Prescription Drugs: Prices Available Through Discount Cards and  
From Other Sources (05-DEC-01, GAO-02-280R).			 
								 
This report compares prices for prescription drugs purchased	 
using drug discount cards with prices available at local	 
pharmacies or over the Internet. Using a list of 17 drugs that	 
are among the most widely prescribed to the Medicare population, 
GAO documented prices from (1) five companies that administer	 
large drug discount card programs, (2) five Internet pharmacies, 
and (3) several retail pharmacies in four different areas.	 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-02-280R					        
    ACCNO:   A02547						        
  TITLE:     Prescription Drugs: Prices Available Through Discount    
Cards and From Other Sources					 
     DATE:   12/05/2001 
  SUBJECT:   Drugs						 
	     Price indexes					 
	     Internet						 
	     Pharmaceutical industry				 
	     Medicare Program					 

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GAO-02-280R
     
GAO- 02- 280R Prescription Drug Prices United States General Accounting
Office

Washington, DC 20548

December 5, 2001 Congressional Requesters Subject: Prescription Drugs:
Prices Available Through Discount Cards and From

Other Sources This letter responds to your request for information on how
the prices for prescription drugs purchased using drug discount cards
compare with the prices available at local pharmacies or over the Internet.
Using a list of 17 drugs that are among the most widely prescribed to the
Medicare population, we have documented prices from several sources. These
included prices available from (1) five companies that administer large drug
discount card programs, (2) five Internet pharmacies, and (3) several retail
pharmacies in four different areas- Washington, D. C.; Chicago; Seattle; and
rural Georgia. (See encl. I for additional details on our scope and
methodology.) We did not independently verify the drug prices provided by
these sources. With this exception, we performed our work from September
through November 2001, in accordance with generally accepted government
auditing standards.

The drug prices we obtained from these sources are presented in enclosures
II through V.

As arranged with your offices, unless you release its contents earlier, we
plan no further distribution of this letter until 30 days after its issuance
date. At that time, we will send copies to interested parties. This letter
will also be available on GAO?s home page at http:// www. gao. gov. If you
or your staffs have any questions regarding this letter, please contact me
at (202) 512- 7119 or John Hansen at (202) 512- 7105.

Laura A. Dummit Director, Health Care- Medicare Payment Issues

Enclosures - 5

2 GAO- 02- 280R Prescription Drug Prices

List of Requesters The Honorable John D. Dingell Ranking Minority Member
Committee on Energy and Commerce House of Representatives

The Honorable Henry A. Waxman Ranking Minority Member Committee on
Government Reform House of Representatives

The Honorable Charles B. Rangel Ranking Minority Member Committee on Ways
and Means House of Representatives

The Honorable Sherrod Brown Ranking Minority Member Subcommittee on Health
Committee on Energy and Commerce House of Representatives

The Honorable Fortney Pete Stark Ranking Minority Member Subcommittee on
Health Committee on Ways and Means House of Representatives

The Honorable Mike Ross House of Representatives

Enclosure I Enclosure I 3 GAO- 02- 280R Prescription Drug Prices

SCOPE AND METHODOLOGY For our study, we identified 17 drugs that are
frequently prescribed for participants in AARP?s drug discount card program.
For our analysis, we used the 10 most frequently prescribed prescription
drugs, and the 10 drugs whose price and utilization made them the highest
expenditure drugs purchased by participants in the AARP program. The
unduplicated drugs from both lists yielded the 17 drugs for which we
obtained prices. 1

Four of the drug discount cards we examined are administered by four of the
nation?s largest pharmacy benefit management (PBM) companies- Merck- Medco
Managed Care, Advance PCS, Express Scripts, and Wellpoint Health. We asked
each PBM to provide us the prices that a participant in its largest drug
card program would pay for each of the 17 drugs if purchased at a retail
pharmacy or through the mail. In some cases, the PBMs provided us with
prices averaged over several of the large drug discount card programs they
administered. The fifth drug card program we examined is administered by
Citizens Energy, a nonprofit company. The Citizens Health card can be used
to obtain discounts at participating pharmacies in Connecticut,
Massachusetts, and Rhode Island and through a mail service pharmacy
administered by Express Scripts. We also asked each drug card administrator
for information on enrollment fees and shipping charges for mail service
prescriptions.

