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Research Letter
January 2017

Variability in Retail Pricing of Generic Drugs for Heart Failure

Author Affiliations
  • 1Department of Medicine, Saint Louis University School of Medicine, St Louis, Missouri
  • 2Department of Psychiatry, Saint Louis University School of Medicine, St Louis, Missouri
  • 3College of Pharmacy, University of New Mexico, Albuquerque
JAMA Intern Med. 2017;177(1):126-128. doi:10.1001/jamainternmed.2016.6955

Generic medications may lessen patients’ financial burden and improve adherence.1 Recent increases in generic drug costs2 raise concerns about the effect on uninsured and underinsured patients whose options may be restricted to retail pharmacies within a limited geographic area. An estimated 7.3 million Americans with cardiovascular disease are in the uninsured group.3 Therefore, we evaluated US retail pharmacy pricing for generic guideline-directed heart failure (HF) drugs in a metropolitan area as a function of dose, supply, pharmacy type and zip code, and zip code median annual income.

Pharmacies were identified across 55 zip codes in a 2-state region using a government website.4 In zip codes with more than 4 pharmacies, the nonrandomized convenience sample included at least half of these stores. Pharmacies were queried by phone during a 3-week period in May 2016 regarding cost, without insurance, of digoxin (0.125 mg/d and 0.25 mg/d), lisinopril (10 mg/d and 40 mg/d), and carvedilol (6.25 mg and 25 mg twice daily) for 30- and 90-day supplies. Median annual income by zip code was determined from US Census Bureau data. Pricing between groups was compared using Kruskal-Wallis and Mann-Whitney tests; associations were assessed with Spearman ρ correlations. Cluster analysis was used to create groups based on zip code and zip code–based median annual income. The TwoStep cluster procedure (SPSS-22) was used to determine the optimal number of natural groupings based on a set of variables such that similarity of cases within a cluster and differences between clusters were maximized.

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