PAYING THE PRICE A 19-State Survey of the High Cost of Prescription Drugs CoPIRG Foundation July 2003 Acknowledgements Written by Rex Wilmouth, Director of CoPIRG Foundation, and Jennifer Thompson, Consumer
Associate with CoPIRG Foundation. Edited by Alison Cassady, Research Director for CoPIRG Foundation. 2003, CoPIRG Foundation The authors would like to thank all of the state PIRG staff and volunteers who surveyed more than 500 pharmacies that form the basis of this report’s findings. Special thanks to Bryan Nelson for his research assistance and Beth McConnell, Director of PennPIRG, for her helpful comments. To order a copy of this report, please visit www.copirg.org, or send a check for $20 made payable to CoPIRG Foundation at the following address: CoPIRG Foundation 1530 Blake Street, Suite 220 Denver, CO 80202 303-573-7474 CoPIRG is a non-profit, non-partisan consumer advocacy organization representing citizen members across the state of Colorado. CoPIRG Foundation is a 501(c)(3) organization specializing in policy analysis and research on consumer protection issues.Table of Contents Executive Executive Summary
hile the pharmaceutical industry is the most profitable industry in the world, millions of
Wuninsured and underinsured Americans struggle to afford the medicines they need, even
forgoing medically necessary drugs when prices are out of reach. Meanwhile, the federal government uses its buying power to negotiate fairer prices for the drugs it purchases for its beneficiaries – such as veterans, government employees, and retirees. Unfortunately, uninsured individuals have no one doing the same on their behalf. They thus remain at the whim of the pharmaceutical industry, one that has behaved in a manner considered by many to be monopolistic and unethical. Frustrated by years of gridlock and inaction at the federal level, states across the nation are now considering filling that role for their citizens by establishing state-run buying pools and using their power to negotiate fairer drug prices, allowing uninsured or underinsured consumers of all ages to buy their prescription drugs at lower cost. The time for state governments to act to lower drug prices has never been greater. The costs of the 50 most popular drugs rose three times higher than the rate of inflation in 2001. As drug prices have climbed, some employers have dropped or reduced the prescription drug coverage offered to their employees. The recent wave of corporate bankruptcies and layoffs has left many consumers without any health insurance at all. Medicare recipients—senior citizens most likely to take prescription medications—lack prescription drug coverage entirely. Moreover, the recent efforts by the Bush administration and U.S. Congress to reform Medicare have failed to
address the root cause of the skyrocketing cost of prescription medication. In the spring of 2003, the National Association of State Public Interest Research Groups
(PIRGs) conducted a survey of more than 500 pharmacies in 18 states across the country and Washington, DC to determine how much uninsured consumers are paying for 10 common prescription drugs. We then compared these prices with the prices the pharmaceutical companies charge one of their “most favored” customers, the federal government.
In each of the surveyed locations, we found that uninsured citizens are paying much more than the federal government for these 10 common prescription medications. Among the key findings
from this survey: In Denver: Of all the metropolitan areas surveyed, Denver ranked as one of the least expensive cities for uninsured consumers. On average, however, uninsured consumers in Denver still have to pay
64% more for the 10 common prescription medications than the federal government. The price differences ranged from 27% for Celebrex to 101% for K-Dur 20 in Denver. This
means that Denver residents without prescription drug coverage suffering from potassium deficiency pay more than double the amount paid by the federal government for K-Dur 20.
