Attorney General Mike Cox
January & February 2006
Prescription Drug Survey Summary
 

Prescription drug prices may vary from day to day, so the prices you find at your pharmacy may not be the prices that appear in this survey.

In conjunction with the survey, the Attorney General published a consumer alert entitled, "Are You Paying Too Much For You Prescription Drugs?  Shop Around and Find Out!" available at www.michigan.gov/ag.

A power point summarizing survey results is also available at: www.michigan.gov/ag.

I.  Attorney General Surveyed Over 200 Pharmacies in 10 Communities

Attorney General staff surveyed over 200 pharmacies around the state.  The communities and dates surveyed are as follows:

    Community                                     Survey Date

The survey tracked the price charged a cash paying customer without insurance for ten of the twenty-five most commonly prescribed medications.

II.  Drug Selection and Call Scripts

A.        Drug Selection

The drugs selected for the survey were obtained from the Michigan Department of Community Health (DCH) Web site.  The URL for the site is http://www.mi.gov/mdch/0,1607,7-132--117767--,00.html.  The Web site lists 25 drugs, which are identified as being the top 25 drugs prescribed in Michigan.  DCH includes "the average usual and customary price for a month's supply" of each of the 25 drugs.  The only quantity information DCH provides is, "for a 30-day supply of medication in the most commonly prescribed dosage."  When called, DCH officials were unable to supply quantity information.

 Reasonable Month's Supply of Drugs

Since the DCH Web site's only quantity information is "a 30-day supply of medication in the most commonly prescribed dosage," we consulted a medical doctor for a typical 30-day supply of medication in the most commonly prescribed dosage.  That 30-day supply is indicated in the following "Quantity" section of the chart.

The ten drugs we selected from the DCH list are:

B.        Call Scripts
 

The medical doctor also assisted the survey team by contributing to the creation of call scripts.  The call scripts contained precise dosing information, a prescribed monthly quantity, and patient profile facts.  Surveyors were instructed to strictly adhere to the scripts, and to insist on pricing information for the prescriptions as written. 

III.  House Bill 4559
 

DCH created their Common Retail Drug Pricing in Michigan Web site around the time House Bill 4559 (Rep. Roger Kahn) passed the state House.  A copy of House Bill 4559 can be found at:  http://www.legislature.mi.gov/documents/2005-2006/billengrossed/House/htm/2005-HEBH-4559.htm.
 

House Bill 4559 was introduced at the request of Attorney General Mike Cox.  The bill would require DCH to provide the Attorney General with the actual cost of prescription drugs that Michigan pharmacies are charging, information that is readily available to DCH.  The Attorney General would then post those actual prescription drug costs on a Web site to benefit consumers.  Quantity information would be easily accessible.
 

The House of Representatives passed HB 4559 on May 18, 2005.  The legislation was referred to the Senate Committee on Health Policy on May 19, 2005.  The legislation requires action by the Senate Committee, the full Senate, and the Governor. 

IV.  Survey Results
 

The results from this survey clearly illustrate that drug prices vary significantly both within a community and from community to community.  The survey also highlights two significant design flaws of the DCH Web site: 1) posting a single apparent statewide average usual and customary price ignores the fact that drug prices vary within communities; and 2) the unknown quantity information is confusing and makes comparisons difficult.
 

The Attorney General's survey evidences the need for a Web site that will give consumers a meaningful tool to save money on their prescription drugs by posting actual drug prices for a clear quantity within a specific community.  

A.        Multi-Community Master Summary Spreadsheets (no pharmacy contact information).

1.  Detroit, Livonia, Royal Oak, and Sterling Heights

2.  Grand Rapids, Lansing, Saginaw, and Traverse City

3.  Monroe and St. Joseph/Benton Harbor

B.        Individual Community Spreadsheets with Pharmacy Contact Information
 

C.        Examples of Pricing Variances within Communities:

 Each community surveyed had notable pricing variances for a given drug surveyed within that community. 

1.   In Detroit, on January 17, 2006, a cash-paying consumer needing a month's supply of acetaminophen with codeine, a pain medication, could pay as little as $14.89 for a month's supply at the SavMor Pharmacy on Warren Avenue.  Consumers who took the same prescription to the Nottingham Pharmacy on Warren Avenue would have paid $42.00, or 2.82 times the amount charged by SavMor.  Both of these reported amounts are greater than the average usual and customary price reported on the DCH Web site (DCH price:  $13.63 for a month's supply).

