An Email Sent to Senator Richard G Lugar
by Bill Sanders - August 28, 2006

Dear Senator Lugar,

Recently, discussing my medications and their high costs with my doctor, he made the statement that, apparently, sometimes he's lied to about the prices. I have a solution to this problem, if you're interested. At over $1000 for three months of prescription medicines, I had easily covered my deductible, and have hit my "donut hole" for the year. I now need to pay a minimum of somewhere around $2500 from my own pocket, which I can ill afford, before the "catastrophic coverage" kicks in. By the time this happens, unless something major comes up, it will be time to start the cycle over again (deductible, etc.)

After some research on prices at nearby pharmacies that actually list them online, I found a HUGE disparity. Many current seniors have absolutely NO CLUE about doing this type of research for their drug costs, and doctors (and others) don't have time, since they are all in these groups (HMOs, PPOs, whatever) and get paid pretty much by the number of patients in the group they can see in any given day/week/month/whatever, not to mention all the paperwork, continuing education, etc., they must do. Most seem to TRY to give their patients everything they need, but while learning what new medications are available, and which will deal with what diseases, they do not seem to be accurately informed of the prices of many of the medications they prescribe.

I realize that something like what I'm about to propose may be difficult to do, since pharmacies (and many retail outlets) do not want their clients to know their profits for each drug. HOWEVER, what I'm proposing doesn't mean they have to provide their profit margins, just what they charge for each drug. It WILL give information on the prices of medications from various pharmacies IN ONE PLACE, allowing the consumer (and their doctors) to "comparison shop", and get their medications at the least cost to themselves and their insurance companies.

The idea is not to make the pharmacies justify their prices, but to allow the consumer a "one-stop-page" for each of their medications, where they can see how much each pharmacy is charging for their prescription. It could also be used for consumer and doctor education, allowing all to see what a given drug covers, the cost, and possible (cheaper) alternatives.

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Background

To show the disparity in drug prices at different pharmacies, the following will use my own prescriptions, both the ones I was taking, and the ones suggested by my doctor (prescribed, if I could afford them), and research on the costs over a one-day period in the last week of July. (Sorry... I didn't keep track of the day.) I'm sure that if you used the online pricing, as I did, you will find prices for other drugs just as disparate.

Since my current mail-order prescription service requests a 90-day supply, and I know that in most cases purchasing by volume provides the largest discount, I tried to find those prices. I couldn't at some places (for example, Kroger, WalMart and Sam's Club do not list prices online - You MUST contact the pharmacy by phone, taking the time of the druggist to look them up, when they could be filling prescriptions or other in-store work they do.) HOWEVER, CVS lists "popular" drugs, and Walgreens, Costco, and Drugstore.com seem to list most of them. These are the pharmacies in my area that I know about. I know there are "mom-and-pop" drugstores in many areas, and others in other states. I would think that except for the latter, the "big pharmacies" would have at least a "standard" format for their drug lists, from which drugs in Medicare's formularies could be retrieved or sent to as often as each updates their prices.

Again, Kroger, WalMart and Sam's Club do not show prices online. And I probably missed a number of pharmacies in Indianapolis, Frankfort or other nearby towns/cities. I also did not include the prices from my current mail-order provider (Pharma-Care), because I tried the other day, and because of the MAJOR disparity in prices they were showing and the report I was given for May/June, 2006, I called and was told their "Copay Counselor" was "messing up". Therefore, I could NOT trust any of the prices they showed online. The green ones, at the bottom, are medications I was talking, or ones I thought my doctor might be interested in for me or maybe someone else. The yellow ones are the lowest prices for the prescriptions he suggested.

Please note that Drugstore.com has the lowest online prices of most of these medications. For the ones they are "high" on, Costco pharmacy is MUCH lower.

I understand that medications, especially generics, are based on manufacturer's prices and "how much the market will bear". But this, especially the latter, can be very unfair to consumers. And, it appears to me that many pharmacies charge not on their costs, but more based on what the insurance companies will pay, without regard to what the consumers who are working with deductibles and those "in their donut hole" must pay. True, there are prescription cards giving discounts, but they DO NOT help that much, and do not help at all if you do not qualify, based on NEED.

