Generic Medication Program Evaluation for Community Health Centers
Project Between IA/NEPCA and
Siouxland Community Health Center
By
Dr. Kyle Peters, Pharm.D.
Clinical Pharmacist, Adjunct Clinical Instructor UNMC College of Pharmacy
Siouxland Community Health Center
Generic Medication Program Evaluation for Community Health Centers
I.
Introduction
A. The purpose of this evaluation is to look at the emergence of generic
medication programs, and to analyze the impact they have on community
health centers and their patients. The generic prescription programs that will
be analyzed are the Wal-Mart and Target $4 generic programs, the K-Mart 90day supply program, and the Rx Outreach mail-order program. Manufacturersponsored medication assistance programs will not be analyzed, since they are
only available for brand name products, and have varying qualification
requirements. The cash price of the medication will be analyzed; however, copays if the prescription is submitted through a third party payer will not be
analyzed, due to the complexity of co-pays from different payers. This analysis
will focus on the cost of the medication, and will not make determinations of
the affordability of medication, since affordability is composed of many
variables.
II.
Currently Available Programs for Low-Cost Generic Medications
A. Wal-Mart
http://i.walmart.com/i/if/hmp/fusion/genericdruglist.pdf
On November 28, 2006, the Wal-Mart $4 generic medication program became
available at all Wal-Mart and Sam’s Club pharmacies in the United States. The list
is comprised of 143 different medications in 26 therapeutic categories. Patients can
get a one-month supply of commonly prescribed dosages from a predetermined
medication list for $4. If the patient requires a prescription for 60 tablets per
month, but the limit is 30 tablets for $4, the patient will have to pay $8 for a onemonth supply. Patients can get more than a one-month supply for multiples of $4,
subject to the pharmacist’s clinical decision, if the prescription is written for more
than a 30-day supply or has refills available. A three-month supply would cost
$12, and a year supply would cost $48. For chronic medications, a 100-day supply
would cost $13.33. If the prescription is written for a higher dose of a medication,
Generic Medication Program; page 1
with the instructions to cut the tablets in half, 15 tablets for a 30-day supply would
cost the patient $4.00, and 30 tablets for a 60-day supply would also be $4.00.
B. Target
http://sites.target.com/images/pharmacy/pharmacy_4dollar_program_list.pdf
On November 20, 2006, the Target $4 generic program became available at all of
its pharmacies nationwide. The list is the same as Wal-Mart’s for the drugs and
doses that are covered. The same number of tablets can be obtained for $4. If the
patient requires a prescription for 60 tablets per month, but the limit is 30 tablets
for $4, the patient will have to pay $8 for a one-month supply. Patients can get
more than a one-month supply for multiples of $4, subject to the pharmacist’s
clinical decision, if the prescription is written for more than a 30-day supply or has
refills available. A three-month supply would cost $12, and a year supply would
cost $48. For chronic medications, a 100-day supply would cost $14.00. If the
prescription is written for a higher dose of a medication, with the instructions to
cut the tablets in half, 15 tablets for a 30-day supply would cost the patient $4.00,
and 30 tablets for a 60-day supply would also be $4.00.
C. K-Mart
(See attachment for medication list)
K-Mart has had their 90-day generic program for longer than both Wal-Mart and
Target Programs. The list is comprised of 94 medications in the classes of:
cardiovascular, diuretics, behavioral health, diabetes, muscle relaxants,
gastrointestinal, women’s health, pain/inflammation, and miscellaneous. The list
is not available online, but can be obtained at the pharmacy. They offer a 90-day
supply for $15.
D. Rx Outreach
http://www.rxoutreach.com/en/index.aspx
Rx Outreach is a mail order prescription assistance program for generic
medications, which is located in St. Louis, Missouri. Their list has 117 different
medications from over 40 different therapeutic classes, and 35 of these
medications do not appear on the Wal-Mart/Target programs. A 90-day supply is
$20 or $30 depending on the medication. This price does not change for the
number of pills the patient receives, and shipping and handling is included.
Patients have to qualify for the program based on household income and number
of people living in the house. No financial documents are required to apply for the
program.
III.
Benefits and Limitations of the Currently Available Programs for Low-Cost
Generic Medications
A. 340B Pharmacy Analysis Explanation
The 340B pharmacy used in the comparison is the Siouxland Community Health
Center (SCHC) Pharmacy. SCHC is located in Sioux City, IA. Randall Rouse,
R.Ph. is the pharmacy manager, and Dr. Kyle Peters, Pharm.D. is the clinical
pharmacist. The medications chosen for this analysis were the top 20 medications
according to the Top 200 Generic Drugs by Units in 2005
(http://www.drugtopics.com/drugtopics/data/articlestandard/drugtopics/102006/31
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1293/article.pdf.) that were on the Wal-Mart/Target list, and in stock at the SCHC
pharmacy. The SCHC filling fee scale is included on the final page of the Excel
document. The limit is the cut off point at which a more expensive fee is applied
to the medication. The limit is determined by the cost of the medication, and the
fee is the amount added to the cost of the medication. For example, if the 340B
price of a medication is $0.49, the fee added to $0.49 would be $5.75. If the 340B
price of the medication is $0.51, the fee added to $0.51 would be $6.00. More
expensive medications have a greater fee added to them, which increases the
amount patients pay for the medication. The cost to the patient is calculated by the
following equation:
(340B price of the medication / # of pills) + fee = cost to the patient
Example: Lisinopril 10 mg #100 tablets 340B price is $3.34; therefore #30 and
#100 tablets would cost the patient:
($3.34/100 * 30 tablets) + $6.50 = $7.50 for 30 tablets
($3.34/100 * 100 tablets) + $7.75 = $11.10 for 100 tablets
B. Benefits and Limitations of The Wal-Mart/Target Programs on a OneMonth Supply of Medication
When comparing the Wal-Mart/Target programs to SCHC’s pricing for a onemonth supply of medication, the Wal-Mart/Target price is less expensive. The
reason for this is the filling fee at SCHC. The filling fee starts at $5.75, and goes
up as the 340B price of the medication increases. The filling fees and patient
medication cost varies between the community health centers in the network, and
this should be taken into account in applying this analysis. With this being said,
patients will save money by getting their medications from Wal-Mart/Target if
they get a one-month supply at a time. The main limitation is that the programs
have a limited number of generics available; whereas, 340B pharmacies can carry
more medications that are less expensive. Patients will be able to save money if
they purchase all of their generic medications at a 340B pharmacy compared to
getting all of them at Wal-Mart or Target, if only a portion of their medications are
available on the $4 programs.