Based on surveys of pharmacies in Denver, Colorado Springs, Boulder and other towns across
the state, on average, uninsured consumers in Colorado pay 64% more for the 10 common prescription medications than the federal government. This is slightly lower than the national
average we found across the 19-state survey sample. The price differences ranged from 24% for Lanoxin to 97% for K-Dur 20 in Colorado. This means that Colorado residents without prescription drug coverage suffering from potassium deficiency pay almost double the amount paid by the federal government for K-Dur 20. Nationally:
Based on the results of our 19-state survey, uninsured Americans pay 72% more on average for these 10 common prescription medications than the federal government. The price differences ranged from 31% for Lanoxin to 110% for K-Dur 20. Many of the drugs featured in the PIRG survey treat chronic conditions – meaning that the percent difference between the retail and discounted prices quickly adds up. An uninsured person regularly taking Zocor for his high cholesterol, for example, would pay at least $1671 for a
year’s supply of Zocor. The government, on the other hand, must pay only $814 for the same quantity of Zocor – a savings of $857. Prices varied sharply amongst the surveyed regions. Prescription drugs cost substantially
more for uninsured consumers in urban areas in the Northeast and Middle Atlantic states; somewhat less in the Midwest and Mid-South; and substantially less in the Southeast and South/Southwest. Of the major metropolitan areas surveyed, the four most expensive cities in which to buy
medication were Baltimore, Washington, D.C., Philadelphia and Boston. Prescription drugs were the least expensive, but still significantly above the federal supply price, in New Orleans,
Denver, Grand Rapids, Houston and Tampa.
he price of prescription drugs has risen sharply in America in recent years. Americans spent
T$192 billion on prescription drugs in 2002, up from $82 billion in 1992. Some groups
suggest that costs could double again by 2011.1 While there are multiple factors behind this increase in drug spending – including drugs being prescribed more frequently to treat a wider variety of conditions – drug prices also are rising. One study found that the prices of individual drugs increased anywhere from 1.7% to 33.2% in 2001 alone.2 These increases have rapidly outrun the rate of inflation, which currently holds steady at around 3%.3 And drug prices show the potential to grow to astounding heights; Roche Holding’s new AIDS drug Fuzeon, for example, may cost a single patient as much as $20,000 a year. 4
Whatever the benefits of new medicines like Fuzeon, their costs are becoming prohibitive to consumers. Even as Americans spend more money than ever on prescription drugs, fewer are able to afford them. The Census Bureau estimates that 41.2 million Americans had no health insurance in 2001.5 Lacking health insurance has a profound effect on one’s ability to obtain needed medication; one study found that 30% of uninsured persons had not filled a prescription within the past year because they could not afford to do so.6
Millions of other Americans – including most Medicare recipients – have health insurance but
lack prescription drug coverage. In 2001, 10% of adults with health insurance reported that they lacked prescription drug coverage.7 Even drug coverage does not necessarily reduce a
patient’s drug expenses, as many plans may require patients to spend somewhere between $100 and $500 in deductibles before covering most services.8 The more a person has to pay for a drug, the less likely he is to have a prescription filled. One study published in the Journal of American Medicine found that increasing co-payments from $5 to $10 per prescription reduced consumer spending on drugs by 22%.9 In short, even health insurance that includes prescription drug
coverage may not make medicine any more affordable. Drug Prices Rise as an Industry Thrives The high price of prescription drugs has helped the pharmaceutical industry remain consistently profitable, even in a stagnant economy. In 2001, it ranked first of any industry in rates of return on equity, assets, or revenues.10 The healthcare consumer group Families USA, meanwhile,
found that the pharmaceutical industry has been the most profitable industry in the United States for the past 10 years, and that it “was five-and-one-half times more profitable than the
average for Fortune 500 companies.”11 In June 2003, the consumer group Public Citizen released
two companion studies. The first found that in 2002, the top ten prescription drug companies netted profits of $36 billion, or “more than one-half of all profits for Fortune 500 companies.” Further, the group also found that “the drug industry hired 675 different lobbyists from 138 firms
in 2002 – nearly seven lobbyists for each U.S. senator, according to federal lobbying disclosure records. The industry spent a record $91.4 million on lobbying activities in 2002, an 11.6 percent
increase from 2001.”12 The industry insists, however, that its high prices are justified by the amount of money it must spend in researching and developing new medications. According to one industry source, the
cost of research and development – also known as R & D – averages $800 million or more for a single compound.13 Another industry source suggests that out of 5,000 drugs under development, only five are likely to be tested in clinical trials and only one will be approved for
patient use, meaning that industry must invest heavily in medicines that never turn a profit.14 The inherent risks of R & D and the need to recover losses from failed trials both necessitate and