For example, I am 51 years old, disabled (physically-challenged), on Social Security Disability and that's ALL the actual income I, personally have. I have money in an IRA, but if I draw from it before I reach a certain age, I must not only pay a penalty, but income taxes on it. I get about enough NET a month from SSD, to cover my house payment, most utilities, AARP membership and insurance, and AAA membership and auto insurance. My wife (49 this year), works third shift in a factory, and makes just enough to cover our food; personal, kitchen and laundry supplies; our second vehicle (a van that's to be modified soon, so I can drive it with hand-controls), and help out her children, one of whom is having a baby - the first granddaughter, the first part of August. She also helps cover utilities/payments I can't, and, again, has precious little-to-no money left over for anything else.

As I told a few people I talked to about hitting my "donut hole" by mid-year, "Now I know why seniors have to make a choice between food and medications", and I understand, now why so many "eat dog food".

Medicare Part D, the way I understood before it was actually implemented, was to be something that would help with prescriptions and be fairly easy to use. Then, it appears, the bureaucrats and insurers that supplement Medicare got hold of it, and made it almost as complicated as the tax code! My father, who was a businessman for 50+ years, and sold insurance for 20+ years, had, and still does have, trouble understanding it! (He's covered based on retirement from the insurance company, not by Medicare, but my mother and grandmother are both on Medicare coverage. And, no... He has no indications of senility!)

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PROPOSAL

I suggest that Medicare (or some other government agency with the "clout" to order compliance from all pharmacies) create a National database listing all drugs in at least the Medicare formulary, and any other drug that is fairly widely used. This database would show the price of each drug in each dosage in each standard prescription level.

It would/should NOT be "sponsored" by any single pharmacy. If they have a consortium group, IT could sponsor the list as it would be ALL member pharmacies. However, if the latter is the case, they MUST allow other pharmacies to be included. It should NOT be sponsored by any individual drug company, unless they can and will allow all drugs from all manufacturers to be listed. It should NOT be sponsored by any advertising agency who promotes individual drugs, pharmacies or pharmacological companies. There should be NO SPIN on this information. It should be presented "as is" based on information received. There should be no "Google", "Yahoo" or other "keyword advertisements", except, possibly, on individual dosage pages (see example, below), showing comparable drugs.

For example, for each drug, the consumer (and doctors and anyone else) would be able to see see a list of known pharmacies within a certain mileage range from the consumer's zip-code/home that carry it, tables for each of the "standard" levels of prescription for that medication (7 days/doses, 14 days/doses, 30 days/doses, 60, 90, 120, 180, etc.), the current price, when that price went/goes into effect, the prior price, and when it went into effect, and the date of the next download of prices from each pharmacy, with the lowest prices highlighted. This table would NOT take into effect the prices charged the insurance companies. Each insurer should have their own tables, based on the pharmacies in their systems, and how much they've contracted with each pharmacy for drugs in THEIR formularies. Maybe there should also be a picture of the pill/drug, itself.

The following would be something everyone (consumers/doctors/etc.) should be able to get on the internet through this site for free. It should NOT be a subscription service. Too many people can't afford their drugs. How could they afford a subscription?

Here's a possible webpage page layout for one medication, one size, and multiple prescription periods [chosen for the popularity]:

I set it up this way, because it would make the page far too wide to list the number of days/dosages and other information across the page. This will give everyone the information necessary (when the current price was set, what it was before and when it that prices was set, when the next update for each pharmacy should occur) for each drug.

HOWEVER, with generics, some pharmacies apparently carry multiple manufacturer versions. These should probably be listed across the page with different columns of boxes for each manufacturer carried. (or maybe only list the lowest-cost or two).

NOTES: For places like Costco and others, who apparently sell their drugs in "packs" or other-than standard prescription periods, it may be necessary to show the closest count/amount to the prescription as possible.

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*** Technical Info ***

If a pharmacy (physical or online) is known to get drugs from overseas/out of the country, and this is not recommended by Medicare or doctors, they will not be listed for ANY drug, or a warning will be attached to their listings.

