Jing Luo, MD, MPH; Martin Kulldorff, PhD; Ameet Sarpatwari, JD, PhD; Ajinkya Pawar, PhD; Aaron S. Kesselheim, MD, JD, MPH
Acknowledgment: The authors thank Michael S. Sinha and Chintan Dave from the Program On Regulation, Therapeutics, And Law (PORTAL) and GoodRx employees Sivakami Sambasivam and Thomas Goetz for comments on earlier drafts of this manuscript.
Financial Support: By Arnold Ventures. The work of Drs. Kesselheim and Sarpatwari is also supported by the Engelberg Foundation and the Harvard-MIT Center for Regulatory Science.
Disclosures: Dr. Luo reports salary support from Alosa Health and Arnold Ventures outside the submitted work. Dr. Sarpatwari reports grants from Arnold Ventures, the Anthem Public Policy Institute, and the Open Society Foundations outside the submitted work. Dr. Kesselheim reports grants from Harvard-MIT Center for Regulatory Science, Arnold Ventures, and the Engelberg Foundation outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1138.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Luo (e-mail, firstname.lastname@example.org). Data set: Not available.
Corresponding Author: Jing Luo, MD, MPH, Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120; e-mail, email@example.com.
Current Author Addresses: Drs. Luo, Kulldorff, Sarpatwari, Pawar, and Kesselheim: Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120.
Author Contributions: Conception and design: J. Luo, M. Kulldorff, A. Sarpatwari, A.S. Kesselheim.
Analysis and interpretation of the data: J. Luo, M. Kulldorff, A. Sarpatwari, A. Pawar, A.S. Kesselheim.
Drafting of the article: J. Luo, A. Sarpatwari.
Critical revision of the article for important intellectual content: J. Luo, M. Kulldorff, A. Sarpatwari, A.S. Kesselheim.
Final approval of the article: J. Luo, M. Kulldorff, A. Sarpatwari, A. Pawar, A.S. Kesselheim.
Statistical expertise: M. Kulldorff, A. Pawar.
Obtaining of funding: A.S. Kesselheim.
Administrative, technical, or logistic support: J. Luo, A. Sarpatwari.
Collection and assembly of data: J. Luo.
Cash prices for prescription drugs vary widely in the United States.
To describe cash price variation by retail pharmacy type for 10 generic and 6 brand-name drugs throughout the United States and stratified by ZIP code.
Drug pricing data from GoodRx, an online tool for comparing drug prices, representing more than 60 000 U.S. pharmacies (fall 2015).
Cash prices for a 1-month supply of generic and brand-name drugs were ascertained. Stratified by ZIP code, relative cash prices for groups of generic and brand-name drugs were estimated for big box, grocery-based, small chain, and independent pharmacies compared with a reference group of large chain pharmacies.
Across 16 325 ZIP codes, 68 353 unique pharmacy stores contributed cash prices. When stratified by 5-digit ZIP code, the relative cash prices for generic drugs at big box, grocery-based, small chain, and independent pharmacies compared with those at large chain pharmacies were 0.52 (95% CI, 0.51 to 0.53), 0.82 (CI, 0.81 to 0.83), 1.51 (CI, 1.45 to 1.56), and 1.61 (CI, 1.58 to 1.64), respectively. The relative cash prices for brand-name drugs were 0.97 (CI, 0.96 to 0.97), 1.00 (CI, 0.99 to 1.00), 1.06 (CI, 1.05 to 1.08), and 1.03 (CI, 1.02 to 1.04), respectively.
Results may not reflect current drug prices and do not account for point-of-sale discounts or price matching that may be offered by smaller pharmacies.
Compared with large chains, independent pharmacies and small chains had the highest cash prices for generic drugs and big box pharmacies the lowest. Relative differences in cash prices for brand-name drugs were modest across types of retail pharmacies.
Luo J, Kulldorff M, Sarpatwari A, et al. Variation in Prescription Drug Prices by Retail Pharmacy Type: A National Cross-sectional Study. Ann Intern Med. 2019;:. [Epub ahead of print 1 October 2019]. doi: 10.7326/M18-1138
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Published: Ann Intern Med. 2019.
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