justify the cost of its products, the argument continues. According to the industry, lowering prices will result in less investment in R & D and fewer new and innovative drugs on the market. Yet R & D is actually a much lower priority for drug companies than they suggest. First, the government funds a substantial portion of the research and development required to produce any given medicine. One group has estimated that R & D can cost companies no more than
$240 million per drug, once government-funded research and tax deductions are taken into account,15 rather than the industry figure of $800 million. While $240 million is still a substantial sum of money, these figures suggest that the pharmaceutical industry’s research and development expenses may be far lower than anticipated. In addition, despite the steep climb in the cost of prescription drugs, FDA approved only 17 new drugs in 2002, the fewest in a decade. Some suggest that this drop in new medications has prompted “companies to keep profits flowing the old-fashioned way: by charging more for their
Furthermore, the pharmaceutical companies spent greater portions of their net revenue on marketing, advertising, and administrative costs than on R & D in 2001. In fact, one study found that eight major American pharmaceutical companies spent more than twice as much on
marketing and administrative costs than on R & D. And in 2001, the major pharmaceutical companies put only 11% of their revenue into R & D, counting 18% as profits.17 How the Drug Industry Keeps Prices High: Monopolies Under current law, companies that file a patent on a drug and receive Food and Drug
Administration approval are the sole vendors of that compound for a set period of time, generally anywhere from 10 to 15 years. Once that patent expires, other companies can file
claims with the FDA to market generic versions of that medicine. The first generic company
whose product is proven safe, effective, and bioequivalent to the original patented compound has a 180-day period within which it can be the sole vendor of the generic version of that drug. This six-month period is frequently enormously profitable for the maker of the generic drug; when Barr Laboratories began marketing a generic version of the Eli Lilly medication Prozac, it
recorded $366 million in sales during those six months, while Eli Lilly’s profits dipped sharply.18
After the first 180 days, additional generic companies can enter the market, provided their products receive FDA approval. Generic drugs typically cost 20% to 30% less than the brand-name drug, and the introduction of multiple generics on the market lowers prices even more.19 The pharmaceutical companies, however, have learned to block the introduction of cheaper,
generic versions of medications onto the market while keeping their own prices high by extending their patents. Companies have filed patents on everything from the color of a capsule to the shape of a bottle, all in an attempt to extend their control over a specific drug. Researchers have found that the average number of patents filed on brand-name medications has
increased from two to twelve in the past 10 years.20
Drug companies can maintain these monopolies
through a loophole in the regulations governing generic
drugs, known informally as the Hatch-Waxman Act.
Litigation project filed suit on behalf of
Under that act, generic companies can challenge brand-
name companies for the right to market a medication if
Bristol-Myers Squibb, alleging that the company acted illegally to lock generic
a patent was never filed, has expired, or is otherwise
competitors out of the BuSpar market. It
invalid. If a generic drug manufacturer claims a patent
to be invalid and the brand-name company retaliates
with a lawsuit, the FDA must automatically delay the
generic company’s claim for 30 months while it
generic version of BuSpar to the market.
investigates the dispute. The investigative process,
In April 2003, consumer advocates settled
repeated for each new patent, can delay the
their suit against Bristol-Myers Squibb,
introduction of generic drugs for even longer. Every
day that a generic drug is kept off the market means
over any of its drugs in the future. The
It is important to note that FDA does not investigate or
validate every patent filed. If a company files or
extends a patent on a prescription drug, it is up to
consumers or generic manufacturers to challenge its
Source: Prescription Access Litigation Project
validity. In its current role, FDA does not confirm that
the patent or its extensions are lawful and justified. Collusion and Price Manipulation by the Pharmaceutical Industry
There are multiple lawsuits pending that allege collusion
between generic and brand name manufacturers. A result of
the ongoing power struggle between brand-name and
manufacturer of the potassium generic manufacturers, most of these cases develop when
brand name companies holding expired or invalid patents
are challenged by generic companies who want to market
two other companies with the same drug. Rather than spend millions defending
agreements “calling for multi-million dollar payments… in themselves against lawsuits, which they would almost
exchange for the generic certainly lose, companies holding expired or invalid patents
decide instead to cut both their losses and a deal with their
of the K-Dur 20 market for competitors. Generally, two or more companies agree that
specified time periods.” These one can continue to sell and market a drug while the other
stays out of the market—usually in exchange for
– are estimated to have cost compensation.
