Variation of prescription drug prices in community pharmacies: A national cross-sectional study

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

4C.6

Presenter:

James Larkin

Twitter:

@LarkinJames

Co-authors:

James Larkin MSc(1), Frank Moriarty PhD(1), Shane McGuinness MPharm(1), Karl Finucane MPharm(1), Karen Fitzgerald BA(1), Susan M. Smith MD(1,2), James F. O’Mahony PhD(3)

Author institutions:

(1) Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, (2) Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2 (3) Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin 2

Problem

There is evidence of significant variation of prescription drug prices in community pharmacies in several countries. Such variation means some patients may face additional costs, adding to an already major source of expenditure. Historically, Ireland has some of the highest retail prices for prescription drugs in Europe. High prices can lead to cost-related non-adherence and adverse health outcomes. This study’s aim was to establish the availability and variation of prescription drug prices in community pharmacies in Ireland.

Approach

Using a cross-sectional design, prices were sought in community pharmacies using phone, email and website enquiries. A purposive sample of 12 prescription drugs was selected from the top 100 medications by dispensing frequency in 2017 on Ireland’s main state drug scheme. For each pharmacy, the price was checked for three drugs only. Data collectors sought to contact 1,500 pharmacies by phone, 320 by email and consult the website of 370 pharmacies. To increase ecological validity, data collectors did not reveal that the enquiries were for research. Data collectors also noted if any discount was offered. Outliers were conducted by re-contacting pharmacies. Summary and descriptive statistics were used to summarise the results. A primary outcome was the price variation between pharmacies for each medication, which was calculated as the ratio of the 90th percentile price to the 10th percentile price. Prices were compared between chain and independent pharmacies using Welch's t-test.

Findings

In total, 1,529 pharmacies responded to queries, 1,362 by telephone and 167 by email. Overall, 88% (N=1,352) of pharmacies who answered queries, provided prices. For all drugs, the average price quoted to data collectors was higher than the price paid by the state for patients who can access subsidised medicines. The ratio of 90th to 10th percentile prices ranged from 1.3-2.0 for the 12 drugs. Aspirin was the drug with the largest variation in quoted priced; the 90th percentile price of €9.12 was 97% higher than the 10th percentile price of €4.62. For nine of the 12 drugs the price was significantly higher (p<.05) for chain pharmacies compared to independent pharmacies. Overall, 4.7% (N=64) of pharmacies who provided prices, offered one of four discounts.

Consequences

Evidence was found of significant price variation in community pharmacies. Higher costs can lead to cost-related non-adherence and consequently adverse health outcomes. There was also evidence that some community pharmacies were not following regulatory guidance on drug pricing transparency. Strengths include the large sample size. Also, conducting outlier checks improved the reliability of the results. While patients may be able to avoid high costs by seeking lower prices, they incur search costs. Policy measures including mandated price transparency, or fixed prescription drug prices could help address these issues.

Submitted by:

James Larkin

Funding acknowledgement:

This research was funded by the RCSI Research Summer School.