If the current price doesn't change on an download of information, no changes are made in the drug record except when the next update should occur. When the current price is changed, the old current price and updated date is shifted to the "PRIOR" columns before the current price and updated date is set. Again, NO CHANGE is to be made if the price remains the same.

Clicking on the drug name would bring up (in a separate window) the drug's information sheet. This COULD be done by clicking on a pharmacy's name, however, the drug, itself, should have a standardized information sheet available from somewhere, and it would be preferable it NOT be one from a single pharmacy. There should also be no advertisement attached to the sheet, other than the drug information, itself.

Clicking on the dosage, (or the word DOSAGE, above) will list all available dosages and the current price for each, available at all pharmacies that will be listed for it. For most patients, the doctor will probably start at a low dosage level and raise it incrementally, as available. This will allow doctors and consumers to know the next available level and cost of raising the dosage.

Clicking on the Class name will bring up other drugs in that class. If generics are available, they, too, will be listed. Since the price is in the database for each, the drug in the class with the lowest price should be highlighted, or they should be listed from lowest price to highest.

It's possible we may also want a "price per pill" as the first or second column after the pharmacy information column(s), for comparison. (or it could be programmatically divided out, showing possible discounts for "volume" purchases).

If cost from a pharmacy is on a "per pill/dose" basis, the program would multiply it for each prescription period shown.

For "chain" pharmacies, all of those in the selected area would be listed, and each would be required to show their prices. (From what I understand, there are times one of a chain may have lower prices than another of the same chain.) While I didn't list an address for each store, above [I did for the webpage], with THIS being the case, each store's address (possibly linked to a MapQuest-type map) should be listed, too.

As each pharmacies' information is downloaded (s/b 24 hours before prices change), and saved, various pieces of data are checked against prior entries. For example, Manufacturer - If a new manufacturer is listed in their download, the information is added to the Manufacture's DB. If a new drug is added, it's information is added to the files/dbs as necessary. If information is missing, once the download is complete, a report of "missing fields" is sent to both the pharmacy and to whomever is in charge of this DB. The missing (or misformed) information should be corrected within 24 hours. 24 hours after the download, hopefully all information in it has been corrected, added, etc., and the data is merged into the main (displayable) database.

The 24 hour limit is based on information I received that data like this is updated weekly. A periodic report is run on the displayable database, showing any "problem" areas.

If a pharmacy is not listed, and wishes to be, they must generate a price list with the data needed. If certain medications are not in their data, they will NOT be listed for that medication.

Any and all "natural supplements" that have been proven to the government's (or sponsoring group's) satisfaction that they are safe and can mitigate a given disease based on the drug in question's class, they and their information could be included in this database, allowing doctors and consumers a possible alternative to pharmacological drugs. (This would possibly add "GNC" and other "health-food stores" into the list.)

For Medicare (or others): The larger mail-order pharmacies they use should also be included in this database. If they only work with insurance companies, this should be noted in the pharmacy db, as well as in the special notes on pages in which they are listed. (Caremark, Pharmacare, etc.)

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Summary

Personally, I'd like to see this database for ALL medications, so it can be used by and for consumers of all ages (babies through seniors), if at all possible. I realize this database would probably be huge, thereby making this a huge undertaking by whatever organization does it, as well as the pharmacies and other companies involved.

But I believe it's needed, immediately, if not sooner, to help consumers, doctors, insurance companies, and watchdog groups keep track of drug costs.

Thank you for reading my ideas. I hope they are something worth considering.

William D. Sanders

PS: I would also have liked to send a copy (To: or Cc:) to Sen. Bayh, Rep. Buyer (and other Indiana Representatives), Medicare, the AARP, and maybe others, but after spending a couple of hours searching for direct email addresses for those I listed, it appears that most others use small contact forms, and, as you can see (I hope), this is a somewhat long and formatted email.

If you do NOT receive email in HTML/RTF format, and are interested, let me know, and I will send another version (WORD? PDF? - which would you prefer?) There are tables in this email, so it would need to be either one of them or HTML. I could also publish a version on my website (and not allow it to be crawled/spidered), and send you the link.