C. Benefits and Limitations of The Wal-Mart/Target Programs on a 100-Day
Supply of Medication
When comparing a 100-day supply of medication on the Wal-Mart/Target
programs with SCHC, there is very little benefit of the Wal-Mart/Target programs
because the SCHC price is lower than all but 5 medications on the Wal-Mart
program, and 4 on the Target program. The limitation of the Wal-Mart/Target
programs is that patients will save money over time if they buy a 100-day supply
at a 340B pharmacy. If patients buy 100 tablets of double the strength, and cut the
tablets in half, they will save even more money.
D. Benefits and Limitations of the K-Mart Program
The main benefit of the K-Mart program is that there are 16 medications available
that are not on the Wal-Mart/Target programs. Some of the same medications
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appear on both lists, but K-Mart has more dosage forms available. Limitations of
the K-Mart program are: the availability of K-Mart stores throughout the network,
out of the 16 medications available, 10 of these are less commonly used generics,
and the cost is more than Wal-Mart/Target, $15 versus $12 for a 90-day supply.
E. Benefits and Limitations of the Rx Outreach Program
Rx Outreach has 35 medications available that are not on the Wal-Mart/Target
program. Five of these medications are benzodiazepines, which have abuse
potential. They do have generics available for Ortho Tri-Cyclen, Ortho-Cyclen,
Zoloft, Zocor, and Prilosec. None of the other plans offer generic birth control
pills. Zoloft and Zocor recently became generic, so the acquisition cost is still
higher than the other generic drugs in their respective drug class; this is the reason
they are not available on the Wal-Mart/Target and K-Mart programs. Generic
Prilosec is not available on the other programs, probably due to the fact that
patients can get it over the counter; and the retailers can make more money if it is
purchased over the counter. Rx Outreach also offers extended-release forms of
verapamil and diltiazem, which the other programs do not. The main limitation of
the Rx Outreach program is the application process. The other 3 programs are
available to all patients without an application. Some patients may not be able or
willing to fill out the application. The medications are only obtainable through the
mail. They can be mailed to the patient’s house, doctor’s office, or a family or
friend’s address. It may be difficult for homeless patients to find a suitable
address, and CHC’s might not be willing to have the medications mailed to them.
Patients in need of these medications might not have $20 up front to pay for the
medications.
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CHC
If patients are able to
afford a 100-day supply,
this is the best price.
Guidance for Patients of Community Health Center
Wal-Mart/Target
K-Mart
Rx Outreach
Based on cost alone, it is the lowest If there is not a Wal-Mart or
If patients require medications not on the
price for a 30-day supply of chronic Target in the area, and the
other programs, they do not mind the
medications, or the listed quantity
medication for 90-days cost more application process, they have a consistent
for acute medications.
at the CHC, this is an option.
mailing address, and they have $20 to mail
in with the application, this is a good option.
Guidance for Community Health Center Pharmacies and Providers
CHC
Wal-Mart/Target
K-Mart
Rx Outreach
Pharmacies can price match other pharmacies, but this For patients who can only afford Not a great option If patients qualify for
can become cumbersome. Revision of the filling fee
a month at a time, this is the
with their limited
manufacturer-sponsored
scale might be a way to be more competitive. Offer
least expensive option. If the
drug list. The
medication assistance programs, I
discounts to patients who qualify for the sliding fee
prescription is written for more
price of $15 is
would recommend this route first.
scale. Recommend that the clinic providers write
tablets than the limit amount for greater than that
The cost to the patient should be
prescriptions for a 100-day supply. Most medications $4, the price will be more.
for a 90-day
less than Rx Outreach. If the
come packaged in 100 tablets/capsules. Offer to
Inform patients of this before
supply at CHC’s.
patient needs medications on this
review the patient’s medication list to find cost saving they pick-up their medication.
program that they cannot get on
alternatives. Combination medications can be a way
Tablet splitting is an option for
the other programs or from the
to save money and increase compliance. Patients can
some medications. Assess the
CHC, this is a good option.
also split tablets* to save money. Frequently check
abilities and probable
Assist patients in filling out the
the wholesaler price for medications to see if a lower
compliance with this for
paper work.
cost equivalent medicine can be obtained from a
patients wanting to save money.
different manufacturer.
* Not all tablets can be split. Medications that are controlled-release or extended-release should generally not be split. Some tablets are
not uniform in shape, and when split, may contain more or less than half of the dose. Patient’s ability to split tablets, and amount of
money saved by splitting the tablets should be taken into account before recommending tablet splitting.
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