Other lawsuits allege that some companies have
Source: Families USA, “Collusion and
systematically overcharged consumers for their medicines or
Other Anti-Competitive Practices: A waged misinformation campaigns against competitors.
Survey of Class Action Lawsuits Against
Wyeth-Ayerst Laboratories, for example, has been accused
Drug Manufacturers.” April 2002.
of maintaining a 99% monopoly over its estrogen supplement Premarin by waging a misinformation campaign
about its generic competitor, Cenestin, that discouraged consumers from purchasing it. Even as Wyeth-Ayerst worked to keep Cenestin off formularies—the list of medications covered by any given health plan—it continued to increase the price of Premarin.21 Other companies facing
lawsuits for fraud include the Bayer Corporation, which recently pled guilty and agreed to pay the government $257 million for overcharging the Medicaid and Medicare programs for its
antibiotic Cipro.22 Several state PIRGs have joined labor unions, senior citizen advocates and other consumer groups in litigation coordinated by the Prescription Access Litigation Project. The cases challenge numerous unfair drug company price manipulation tactics. One suit alleges manipulation of Medicare and Medicaid’s average wholesale price rules, resulting in consumers nationwide being over-charged $800 million.23
hile the pharmaceutical industry is the most profitable industry in the world, millions of
Wuninsured and underinsured Americans struggle to afford the medicines they need, even
forgoing medically necessary drugs when prices are out of reach. Meanwhile, the federal government uses its buying power to negotiate fairer prices for the drugs it purchases for its beneficiaries – such as veterans, government employees and retirees. Unfortunately, uninsured individuals have no one doing the same on their behalf. In the spring of 2003, the National Association of State Public Interest Research Groups (PIRGs) conducted a survey of 559 pharmacies in 18 states across the country and Washington, DC to determine how much uninsured consumers are paying for 10 common prescription drugs. We then compared these prices with the prices the pharmaceutical companies charge one of its “most favored” customers, the federal government. We found that uninsured citizens are paying much more than the federal government for these 10 common prescription medications. As detailed in Table 1, nationally, uninsured Americans pay 72% more on average for these 10 common prescription medications than the federal government. The price differences ranged from 31% for Lanoxin to 110% for K-Dur 20. In Denver: Of all the metropolitan areas surveyed, Denver ranked as one of the least expensive cities for uninsured consumers. On average, however, uninsured consumers in Denver still have to pay 64% more for the 10 common prescription medications than the federal government.
The price differences ranged from 27% for Celebrex to 101% for K-Dur 20 in Denver. This
means that Denver residents without prescription drug coverage suffering from potassium deficiency pay more than double the amount paid by the federal government for K-Dur 20. In Colorado:
Based on surveys of pharmacies in Denver, Colorado Springs, Boulder and other towns across
the state, on average, uninsured consumers in Colorado pay 64% more for the 10 common prescription medications than the federal government. This is slightly lower than the national average we found across the 19-state survey sample.
The price differences ranged from 24% for Lanoxin to 97% for K-Dur 20 in Colorado. This
means that Colorado residents without prescription drug coverage suffering from potassium
deficiency pay almost double the amount paid by the federal government for K-Dur 20. Refer to Appendix A for a detailed breakdown of the average cost of these prescription drugs in all of the states and major metropolitan areas surveyed.