2.   In Grand Rapids, on January 31, 2006, a cash-paying consumer needing a month's supply of acetaminophen with codeine, a pain medication, could pay as little as $12.08 for a month's supply at The Chemist Shoppe on Wealthy Street.  Consumers who took the same prescription to the CVS on Fuller Avenue would have paid $45.29, or 3.75 times the amount charged by The Chemist Shoppe.

      Also in Grand Rapids, on January 31, 2006, a cash-paying consumer needing a month's supply of Albuterol to relieve her asthma could pay $5.59 if she had the prescription filled at the Sam's Club Pharmacy on 28^th Street.  Alternatively, the consumer could pay $26.99 if she had the same prescription filled at the Rite Aid on Breton Road.  The Rite Aid price is 4.83 times the price at Sam's Club Pharmacy.  (According to the DCH Web site, the average usual and customary price for this drug is $28.33 which is higher than BOTH the lowest and the highest prices within the entire Grand Rapids area.)

3.   In Lansing, on January 31, 2006, a cash-paying consumer needing a month's supply of Albuterol to relieve her asthma could pay $6.16 if she had the prescription filled at the Sam's Club Pharmacy on Edgewood Boulevard.  Alternatively, the consumer could pay $26.49 if she had the same prescription filled at the CVS on Martin Luther King Jr. Boulevard in Lansing.  The CVS price is 4.30 times the price at Sam's Club Pharmacy.  (According to the DCH Web site, the average usual and customary price for this drug is $28.33 which is higher than BOTH the lowest and the highest prices within the entire Lansing area.)

4.   In Livonia, on January 17, 2006, a cash-paying consumer needing a month's supply of Prevacid could pay $163.99 if he had the prescription filled at the Walgreens on Plymouth Road.  Alternatively, the consumer could pay $124.99 if he had the same prescription filled at Ray's Drug on Professional Center.  The Walgreen's price is 1.31 times the Ray's Drug price.  The $39.00 monthly difference is a $468.00 yearly difference.  (DCH price: $157.86 for a month's supply.)

5.   In Monroe, on February 10, 2006, a cash-paying consumer needing a month's supply of acetaminophen with codeine would have paid $8.95 for it if she filled the prescription at the Yinger Pharmacy Shoppe on Custer Road on the day of the Attorney General's survey.  The same prescription on the same day at the Walgreens Pharmacy on South Telegraph Road in Monroe would cost that same consumer $28.99, or 3.24 times the Yinger Pharmacy price.  (According to the DCH Web site, the average usual and customary reported price for this drug is $13.63.)

6.   In Royal Oak, on January 17, 2006, if a cash-paying consumer took his prescription for a month's supply of Nasonex allergy inhaler to the Troy Pharmacy on Coolidge Highway, he could expect to pay $74.00.  If the consumer filled the same prescription at the Wabeek Medical Pharmacy on 13 Mile in Royal Oak, the cash price would be $130.00, or 1.76 times the cost charged by the Troy Pharmacy.  (DCH average reported price:  $95.10.)

7.   In Saginaw, on January 31, 2006, if a cash-paying consumer took his prescription for a month's supply of Nasonex allergy inhaler to the Rite Aid on Genesee, he could expect to pay $12.99.  If the consumer filled the same prescription at the Healthway Pharmacy on Saginaw Street in Saginaw, the cash price would be $106.25, or 8.18 times the cost charged by the Rite Aid.  (According to the DCH Web site, the average usual and customary reported price for this drug is $95.10).

8.   In the St. Joseph/Benton Harbor area, on February 10, 2006, a cash-paying consumer needing a month's supply of Albuterol to relieve her asthma could pay $8.44 if she had the prescription filled at Synder's Pharmacy on Grant Street in Niles, Michigan.  Alternatively, the consumer could pay $38.31 if she had the same prescription filled at the Felpausch Pharmacy on M-51 South in Dowagiac.  The Felpausch price is 4.54 times the price at the Synder's Pharmacy.  (According to the DCH Web site, the average usual and customary price for this drug is $28.33).

