Variability in Pricing of Generic Antipsychotic Medications Used in the Treatment of Schizophrenia at Community Pharmacies in the Kansas City Metropolitan Area

Abstract

Studies examining variability in generic medication pricing at community pharmacies have revealed conflicting results. No studies have examined variability in costs of antipsychotic medications or if these costs vary across types of pharmacies. Specifically, comparative drug pricing for generic formulations of five commonly used second-generation antipsychotic medications (risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) recommended for first line therapy in the treatment for schizophrenia is lacking. Pharmacy-level variability in retail cash pricing for five generically available second-generation and one first-generation antipsychotic medications at therapeutic doses for the treatment of schizophrenia in the Kansas City metropolitan area was examined. Two hundred and sixty-five pharmacies were queried by telephone between April 25 and May 25, 2017 for the cash price of a 30-day supply of haloperidol 10 milligrams (30 tablets), risperidone 4mg (30 tablets), olanzapine 20mg (30 tablets), quetiapine 300mg (60 tablets), ziprasidone 80mg (60 tablets), and aripiprazole 20mg (30 tablets). Each pharmacy was then classified as being either a chain (n=182), grocery store (n= 53), or independent pharmacy (n= 30). Retail cash prices varied for all antipsychotic medications, with significant differences in price by pharmacy type. Price variation across all pharmacy types for a 30 day supply was the least for haloperidol (range $20.00 - $102.99) and the greatest for aripiprazole (range $29.99 - $1,345.00). Pairwise comparisons showed chain pharmacies had higher prices compared with independent pharmacies (p <.001) for all drugs except haloperidol (p =.49). Overall, chain pharmacies had the highest prices, with prices at grocery store pharmacies averaging $180.00 lower than chain and independent pharmacies $414.00 lower than chain pharmacies. This is the first report on the pharmacy-level variability in the costs of generic antipsychotic treatment options for schizophrenia. There are appreciable differences in the costs of antipsychotic medications and understanding variability in pricing for these medications may be valuable for providers serving uninsured patients. Further analyses will examine the contribution of geographic-level socio-demographic factors to these differences.