Table 1. Average Cost to Uninsured Consumers of 10 Common Prescription Drugs Average price % more paid price paid by price paid by uninsured uninsured uninsured in uninsured uninsured in uninsured in nationally nationally in Denver Colorado Colorado Prilosec Celebrex
$94.26 $131.46 39% $128.53 36% $127.27 35%
$67.81 $139.28 105% $131.52 94% $131.82 94%
$90.21 72% $86.29 64% $86.12 64%
Prices varied sharply amongst the surveyed regions. Prescription drugs cost substantially more for uninsured consumers in urban areas in the Northeast (MA, RI, VT) and Middle Atlantic states (DC, MD, NC, PA, VA), where retail prices are almost twice that of the federal supply
price. The retail price for uninsured consumers is somewhat less in the Midwest and Mid-South
(MI, OH, TN), Southeast (AL, FL, GA, LA, SC) and South/Southwest (CO, NM, TX). Even in the South/Southwest, however, consumers lacking prescription drug coverage pay 1.6 times the price for prescriptions on average than the federal government.
Table 2. Average Cost to Uninsured Consumers of 10 Common Prescription Drugs: By Region Regional Federal Supply Price Average
Of the major metropolitan areas surveyed, the most expensive city in which to buy medication
was Baltimore, where uninsured consumers have to pay almost twice the average price paid by the federal government, followed closely by Washington, D.C., Philadelphia and Boston. Prescription drugs were the least expensive in New Orleans, Denver, Grand Rapids, Houston
and Tampa. Even in New Orleans, however, uninsured consumers pay 1.5 times more on average than the federal government for these 10 common prescription drugs.
Table 3.10 Major Metropolitan Areas with Highest Average Cost to Uninsured Consumers of 10 Common Prescription Drugs Supply Price Solutions and Policy Recommendations
hile the prescription drug crisis is undeniably
complex, there is no shortage of suggestions
At the Federal Level
The Bush administration’s preferred policy, recently
passed Medicare reform bills that attempt to
passed by the U.S. House and Senate (see sidebar),
achieve the Bush administration’s goal of
follow the pharmaceutical industry’s preferred road:
providing more comprehensive health insurance,
recipients. Seniors seeking the drug benefit
especially to senior citizens and the disabled, instead
of taking action to reduce the costs of prescription
insurance providers organized on a regional
drugs.24 Rather than instituting the “price controls”
basis and to pay unknown premiums not set
of some healthcare systems, the pharmaceutical
by the law. In effect, this policy would not
industry would prefer that legislators “empower
guarantee that Medicare beneficiaries will
have an affordable prescription drug benefit
seniors to choose among competing private-sector
plans that would give them coverage similar to the
plans that millions of working Americans, including
The Bush administration and Congress have
not proposed any policy that would lower
the cost of prescription drugs on the market. Creating a drug benefit for seniors is a step
This approach has many flaws. Most importantly, it
fails to address the root causes of rising drug prices
and does not offer any relief to uninsured or
underinsured consumers that are too young to
As this report went to print, Congress had
yet to produce a final bill out of conference
In order to fill these important holes, the state PIRGs
support the following solutions to the problem of unaffordable prescription drugs: Prescription drug buying pools. The state PIRGs support creating prescription drug-buying
pools at the state level that would allow businesses, the government and individuals of all ages
to use their combined buying power to negotiate lower drug prices, similar to what the federal government and big HMOs do. Specifically, this would: Give the state government the ability to negotiate substantial rebates from drug companies
and discounts from retailers, then pass those savings along to participants; and Provide tools to help persuade drug companies to negotiate prices in good faith, including public disclosure of uncooperative companies.