9.   In Sterling Heights, on January 17, 2006, an asthmatic cash-paying consumer needing a month's supply of her Albuterol inhaler would have paid $13.99 for it if she filled the prescription at Meijer on Van Dyke Avenue on the day of the Attorney General's survey.  The same prescription on the same day at the Holiday Pharmacy on Schoenherr Road in Sterling Heights would cost that consumer $49.00, or 3.5 times the Meijer price.  (According to the DCH Web site, the average usual and customary reported price for this drug is $28.33.  A consumer who only checks the DCH price may not be aware that the Meijer pharmacy sells the drug for half that price.)

10.  In Traverse City, on January 31, 2006, a cash-paying consumer needing a month's supply of acetaminophen with codeine would have paid $11.24 for it if she filled the prescription at Thompson Pharmacy either on Long Lake Road or South Union on the day of the Attorney General's survey.  The same prescription on the same day at the Meijer Pharmacy on US-31 South in Traverse City would cost that same consumer $44.98, or 4.00 times the Thompson Pharmacy price.  (According to the DCH Web site, the average usual and customary reported price for this drug is $13.63.)

 D.        Pharmacies with Consistently High and Consistently Low Prices

 Only pharmacies that had 5 or more of the highest or lowest prices are referenced. 

1.  Detroit 

HIGH:  On January 17, 2006, the St. John

           Jefferson Pharmacy, 7815 E Jefferson

           Ave, 48214, provided 7 of the 10

           highest drug prices in Detroit.

LOW:  On January 17, 2006, Reid's Prescription

           Pharmacy, 9938 Harper Ave, 48213,

           provided 7 of the 10 lowest drug prices in Detroit.
 

2.  Grand Rapids

HIGH:  On January 31, 2006, no pharmacy stood

           out as providing consistently high prices.

LOW:  On January 31, 2006, the Sam's Club

           Pharmacy, 4326 28^th St SE, 49512,

           provided 9 of the 10 lowest drug

           prices in Grand Rapids.
 

 3.  Lansing

HIGH:  On January 31, 2006, the Walgreens at

           3404 S Martin Luther King Jr. Blvd, Lansing,

           MI 48910, provided 5 of the 10 highest drug

           prices in Lansing.

LOW:  On January 31, 2006, the Sam's Club

           Pharmacy, 340 E Edgewood Blvd, 48911,

           provided 7 of the 10 lowest drug prices in

           Lansing.
 

 4.  Livonia 

HIGH:  On January 17, 2006, no pharmacy stood

           out as providing consistently high prices

           in Livonia.

LOW:  On January 17, 2006, no pharmacy stood

           out as providing consistently low prices

           in Livonia.
 

 5.  Monroe 

HIGH:  On February 10, 2006, Weisel Clinic &

           Pharmacy, 7505 Grafton Road #2, 48166,

           provided 5 of the 10 highest drug prices in

           Monroe.

LOW:   On February 10, 2006, Food Town

            Pharmacy, 211 N Telegraph, 48162,

            provided 8 of the 10 lowest drug prices

            in Monroe.
 

6.  Royal Oak 

HIGH:  On January 17, 2006, Wabeek Medical

           Pharmacy, 3535 W 13 Mile Rd, 48073,

           provided 8 of the 10 highest drug prices

           in Royal Oak.

LOW:  On January 17, 2006, Troy Pharmacy,

           1380 Coolidge Highway, 48084, provided

            6 of the 10 lowest drug prices in Royal

           Oak.
 

7.  Saginaw 

HIGH:  On January 31, 2006, the Healthway

           Pharmacy, 1008 North Saginaw Street,

           Saginaw, MI 48655, provided 8 of

           the 10 highest drug prices in Saginaw.

LOW:  On January 31, 2006, no pharmacy stood

           out as providing consistently low prices in

           Saginaw.
 

8.  St. Joseph/Benton Harbor Area

HIGH:  On February 10, 2006, three Walgreens

           locations: 1595 Pipestone Road, 49022;

           Glenlord location and 1260 Hilltop Road,

           49085, provided 5 of the 10 highest drug

           prices in the St. Joseph/Benton Harbor

           area.

LOW:  On February 10, 2006, Gillespie's

           Pharmacy, 2020 Washington Avenue,

           49085, provided 5 of the 10 lowest

           drug prices in the St. Joseph/Benton

           Harbor area.
 

9. Sterling Heights 

HIGH:  On January 17, 2006, Familymeds

           Pharmacy, 43071 Hayes Rd, 48313,

           provided 6 of the 10 highest drug

           prices in Sterling Heights.

