Costs of Generic Drugs for Heart Failure Can Vary Widely Interview with:

Paul J. Hauptman, MD</strong> Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health

Dr. Paul Hauptman

Paul J. Hauptman, MD
Professor Internal Medicine, Division of Cardiology
Health Management & Policy, School of Public Health What is the background for this study? What are the main findings?

Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month’s supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely.

We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply.

The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain. What should readers take away from your report?

Response: As physicians we try to be cognizant to the financial burden of heart failure management by prescribing generic medication whenever possible.

However, our findings suggest that not all generic heart failure medications are as affordable as we previously thought, presenting a very real obstacle to uninsured and underinsured patients. Comparative shopping at the retail pharmacy may be required but this places an additional burden on patients (and on physician/physician offices). What recommendations do you have for future research as a result of this study?

Response: Similar studies should be repeated in other regions of the country to determine if this is a nationwide phenomenon.

These studies will also allow us to assess for regional variability in pricing. There are several other routinely prescribed generic heart-failure medications that can be similarly evaluated.

More importantly, we believe that the pricing should be more transparent. It is not clear where the major price augmentation occurs: at the generic manufacturer, at the distributor/wholesaler or at the retail pharmacy. Ultimately, the impact on patient adherence and outcomes is the most important issue: these medications work! Thank you for your contribution to the community.


Hauptman PJ, Goff ZD, Vidic A, et al. Variability in retail pricing of generic drugs for heart failure [published online November 15, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.6955.   –

Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 16, 2016 by Marie Benz MD FAAD