Access for generic drugs. The state PIRGs support policy to close the loopholes that allow
companies to block lower-priced generic versions of their drugs from reaching the marketplace. Greater Use of Preferred Drug Lists. The state PIRGs support policy that allows states to convene panels of experts to evaluate the effectiveness and prices of similar medications, placing equally effective yet lower cost medications on “preferred drug lists,” or PDLs. Health care
providers and state governments could use
The Maine Rx Program: Groundwork for State Action
decisions, ensuring that patients get the most
In May 2000, the Maine legislature passed the Maine
Rx Program, which allows the state to negotiate
fairer drug prices for all residents, regardless of
income level or age, by using the buying power of its
Medicaid program. Maine Rx also gives the state the
Disclose gifts by pharmaceutical industry.
authority to establish maximum retail prices for
At minimum, the state PIRGs support policy
pharmaceuticals if negotiations failed to lower drug
to require pharmaceutical manufacturers to
report to state officials (and the state officials
to report to the public) information about
The U.S. Supreme Court heard arguments in a
lawsuit brought by the Pharmaceutical Research and
Manufacturers Association (PhRMA), ruling in May
prescribe, dispense, or purchase prescription
2003 that the program does not interfere with
interstate commerce and that the state could go
Meanwhile, dozens of states are considering adopting programs similar to Maine Rx.
Concerned over future legal challenges, Maine Governor John Baldacci signed legislation in June
2003 amending the state program to limit its benefits
to Maine residents whose income falls under 350% of
the federal poverty level ($64,400 for a family of four and $31,400 for an individual) and to individuals
whose drug expenses exceed 5% of their income.
Source: National Conference of State Legislatures, Maine Citizen Leadership Fund Methodology
he ten drugs selected for this survey were the drugs most frequently prescribed to seniors
Tcitizens, according to the 2001 list of the Pennsylvania Pharmaceutical Assistance Contract
for the Elderly (PACE). PACE is the largest state pharmaceutical assistance program for older adults.a The dosages were the most commonly prescribed amounts, according to the PACE database. The drugs surveyed and their uses are as follows.26 Prilosec, 20 mg/30 capsules. Prilosec belongs to a class of drugs called proton pump inhibitors. These drugs work to decrease the amount of acid produced in the stomach and is prescribed for
patients with ulcers, gastric reflux disease or heartburn, and other conditions. Norvasc, 5 mg/30 tablets. Norvascis a calcium channel blocker, which works by relaxing and widening veins and arteries, thus reducing the heart’s workload by making it easier for it to pump blood. Norvasc may be prescribed for patients with hypertension (high blood pressure) and angina (chest pain). Lipitor, 10 mg/30 tablets. Lipitorworks by blocking the production of cholesterol in a patient’s body. Lowering cholesterol levels can reduce a patient’s risk of hardened arteries, which can
lead to heart attacks, strokes and peripheral vascular disease. Celebrex, 200 mg/60 capsules. Celebrex is prescribed to patients suffering from osteoarthritis and rheumatoid arthritis and works by reducing substances that cause inflammation, pain, and fever.
Plavix, 75 mg/30 tablets. Plavixprevents blood clots from forming by preventing platelets, or red blood cells, from clumping in a patient’s blood. Plavix can be prescribed to prevent and treat
heart attacks, stroke, blood clots, and acute coronary syndrome. Furosemide, 40 mg/60 tablets. Furosemide, a diuretic, reduces the amount of fluid in the body by increasing the amount of salt and water lost in urine. Patients with congestive heart failure, kidney or liver disease may be prescribed furosemide to reduce swelling caused by excess fluid.
Furosemide is the generic version of the drug Lasix. Prevacid, 30 mg/30 tablets. Prevacid, like Prilosec, reduces the quantity of acid produced by the stomach. Prevacid may be prescribed for patients with stomach and intestinal ulcers and
erosive esophagatis, in which stomach acid damages the esophagus. K-Dur 20, 20 MEQ/30 tablets. K-Dur 20 is a potassium chloride supplement used to treat patients with a potassium deficiency. There are multiple versions of K-Dur 20 available.
a While high drug prices are a problem for all age groups, we decided to focus on the elderly, since they tend to take more medications and have limited incomes and are thus hardest hit by high drug prices.
Lanoxin, .125 mg/30 tablets. Lanoxin works to help the heart beat more strongly and regularly. Patients with congestive heart failure and irregular heartbeats may be prescribed Lanoxin.
