Yes, please, take my money.
March 8, 2011 6:15 PM   Subscribe

Prescription drug pricing wtf: Compared to last month, this month I got 50% more milligrams of an antidepressant, but had to pay 200% more money. The only difference is the pills were smaller, and so there were more of them. I don't understand what's going on here.

Bupropion (Wellbutrin generic) is the drug I got. Last month I paid $40 for 30 pills of 300mg each. 300mg x 30 pills = 9000mg. This month, my dosage was upped from 300mg to 450mg. I paid $120 for 90 pills of 150mg each. 150mg x 90 pills = 13,500mg. So that's a 50% increase in total milligrams, but a 200% increase in price. When I voiced my bewilderment to the clerk, she asked the pharmacist, and the only explanation given was that this month I got 90 pills instead of 30. I looked at the smaller pills and they were the same as the bigger ones, just smaller; it's not the case that one was "extended release" and the other was not, or something like that.

Surely the cost to the drug company to make more and smaller pills is negligible. So what's going on here? Is it just the drug companies being arbitrary?
posted by frankly mister to Health & Fitness (16 answers total)
Perhaps part of the bill is a per-pill dispensing fee paid to the pharmacy. Does your receipt not itemize this and the cost of the drug separately?
posted by astrochimp at 6:22 PM on March 8, 2011

The same thing happened to me when I switched from a 60 mg dosage (one 60 mg pill) to a 90 mg dosage (three 30 mg pills) of the same medication. It really is just about the number of pills they're giving you. My pharmacist told me that she could issue thirty 60 mg pills and thirty 30 mg pills each month but THEN she'd have to charge two dispensing fees, one for each size, and that would effectively negate any money I'd saved. Yeah. It is dumb. But it's definitely not unheard of.
posted by kate blank at 6:23 PM on March 8, 2011

I've had this happen to me a few times; from what I understand, pricing is per pill, not necessarily a function of how much medication you're actually getting. It's arbitrary and it sucks. If you're getting tablets (as opposed to capsules, I forget what buproprion comes in), you might be able to just get more of the 300mg ones and split them to take 1.5 pills = 450mg. YMMV, depending on your doctor and pharmacist.
posted by greatgefilte at 6:28 PM on March 8, 2011

Probably not a dispensing fee, but just the way the Pharma company prices things. Pills aren't priced "per ounce" by the company, and it *is* more expensive to produce 3 little pills than one big pill with the equivalent dosage.

Next time, ask your doctor to prescribe you 30 300mg pills, and 30 150mg pills. Should save you a bit of money.
posted by schmod at 6:29 PM on March 8, 2011 [1 favorite]

(Oh. And FWIW, I used to work in generic Pharma)
posted by schmod at 6:30 PM on March 8, 2011

You paid 3 times as much for 3 times as many pills -- it's per-pill pricing.

While pharma pricing is insane throughout, they do have a per-pill production cost when making the pills, not a per-milligram production cost ... and cost of making the pill doesn't really depend on size-of-pill.
posted by Eyebrows McGee at 6:46 PM on March 8, 2011 [3 favorites]

Try asking for a pill that is a higher dose and splitting it. So ask for your pills in 300 mg, split one, and take 1.5 pills a day. You may pay less. This is what I do. Typically, lower dose pills tend to cost more over all.
posted by wandering_not_lost at 6:55 PM on March 8, 2011 [1 favorite]

If you pay $25 for a year and there's a Walgreens near you, you can get Buproprion under its Prescription Savings Club. It's $12 for 180 pills. TOTALLY AWESOME. Unfortunately it's doesn't seem to be covered by any other commercial pharmacy chain.
posted by schroedinger at 7:08 PM on March 8, 2011 [1 favorite]

Oh, sorry, forgot to mention the pills are 75mg each. You end up taking more pills, but that's still 30 days for $12.
posted by schroedinger at 7:09 PM on March 8, 2011

wandering_not_lost suggests splitting the pill. Some pills can't be split; the wikipedia article on bupropion is a bit confusing about this, because apparently the term "extended release" is ambiguous. You should probably ask the pharmacist what effect, if any, splitting a 300 mg pill in half would have.