LOW:  On January 17, 2006, no pharmacy stood

           out as providing consistently low prices in

           Sterling Heights.
 

 10.  Traverse City 

HIGH:  On January 31, 2006, four Rite Aid

           locations: 939 US-31 S; 13916 S Bay

           Shore Dr; 1201A S Division St; and

           511 S Garfield Avenue, provided 6 of

           the 10 highest drug prices in Traverse City.

LOW:  On January 31, 2006, two Thompson

           Pharmacy locations: 324 S Union; and

           3850 N Long Lake Road, 49684, provided

           5 of the 10 lowest drug prices in Traverse

           City.

 V.  Public Health Code Requires Price Disclosure

The Public Health Code requires pharmacists to give drug pricing information to consumers who ask for it either in person or over the phone.  The law is not discretionary.  Pharmacists cannot refuse to comply with this provision.  The law states:

Upon request made in person or by telephone, a pharmacist in the business of selling drugs at retail shall provide the current selling price of a drug dispensed by that pharmacy or comparative current selling prices of generic and brand name drugs dispensed by that pharmacy.[1]

The statute further specifies that the pharmacy must supply pricing information to the person making the request "before a drug is dispensed to the person" and that a person requesting pricing information is under no obligation to purchase the drug or drugs for which prices are requested.

Pharmacists are also required to conspicuously post written notice of this consumer right over each counter where prescription drugs are dispensed.[2]

A total of 26 pharmacies refused – in varying degrees – to provide pricing information.  Each pharmacy received a letter from the Consumer Protection Division reminding the pharmacy of their obligation to provide price information under the Public Health Code, asking for specific information, and assurances that such information will be provided in the future.  The letter was copied to the Michigan Department of Community Health Bureau of Health Professions.  The pharmacies have been asked to provide a written response to both the Attorney General and the Pharmacy Board.

VI.  Why HB 4559 Web Site is Important to Michigan Consumers

According to a 2003 report commissioned by Governor Granholm, 11.7% of the population in Michigan (1,162,797 citizens) are uninsured:

• almost all of them are under the age of 65;

• one in five are children.

Some insurance companies charge a percentage co-pay instead of the flat-fee co-pay that many enjoy.  Additionally, Medicare Part D helps seniors, but they can save by comparison shopping.

Relevance of Medicare Part D

Those who oppose the Attorney General Web site may point to the new Medicare Part D prescription drug benefit and claim that the implementation of the benefit negates the need to publish actual pricing information.  That argument is flawed.

The Medicare Part D benefit does not provide qualifying seniors with complete prescription drug coverage.  While the benefit is helpful, covered seniors still need to carefully watch the retail prices of every drug they must buy.  The plan's coverage is best described by the following chart: 
 

The $2,251 – $5,100 annual drug costs range is considered the benefit's "donut hole."  Only after a senior's prescription drug costs exceed $5,100 will catastrophic coverage apply – requiring the senior to pay a low co-pay.
 

The opposition is also flawed because it overlooks the fact that Medicare Part D is a voluntary benefit.  Seniors do not have to sign up for it.  In fact, only 6 – 7 million of the 43 Americans eligible for the benefit have signed up as of January 1, 2006.[3]  Recently the media has provided coverage of the glitches that have arisen with the January 1 implementation of the benefit.[4]  The publication of cash prices of

prescription drug prices is useful information for the senior population who are Medicare Part D eligible. 

VII.  Conclusion

The Attorney General's drug survey illustrates the need to have local drug-pricing information disseminated for specific quantities of drugs.  Drug pricing Web sites are maintained by:
 

1.   Arizona Attorney General Terry Goddard (D)

      http://www.azag.gov/rx/rx_drug_cost_search.php;
 

2.   Florida Attorney General Charlie Crist (R)

      www.myfloridarx.com;
 

3.   Indiana Attorney General Steve Carter (R)

      http://www.in.gov/attorneygeneral/consumer/rx/index.html;
 

4.   Maryland Attorney General J. Joseph Curran, Jr, (D)

      http://www.oag.state.md.us/Drugprices/index.htm; and
 

5.   New York Attorney GeneralEliot Spitzer (D)

      http://www.nyagrx.org/.

The Governor and the Department of Community Health should take drug price information that they already have and make it available on a drug price Web site, including:
 

1.  All communities (searchable by city and zip code);

2.  All drugs (dosage and quantity);

3.  Monthly updates.