14.37 6.99 14.15

Brand name drugs

Celebrex 200 mg 87.02 71.09 86.84 79.48 70.27 78.94

Evista 60 mg 76.85 65.69 76.49 80.40 65.37 72.96

Fosamax 70 mg 61.28 59.39 72.44 72.62 56.69 64.48

Glucophage 500 mg 31.58 32.39 29.69 30.44 23.19 29.46

Klor-Con 10 mEq 7.19 8.99 11.69 11.19 4.89 8.79

Lipitor 10 mg 64.61 58.49 53.09 58.34 54.97 57.90

Lipitor 20 mg 98.09 87.29 87.29 99.77 83.57 91.20

Norvasc 5 mg 43.01 44.99 45.89 44.81 36.37 43.01

Plavix 75 mg 108.44 103.49 107.09 117.08 96.29 106.48

Premarin .625 mg 25.64 24.29 27.89 27.06 20.47 25.07

Prilosec 20 mg 128.96 118.79 118.79 118.37 115.00 119.98

Zocor 20 mg 131.03 114.29 110.69 128.52 107.00 118.31

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4

tablets.

b

Pharmacies include a regional and a national drugstore chain, national grocery store chains,

and a members-only discount price club.

c

Prices for these drugstores reflect a 10-percent senior citizens discount.

d

Prices for this drugstore reflect a 20-percent senior citizens discount for generic drugs and a

10-percent senior citizens discount for brand name drugs.

e

Prices for this drugstore reflect a 5-percent senior citizens discount.

f

This drugstore has a $45 annual membership fee.
Enclosure V Enclosure V

10 GAO-02-280R Prescription Drug Prices

Table 4: Rural Georgia Drug Prices

Rural Georgia drugstoreb

Drug descriptiona 1c 2345 Average

Generic drugs

Atenolol 50 mg $7.89 $9.99 $9.99 $23.51 $40.29 $18.33

Digoxin/Digitek .25 mg 7.70 9.99 8.99 10.97 9.39 9.41

Furosemide 40 mg 7.13 9.99 8.99 6.79 14.59 9.50

Hydrochlorothiazide 25 mg 5.10 9.99 8.99 5.67 9.79 7.91

Metoprolol 50 mg 6.92 9.99 12.49 20.33 28.39 15.62

Brand name drugs

Celebrex 200 mg 74.32 86.59 83.89 80.25 86.39 82.29

Evista 60 mg 69.04 76.99 77.59 74.49 79.99 75.62

Fosamax 70 mg 64.12 65.59 68.29 69.51 70.39 67.58

Glucophage 500 mg 27.00 25.99 31.09 28.48 30.09 28.53

Klor-Con 10 mEq 7.77 9.99 8.99 13.23 20.29 12.05

Lipitor 10 mg 60.40 65.59 67.29 65.01 69.29 65.52

Lipitor 20 mg 93.38 99.99 102.69 99.08 105.69 100.17

Norvasc 5 mg 41.84 44.99 44.49 47.26 45.79 44.87

Plavix 75 mg 114.83 109.99 111.69 111.35 115.09 112.59

Premarin .625 mg 25.32 24.69 27.09 24.90 27.89 25.98

Prilosec 20 mg 116.12 122.99 131.29 133.77 135.29 127.89

Zocor 20 mg 123.65 121.99 119.19 129.65 122.69 123.43

Note: mg = milligrams; mEq = milliequivalents.

a

The quantity for each drug is 30 tablets or capsules except for Fosamax, whose quantity is 4

tablets.

b

Pharmacies include privately owned drugstores and national drugstore chains.

c

Prices for this drugstore reflect a 10-percent senior citizens discount.

(290157)