Or -- and I'm thinking outside the box here -- could you take a 300 mg pill every sixteen hours? So on one day you take the pill when you wake up (say 7am) and at bedtime (11pm) and the next day in the middle of the day (3pm). I don't know enough about antidepressants to know if this is a reasonable option, though.

(I'm not a physician. Or a pharmacist. I just know lots of random crap and have access to wikipedia.)
posted by madcaptenor at 7:36 PM on March 8, 2011

Capitalism just made you its bitch. That's what happened.

Drug companies play all sorts of pricing games to maximize revenue. The price of a set of pills bears almost no relation to how much it costs to manufacture them. You have to recoup research costs, pay for advertising, and provide a healthy profit margin on top of all that. So, a drug company will tweak prices as much as it can for all sorts of market-slice demographics, and as long as insurance companies and end-use consumers go along for the ride, rationality goes out the window.

But in all seriousness, if someone/insurance-company is willing to pay $X to alleviate depression, (and the dosage/marginal-cost is immaterial) then you may as well charge people who need 150mg a day the same as those who need 300mg a day. After all, they both wind up significantly less depressed, and as to why 150mg is the magic number for one person, and 300mg the magic number for the other, that is a matter of a person's unique pharmacological makeup, and not of economics.

If your doctor prescribes for you the per-pill dosage recommended for light users, but taken several times per day, you will lose out. Because it is assumed that you are a one-pill-per-day user. But you aren't. So you pay through the nose.
posted by Maxwell_Smart at 7:43 PM on March 8, 2011 [2 favorites]

I get a particular 30-mg-daily med as two scrips (10 mg and 20 mg daily) because the 30 mg tablets (and the 15 mg tablets) are less commonly prescribed than the 10 or 20, and so they're more expensive per pill. This was true in the US and it's true in Australia.
posted by gingerest at 8:26 PM on March 8, 2011

It might be the difference between generic and brand name bupropion. Many insurance companies will charge less if you go with a generic med.
posted by BadCat! at 8:30 PM on March 8, 2011

It may also have to do with the contract that your health insurance cut with the drug company. Some strengths are more common and used in larger volume, so the contractors can negotiate a better price.
posted by SLC Mom at 8:32 PM on March 8, 2011 [1 favorite]

If your doctor prescribes for you the per-pill dosage recommended for light users, but taken several times per day, you will lose out.

Not to derail here, but I'm having a tough time thinking of a perfectly-fair system for this. Standard economic models do not work particularly well for pharma (and not just because of our f**ed up insurance system). When your per-unit costs are quite low, your R&D costs are (often literally) on par with putting a man on the moon (and not every drug gets approved), and patents only valid for ~10 years, supply/demand curves don't really help you set prices. I honestly cannot think of a fair way to price a drug that requires a highly variable dose.

(And mind you, I worked for one of the generic companies, so I have no particular sympathies to the name brand guys)

There's also the small issue that "Several pills over the course of a day" is almost certainly off-label use, which is murky territory at best. (There are some drugs that you can take this way -- most you can't). Unfortunately, people who need several pills to add up to the correct dose are casualties of the system, which can only accommodate a small handful of the most common dosages – and because it's a generic, there's nothing stopping the manufacturer from making a single-pill 450mg dose apart from the (apparently insufficient) market demand. (That said, my insurance company charges me by the number of days, and not the dosage -- several pharmacies I know of do the same for uninsured patients on generics.)
posted by schmod at 8:57 PM on March 8, 2011

Actually, if you're not on extended-release taking multiple doses of Wellbutrin throughout the day is recommended. It has a relatively short half-life in the body.
posted by schroedinger at 5:10 AM on March 9, 2011

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