We also obtained prices for the 17 drugs from five retail pharmacies in
Washington, D. C., five in Seattle, four in Chicago, and five in rural
Georgia. These included pharmacies that were part of national or regional
chains, part of national supermarket chains, discount department stores,
members- only price clubs, and independent retail pharmacies. We asked each
pharmacy to give us the price that would be paid by a cash- paying customer.
After obtaining the prices, we asked whether the pharmacy offered a senior
citizen discount on prescriptions. We reduced the reported drug prices to
reflect any available senior citizens discount. Finally, we obtained prices
and shipping costs from five Internet pharmacies.

We did not independently verify the drug prices provided by these sources.
With this exception, we performed our work from September through November
2001, in accordance with generally accepted government auditing standards.

1 The drug information provided by AARP included a specific dosage form,
strength and package size. With one exception, the drugs were in packages of
30 tablets or capsules. Fosamax was in a package of four tablets.

Enclosure II Enclosure II 4 GAO- 02- 280R Prescription Drug Prices

Drug Discount Card Retail Prices Compared to Drugstore Prices in Four
Geographic Areas

Drug discount card Drug description a 1 b 2 c 3 d 4 5 e

Washington, D. C., average

price g Chicago

average price h

Seattle average

price g Rural

Georgia average

price g Generic drugs

Atenolol 50 mg $5.69 $5.55 $4.57 $6.32 $4.90 $8.55 $9.09 $9.72 $18.33
Digoxin/ Digitek .25 mg 7.03 8.72 8.36 7.70 n/ a f 8.35 10.52 9.19 9.41
Furosemide 40 mg 4.81 5.30 4.08 5.04 5.04 7.83 8.67 7.71 9.50
Hydrochlorothiazide 25 mg 4.42 4.61 5.82 4.97 4.09 7.13 8.34 7.27 7.91
Metoprolol 50 mg 5.53 6.13 5.08 5.32 5.32 9.13 9.42 14.15 15.62

Brand name drugs

Celebrex 200 mg 74.92 69.09 68.44 75.28 76.18 80.34 79.89 78.94 82.29 Evista
60 mg 63.62 64.10 63.43 64.05 64.87 72.30 71.49 72.96 75.62 Fosamax 70 mg
59.24 59.71 59.09 59.84 60.49 65.02 67.07 64.48 67.58 Glucophage 500 mg
22.91 23.82 23.17 23.93 24.16 29.77 28.07 29.46 28.53 Klor- Con 10 mEq 6.20
9.50 5.82 6.34 6.34 9.51 10.02 8.79 12.05 Lipitor 10 mg 55.94 56.37 56.34
56.48 57.20 61.81 58.92 57.90 65.52 Lipitor 20 mg 85.26 85.42 86.87 85.45
86.51 93.25 90.67 91.20 100.17 Norvasc 5 mg 39.44 39.85 39.16 40.25 40.70
44.18 41.52 43.01 44.87 Plavix 75 mg 96.06 96.13 95.49 96.16 97.31 106.43
107.49 106.48 112.59 Premarin .625 mg 22.19 21.02 20.40 23.22 22.73 24.84
25.12 25.07 25.98 Prilosec 20 mg 115.79 115.41 115.00 115.73 117.04 121.64
124.02 119.98 127.89 Zocor 20 mg 112.16 111.77 111.41 112.08 113.41 122.25
116.67 118.31 123.43

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets.

b This drug card program has an annual enrollment fee of $25 for individuals
and $40 for families. c Prices are the average prices paid by customers of
several different card programs. d This drug card program has an enrollment
fee of $11.95 per month for individuals and $19.95 for families. e This drug
card program has an annual membership fee of $12 for individuals and $28 for
families.

f This company did not have a price for digoxin/ digitek for the dosage we
requested. g Reflects the average of the prices obtained from five area
drugstores. h Reflects the average of the prices obtained from four area
drugstores.