Generic versions of Lanoxin are sold as its active ingredient, digoxin.
Zocor, 20 mg/30 tablets. Zocorworks like Lipitor to reduce a patient’s production of LDL, or “bad” cholesterol, while increasing the amount of HDL, or “good” cholesterol. Reducing cholesterol levels can reduce the risk of hardened arteries, which may lead to heart attacks, stroke, and peripheral vascular disease. Average Retail Prices We surveyed a total of 559 retail pharmacies in 18 states and Washington, DC in March and April of 2003. We chose to survey pharmacies – rather than online retailers or other outlets – because the vast majority of Americans purchase their medications from retail pharmacies. Retail pharmacies filled more than 3 billion prescriptions in 2001, totaling $164 billion.27 The pharmacies surveyed included independent and chain pharmacies, as well as pharmacies in larger discount retailers. We selected the pharmacies at random from telephone books. As a condition of their voluntary participation, we assured pharmacists that we were not conducting a store comparison, only a prescription drug price comparison.
Federal Supply Schedule Pricing The most favored customer price used for comparison is the federal supply schedule price, provided by the Pharmacy Strategic Benefit Management Group of the Department of Veterans Affairs, which oversees the federal supply schedule prices. We downloaded the Federal Supply
Schedule prices from http://www.vapbm.org/PBM/prices.htm on June 30, 2003. The
pharmaceutical industry, HMOs, and large insurers do not make public the drug prices paid by most favored private sector customers. The U.S. General Accounting Office, however, has found
that “federal supply schedule prices represent the best publicly available information of the prices that pharmaceutical makers charge their most favored customers.”28 When multiple Federal Supply Schedule prices were available for a specific drug, we used the highest available price. Because the Federal Supply Schedule prices do not include pharmacy dispensing fees, we added $4 to each price to reflect a reasonable fee. Large purchasers,
including HMOs and the federal government, negotiate a fixed dispensing fee per prescription. Appendix A.Average Retail Prices by Location for 30-day Supply of Medication Prilosec Celebrex Furosemide Prevacid
$53.81 $81.96 $189.18 $137.88 $13.25 $159.14
$147.46 $26.47 $10.17 $144.47 $93.78
$25.19 $10.52 $141.76 $92.88
$52.14 $79.22 $180.71 $135.14 $12.75 $148.47
$10.85 $141.77 $92.87
$24.49 $9.89 $141.93 $91.43
$78.15 $177.37 $131.49 $10.10 $146.55 $23.94 $10.04 $142.87 $91.05
$50.57 $75.03 $176.71 $132.59 $14.16 $140.72 $26.18 $12.74 $137.17 $90.17
$73.75 $173.20 $136.80 $12.07 $150.14 $24.10 $10.69 $137.20 $90.17
$142.63 $25.30 $10.24 $140.71 $90.03
$141.12 $25.33 $11.08 $138.39 $89.48
$142.68 $48.96 $74.69 $166.70 $129.25 $9.57 $142.74
$24.82 $11.21 $137.82 $88.17
$48.86 $74.29 $168.83 $127.22 $12.20 $140.14 $25.87 $10.96 $136.83 $87.97
$71.35 $168.09 $128.42 $17.84 $140.35 $25.68 $11.04 $134.05 $87.97
$141.12 $24.10 $10.97 $135.73 $87.09
$140.97 $25.51 $10.78 $131.87 $86.98
$138.79 $26.32 $11.40 $134.73 $86.92
$69.73 $168.56 $129.08 $10.65 $137.22 $22.99 $10.23 $133.51 $86.62
$73.50 $164.66 $128.53 $12.65 $134.34 $24.52 $11.18 $131.52 $86.29
1 Robert Langreth, “The New Drug War,” Forbes, 21 March 2003, 84.
2 “Prescription Drug Expenditures in 2001: Another Year of Escalating Costs,” National Institute for Health Care Management, 6 May 2002: 13.
