What's with this inverse correlation?

September 21, 2006 1:29 PM

I recently increased my dosage of lamictal from 100mg/day to 200mg/day. I was prescribed 100mg pills, whereas before I had 25mg pills. For a month's supply of 100mg/daily in 25mg units, the bill sent to my insurance was over $500. For 200mg in 100mg units, it was just under $300. Why would more of the active ingredient cost less? I know the difference in pill count can't account for that much of a differential. What's the creative economics here?
posted by jammer to health (8 comments total)

Sadly, they do not charge for meds by how many mg they are. It's odd, I know... Also, look into 200mg pills. They actually make them. I would take one a day and it was cheaper then buying two 100mg pills (I was paying out of pocket)
posted by lockle at 1:48 PM on September 21, 2006

Well you are getting half the number of pills, and drug prices are often based solely on pill count rather than the amount of active ingredient in any given pill.

For reference, the red book (a Pharmaceutical reference) price of lamictal is $138.52 for 35 25mg pills, $395.78 for 100 25mg pills, $419.04 for 100 100mg pills, $278.98 for 60 150mg pills and $298.07 for 60 200mg pills.

Thus, there appears to be a per pill cost, with only a fractionary increase in cost per pill for an upped dosage.
posted by langeNU at 1:49 PM on September 21, 2006 [1 favorite]

I don't have an answer, but I recently ran into the same thing with Zoloft (the generic, even). I am prescribed 50mg daily, and it was cheaper to get a 15 day supply of 100mg tabs instead of a 30 day supply of 50mg tabs. I'm just as curious. I can't believe they charge by the pill instead of by the dosage. (I mean, I can, but it doesn't make sense to my medicated brain.)
posted by ArsncHeart at 1:50 PM on September 21, 2006

Here are the AWPs (source: Red Book)

LAMICTAL TAB 25MG (100) $395.78, $3.96 each
LAMICTAL TAB 100MG (100) $419.04, $4.19 each
LAMICTAL TAB 150MG (60) $278.98, $4.65 each
LAMICTAL TAB 200MG (60) $298.07, $4.97 each
posted by MarkAnd at 1:53 PM on September 21, 2006

Darn!
posted by MarkAnd at 1:54 PM on September 21, 2006

"Pills often have similar prices for different doses because 'the actual amount of the active chemical is a very small part of many pills. The bulk of the cost comes from packaging, advertising, and R&D, which are the same regardless of dose,' says Stafford. Drug companies also try to keep prices similar because they don't want to penalize patients who need higher doses." (cite)

Also, when I asked a similar question at the vet's, they said the reason why the 4 week supply cost exactly the same as the 1 week supply is because most of the charge is their pharmacist's flat rate "filling fee". Always ask your doctor (or vet) to specify max number of refills on the script. It gives the pharmacist a lot more latitude for saving you money. Also ask both doctor and pharmacist about which meds are eligible for pill splitting.

Insurers have begun to catch on to the huge savings potential and encourage splitting where possible, so don't assume yours will object.
posted by nakedcodemonkey at 2:00 PM on September 21, 2006

I've assumed that part of the pricing was due to the frequency with which a given dosage is rx'ed. In the insidious model, those pills most frequently rx'ed are priced higher to maximize profit. In the generous model, those rx'ed less frequently are priced higher because fewer of them are made so there is less economy of scale in the manufacturing. I have no evidence for either, but it at least suggest a reason for the price difference.
posted by OmieWise at 3:40 PM on September 21, 2006

I pay for my own Lamictal, sadly, and have found the same thing at my local Target pharmacy: 60 100 mg Lamicatals cost about $190; 30 200s cost $135.

Then again, the Canadian generic Lamictal - not available in the US - is about one-third either of those prices (2008 is when the generic should be available here.)

BTW, if you do have to pay for your own meds, Target and Costco's pharmacies are usually MUCH cheaper than your local Rite-Aid or CVS. (Rite-Aid claims to match prices, but two in my neighborhood outright refused.)
posted by soulbarn at 7:56 PM on September 21, 2006