Enclosure III Enclosure III 5 GAO- 02- 280R Prescription Drug Prices

Drug Discount Card Mail Order Prices Compared to Internet Pharmacy Prices
Drug discount card

Drug description a 1 b 2 c 3 d 4 5 e Internet

pharmacy average price Generic drugs

Atenolol 50 mg $14.17 $2.22 $12.67 $3.57 $0.80 $7.02 Digoxin/ Digitek .25 mg
5.78 3.74 5.57 4.85 n/ a f 7.80 Furosemide 40 mg 5.51 1.86 5.21 3.08 2.04
7.07 Hydrochlorothiazide 25 mg 4.14 1.48 3.97 3.08 0.34 7.12 Metoprolol 50
mg 10.74 2.63 10.39 2.57 8.33 7.27

Brand name drugs

Celebrex 200 mg 70.79 62.67 62.91 70.88 67.72 72.33 Evista 60 mg 60.26 57.89
58.29 59.91 57.19 66.42 Fosamax 70 mg 56.18 53.75 54.31 55.80 53.10 62.24
Glucophage 500 mg 22.32 19.48 21.28 20.71 19.25 22.54 Klor- Con 10 mEq 7.18
6.68 7.26 3.59 3.84 8.41 Lipitor 10 mg 53.11 50.64 51.78 52.52 50.04 56.86
Lipitor 20 mg 80.43 78.30 79.85 80.82 77.35 86.35 Norvasc 5 mg 37.73 34.38
35.98 36.65 34.66 38.45 Plavix 75 mg 90.48 88.48 87.78 91.28 87.41 95.94
Premarin .625 mg 21.65 16.32 18.73 20.01 17.92 19.59 Prilosec 20 mg 108.87
107.09 105.72 110.40 105.80 114.65 Zocor 20 mg 105.49 103.67 102.42 106.83
102.42 110.28

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets.

b This drug card program has an annual enrollment fee of $25 for individuals
and $40 for families. c Prices provided by the drug card administrator are
estimates for a 30- day supply based on average prices for a 90- day supply
available to customers of several different drug card programs. d This drug
card program has an enrollment fee of $11.95 per month for individuals and
$19.95 for families. e This drug card program has an annual membership fee
of $12 for individuals and $28 for families.

f This company does not have a price for digoxin/ digitek for the dosage we
requested. g Reflects the average of the prices obtained from five Internet
pharmacies.

Enclosure IV Enclosure IV 6 GAO- 02- 280R Prescription Drug Prices

Internet Pharmacy Drug Prices Internet pharmacy Drug description a 1 2 3 45
b Average Generic drugs

Atenolol 50 mg $6.99 $9.99 $5.01 $6.87 $6.23 $7.02 Digoxin/ Digitek .25 mg
7.99 9.99 5.01 6.87 9.15 7.80 Furosemide 40 mg 6.99 9.99 5.01 6.87 6.48 7.07
Hydrochlorothiazide 25 mg 6.99 9.99 5.01 6.87 6.75 7.12 Metoprolol 50 mg
7.99 9.99 5.01 6.87 6.48 7.27

Brand name drugs

Celebrex 200 mg 69.46 73.99 65.92 79.87 72.40 72.33 Evista 60 mg 65.36 69.59
63.87 69.87 63.41 66.42 Fosamax 70 mg 63.94 63.59 62.72 63.87 57.07 62.24
Glucophage 500 mg 21.04 23.69 20.52 23.87 23.58 22.54 Klor- Con 10 mEq 7.99
9.99 5.01 11.87 7.17 8.41 Lipitor 10 mg 54.61 57.99 53.75 61.87 56.10 56.86
Lipitor 20 mg 84.43 86.59 79.85 95.87 85.00 86.35 Norvasc 5 mg 37.62 40.99
33.78 40.87 38.98 38.45 Plavix 75 mg 96.22 93.99 86.71 107.87 94.91 95.94
Premarin .625 mg 18.68 20.69 16.48 19.87 22.22 19.59 Prilosec 20 mg 108.03
109.99 108.30 130.87 116.06 114.65 Zocor 20 mg 107.22 109.99 104.92 120.87
108.42 110.28

Note: mg = milligrams; mEq = milliequivalents a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets. b
This Internet pharmacy lists more than one price for Atenolol, Furosemide,
and Hydrochlorothiazide. The prices presented for these drugs are the median
prices. Also, this Internet pharmacy has a mailing charge that varies
depending on package weight.