3 Scot Hensley, “Drug Prices Rise at Faster Clip, Placing Burden on Consumers,” Wall Street Journal, 15 April 2003.
4 Robert Langreth, “The New Drug War,” Forbes, 21 March 2003, 84.
5 “New Census Bureau Numbers Increase Estimates of Uninsured for 2000 and 2001”, Families USA press release, 30
6 “The Uninsured and their Access to Health Care,” Kaiser Commission on Key Facts: Medicaid and the Uninsured, February
7 “Underinsured in America: Is Health Coverage Adequate?” Kaiser Commission on Key Facts: Medicaid and the Uninsured,
9 Bill Brubaker, “Drug Spending Falls As Co-Payments Rise,” Washington Post, 9 October 2002, E03.
10 “Pharmaceuticals Rank as Most Profitable Industry, Again.” Public Citizen, April 2002.
11 “Profiting from Pain: Where Prescription Drug Dollars Go,” Families USA, July 2002, 1.
12 “Drug Industry Employs 675 Washington Lobbyists, Many with Revolving-Door Connections, New Report
Finds,” Public Citizen press release, 23 June 2003, available at
13 “Intellectual Property Overview,” http://www.phrma.org/issues/intprop/. Accessed 18 March 2003.
14 “Why Do Prescription Drugs Cost So Much?… and Other Questions About Your Medicine,” Pharmaceutical
Research and Manufacturers Association (PhRMA), available at
15 “Would Lower Prescription Drug Prices Curb Drug Company Research and Development?” Public Citizen,
http://www.citizen.org/congress/reform/drug_industry/profits/articles.cfm?ID=7909. Accessed 18 March 2003.
16 Scott Hensley, “Drug Prices Rise at Faster Clip, Placing Burden on Consumers,” Wall Street Journal, 15 April 2002.
17 “Profiting from Pain: Where Drug Dollars Go,” Families USA, July 2002, 3.
18 Gardiner Harris and Joanna Slater, “Generic Drug Makers Use Altered Copies to Outmaneuver Patients in Legal Battles,” Wall Street Journal, 17 April 2003.
19 “The Drug Industry: Facts and Figures.” Families USA, April 2002.
20 Gardiner Harris and Joanna Slater, “Generic Drug Makers Use Altered Copies to Outmanuever Patients in Legal Battles,” Wall Street Journal, 17 April 2003.
21 Patrick Cafferty, “Collusion and Other Anticompetitive Practices: a Survey of Class Action Lawsuits Against Drug Manufacturers,” Families USA, April 2002: 29.
22 Melody Petersen, “Bayer Agrees to Pay U.S. $257 Million in Drug Fraud,” New York Times, 17 April 2003.
23 For example, see “Consumer Groups Charge Industry-Wide Price Manipulation - Over $800 Million in Illegal
Profits from Medicare & Medicare Patients,” Press release, Prescription Access Litigation Project, 20 December
2001, available at http://www.prescriptionaccesslitigation.org/press-awp-1201.htm
24 “Why Do Prescription Drugs Cost So Much?… And other Questions About Your Medicine,” Pharmaceutical
Reserachers and Manufacturers of America (PhRMA): June 2000, 19.
26 All descriptions of the drugs surveyed and their therapeutic use come from the website www.rxlist.com.
27 “In 2001 Retail Pharmacies Filled Over 3 Billion Prescriptions Totaling $164 Billion,” National Association of
Chain Drug Stores press release, 12 August 2002.
28 Correspondence by William J. Scanlon, Director, Health Financing and Public Health Section, U.S. General Accounting Office, 21 April 1999.
Informatie voor deelnemers aan het onderzoek “Losartan en Marfan syndroom” Coördinerend onderzoeker: Dr. M. Groenink, cardioloog AMC Amsterdam Artsonderzoekers: F. S. van Dijk, artsonderzoeker VUmc Amsterdam T. Radonic, artsonderzoeker AMC Amsterdam Academisch Medisch Centrum Meibergdreef 9 1105 AZ Amsterdam VU Medisch Centrum Amsterdam De Boelelaan 1117 1081 HV Ams