Enclosure V Enclosure V 7 GAO- 02- 280R Prescription Drug Prices

Area Drug Prices

Table 1: Washington, D. C., Area Drug Prices

Washington, D. C., area drugstore b Drug description a 1 2 c 3 c 4 c 5 c
Average Generic drugs

Atenolol 50 mg $10.68 $9.50 $4.50 $9.08 $8.99 $8.55 Digoxin/ Digitek .25 mg
8.46 8.99 6.30 8.99 8.99 8.35 Furosemide 40 mg 9.46 8.99 4.50 8.99 7.19 7.83
Hydrochlorothiazide 25 mg 5.98 8.99 4.50 8.99 7.19 7.13 Metoprolol 50 mg
13.78 10.72 4.50 9.44 7.19 9.13

Brand name drugs

Celebrex 200 mg 82.98 82.03 86.40 84.59 65.69 80.34 Evista 60 mg 72.98 76.49
72.90 77.03 62.09 72.30 Fosamax 70 mg 66.46 65.69 68.22 64.43 60.29 65.02
Glucophage 500 mg 26.46 27.56 25.65 29.60 39.59 29.77 Klor- Con 10 mEq 10.68
8.99 8.10 8.99 10.79 9.51 Lipitor 10 mg 63.92 62.08 64.26 63.89 54.89 61.81
Lipitor 20 mg 98.84 91.66 99.36 94.49 81.89 93.25 Norvasc 5 mg 43.92 44.59
44.55 49.13 38.69 44.18 Plavix 75 mg 109.68 100.31 111.60 104.39 106.19
106.43 Premarin .625 mg 25.62 24.37 23.90 26.00 24.29 24.84 Prilosec 20 mg
127.62 118.79 135.00 116.09 110.69 121.64 Zocor 20 mg 127.98 117.89 131.40
127.79 106.19 122.25

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets. b
These pharmacies include national chain drugstores, an independent
drugstore, and a national chain grocery store. c Prices for these drugstores
reflect a 10- percent senior citizens discount

Enclosure V Enclosure V 8 GAO- 02- 280R Prescription Drug Prices

Table 2: Chicago Area Drug Prices

Chicago area drugstore b, c Drug description a 1 2 3 4Average Generic drugs

Atenolol 50 mg $8.99 $9.99 $7.69 $9.69 $9.09 Digoxin/ Digitek .25 mg 8.99
9.99 13.39 9.69 10.52 Furosemide 40 mg 8.99 9.99 6.99 8.69 8.67
Hydrochlorothiazide 25 mg 8.99 9.99 6.39 7.99 8.34 Metoprolol 50 mg 9.69
9.99 6.99 10.99 9.42

Brand name drugs

Celebrex 200 mg 81.89 77.99 68.99 90.69 79.89 Evista 60 mg 69.99 71.59 67.39
76.99 71.49 Fosamax 70 mg 68.99 63.59 63.99 71.69 67.07 Glucophage 500 mg
29.49 27.39 22.69 32.69 28.07 Klor- Con 10 mEq 9.39 9.99 9.69 10.99 10.02
Lipitor 10 mg 60.99 58.99 52.69 62.99 58.92 Lipitor 20 mg 93.99 93.99 80.69
93.99 90.67 Norvasc 5 mg 42.99 42.39 36.99 43.69 41.52 Plavix 75 mg 114.99
105.99 107.99 100.99 107.49 Premarin .625 mg 26.89 22.89 21.69 28.99 25.12
Prilosec 20 mg 124.99 119.99 118.39 132.69 124.02 Zocor 20 mg 119.99 117.99
107.99 120.69 116.67

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets. b
These pharmacies include national drugstore chains and a discount store.

c None of the pharmacies provide senior citizens discounts.

Enclosure V Enclosure V 9 GAO- 02- 280R Prescription Drug Prices

Table 3: Seattle Area Drug Prices

Seattle area drugstore b Drug description a 1 c 2 c 3 d 4 e 5 f Average
Generic drugs

Atenolol 50 mg $8.54 $9.62 $11.19 $12.68 $6.57 $9.72 Digoxin/ Digitek .25 mg
8.09 9.89 8.39 13.29 6.29 9.19 Furosemide 40 mg 6.29 8.09 9.19 9.88 5.09
7.71 Hydrochlorothiazide 25 mg 9.89 7.19 6.79 8.41 4.09 7.27 Metoprolol 50
mg 21.32 15.29 12.79 14.37 6.99 14.15

Brand name drugs

Celebrex 200 mg 87.02 71.09 86.84 79.48 70.27 78.94 Evista 60 mg 76.85 65.69
76.49 80.40 65.37 72.96 Fosamax 70 mg 61.28 59.39 72.44 72.62 56.69 64.48
Glucophage 500 mg 31.58 32.39 29.69 30.44 23.19 29.46 Klor- Con 10 mEq 7.19
8.99 11.69 11.19 4.89 8.79 Lipitor 10 mg 64.61 58.49 53.09 58.34 54.97 57.90
Lipitor 20 mg 98.09 87.29 87.29 99.77 83.57 91.20 Norvasc 5 mg 43.01 44.99
45.89 44.81 36.37 43.01 Plavix 75 mg 108.44 103.49 107.09 117.08 96.29
106.48 Premarin .625 mg 25.64 24.29 27.89 27.06 20.47 25.07 Prilosec 20 mg
128.96 118.79 118.79 118.37 115.00 119.98 Zocor 20 mg 131.03 114.29 110.69
128.52 107.00 118.31

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets. b
Pharmacies include a regional and a national drugstore chain, national
grocery store chains, and a members- only discount price club. c Prices for
these drugstores reflect a 10- percent senior citizens discount.

d Prices for this drugstore reflect a 20- percent senior citizens discount
for generic drugs and a 10- percent senior citizens discount for brand name
drugs. e Prices for this drugstore reflect a 5- percent senior citizens
discount.

f This drugstore has a $45 annual membership fee.

Enclosure V Enclosure V 10 GAO- 02- 280R Prescription Drug Prices

Table 4: Rural Georgia Drug Prices

Rural Georgia drugstore b Drug description a 1 c 2 3 4 5Average Generic
drugs

Atenolol 50 mg $7.89 $9.99 $9.99 $23.51 $40.29 $18.33 Digoxin/ Digitek .25
mg 7.70 9.99 8.99 10.97 9.39 9.41 Furosemide 40 mg 7.13 9.99 8.99 6.79 14.59
9.50 Hydrochlorothiazide 25 mg 5.10 9.99 8.99 5.67 9.79 7.91 Metoprolol 50
mg 6.92 9.99 12.49 20.33 28.39 15.62

Brand name drugs

Celebrex 200 mg 74.32 86.59 83.89 80.25 86.39 82.29 Evista 60 mg 69.04 76.99
77.59 74.49 79.99 75.62 Fosamax 70 mg 64.12 65.59 68.29 69.51 70.39 67.58
Glucophage 500 mg 27.00 25.99 31.09 28.48 30.09 28.53 Klor- Con 10 mEq 7.77
9.99 8.99 13.23 20.29 12.05 Lipitor 10 mg 60.40 65.59 67.29 65.01 69.29
65.52 Lipitor 20 mg 93.38 99.99 102.69 99.08 105.69 100.17 Norvasc 5 mg
41.84 44.99 44.49 47.26 45.79 44.87 Plavix 75 mg 114.83 109.99 111.69 111.35
115.09 112.59 Premarin .625 mg 25.32 24.69 27.09 24.90 27.89 25.98 Prilosec
20 mg 116.12 122.99 131.29 133.77 135.29 127.89 Zocor 20 mg 123.65 121.99
119.19 129.65 122.69 123.43

Note: mg = milligrams; mEq = milliequivalents. a The quantity for each drug
is 30 tablets or capsules except for Fosamax, whose quantity is 4 tablets. b
Pharmacies include privately owned drugstores and national drugstore chains.

c Prices for this drugstore reflect a 10- percent senior citizens discount.
(290157)
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