Big differences in prices of prescription medicine

At some stage we all have to buy prescription medicine, and some people have to purchase medicine on a regular or ongoing basis.

But did you know that the prices for medicine vary from pharmacy to pharmacy?

For example you could pay €6 more for your pain relief spray, almost €19 more for heart tablets and €27 more for medicine to treat stomach ulcers, depending on where you make the purchase.

But prices aren’t displayed or advertised so just what are the price differences and how can you go about spending less?

From Tina’s slot on RTE Radio 1’s Today with Pat Kenny, 11th April 2013. 

The National Consumer Agency price survey

The survey priced 42 common medicines (details provided by HSE). The prices quoted in the National Consumer Agency (NCA) survey refer to the price charged to a first time private customer for each of the specific medicines, purchased individually on prescription.

These prices won’t be of concern if you are a public patient, or indeed if you participate in the drugs payment scheme where your payment is capped at €144 a month (unless perhaps if the cost falls very close to that cut-off).

132 pharmacy stores were selected for inclusion in the written survey and from those, information was received from 45 (34%). This seems like a low response rate but the NCA says it was “in the expected range” and that they are “confident that the methodology and sample size are robust and that the results represent an accurate description of the levels of price variation in the sector.”

In the news

Following the publication of the survey an article in the Irish Times reported that there were inaccuracies in the prices published. Pharmacies who had provided the prices in question were contacted again and in two cases it turns out they had given incorrect quotes. (There were 1,750 quotes received overall). These have been amended in the report but to do not change the overall findings and headline prices published.

But it goes to show just how little transparency there is when it comes to prices for prescription medicine. Consumers are reliant on prices quoted by the pharmacy and cannot check as there is no price display. Further, we can’t assume what the cost price is and add an average mark-up and dispensing fee to that to ‘guess’ a retail price, as the cost price too can vary.

Why such differences in price?

As with other retail sectors, a pharmacy can charge what they wish for a product they sell and that contributes to healthy competition.

In general when it comes to prescription medicines, there is the cost of the medicine to the pharmacy; on top of that a pharmacy will add a retail mark-up and also their dispensing charge.

The cost price to the pharmacy may come from the HSE list price (as agreed with the Irish Pharmaceutical Healthcare Association), or it may be different if sourced via ‘parallel importing’. This is where a pharmacy or group of pharmacies source from a different distributor, and many pharmacies employ a mix of both methods in order to source the cheapest cost price.

Given dispensing charges and margins can vary, this also contributes to price differentials.

For example, in relation to dispensing fees the NCA survey found that different policies apply across the pharmacies. Some apply a standard dispensing fee and others a dispensing fee varying with the price of the prescription medicines. Dispensing fees ranged from €3.15 to €7.00. But in a small number of instances a dispensing fee is not charged.

Other pharmacies charge no mark-up and just one ‘all-in’ professional / dispensing fee. For example Boots introduced this last year and charge a flat fee of €7.50 on top of their cost price. This can mean a lower end price to the customer but bear in mind that for lower cost medicine a pharmacy employing a percentage margin and dispensing fee may work our cheaper that this flat rate method.

The prices

Nationally, the average percentage price variation was found to be 56%. Prices differences ranged from 37% to 199%.

The most expensive area was Dublin with prices at 4.4% above the national average. But within Dublin the prices varied for individual products by a minimum of 34% and an average price difference of 44%, no doubt due in part to the presence or more pharmacies and therefore greater competition.

Galway was the least expensive with average prices 4.5% less than the national average. The average price difference in Galway was 30%.

In both Cork and Limerick the average price difference was 29% and in Waterford it was 27%, which was the lowest found nationally.

These high percentage differences show just how much prices can vary, especially in Dublin.

For a single prescription medicine within an area, the largest percentage variation in price was found in Waterford: Prices ranged from €22.43 to €49.69, a 122% difference (or €27.26), for the product Losec Mups 20 Mg (28) (used to treat stomach ulcers).

The second highest percentage price variation for a single product within a region was found in Dublin at 112% (or €22.37) as prices ranged from €19.96 to €42.33, for Zoton Fastab Tabs 30 Mg (28) (for stomach complaints).

  Prescription Medicine Lowest Price (€) Highest Price (€) Difference (€) Difference (%)
Nationally Losec Mups 20mg (28) 16.62 49.69 33.07 199%
Zoton Fastab Tabs 30 Mg (28) 19.96 42.33 22.37 112%
Emcor Tabs 5 Mg (28) 7.41 15.65 8.24 111%
Dublin Zoton Fastab Tabs 30 Mg (28) 19.96 42.33 22.37 112%
Co-Diovan Film Coated Tabs 160/12.5 Mg (28) 22.06 43.35 21.29 97%
Valium Tabs 5 Mg (100) 4.90 8.27 3.37 69%
Losec Mups 20mg (28) 16.62 28.02 11.40 69%
Cork Valium Tabs 5 mg (100) 5.07 8.27 3.20 63%
Lyrica Caps 50 mg (84) 93.17 134.33 41.16 44%
Seretide Evohaler 250 Mcg (1) 74.73 106.67 31.94 43%
Difene Spray Gel 4 % (25) 14.12 20.15 6.03 43%
Limerick Zoton Fastab Tabs 30 Mg (28) 21.46 41.64 20.18 94%
Co-Diovan Film Coated Tabs 160/12.5 Mg (28) 23.56 42.66 19.10 81%
Valium Tabs 5 Mg (100) 5.06 8.27 3.21 63%
Galway Lipostat Tabs 20 Mg (28) 19.42 38.30 18.88 97%
Valium Tabs 5 Mg (100) 4.50 8.27 3.77 84%
Tenormin-50 Tabs (28) 6.03 9.39 3.36 56%
Waterford Losec Mups  20 Mg (28) 22.43 49.69 27.26 122%
Emcor Tabs 5 Mg (28) 9.26 15.65 6.39 69%
Lyrica Caps 50 Mg (84) 93.17 133.33 40.16 43%

How can you save?

  • Given the survey information the obvious solution is to shop around. This means visiting or telephoning pharmacists to ask what your prescription would cost. However, while pharmacies should be happy to quote you I have heard of situations where they will not, though that seems like poor business sense!

But, while price is always important, there are other considerations that may be equally or more important to you when buying medicine; your relationship with your pharmacist for example, or proximity. In any case, it is important to know that prices vary considerably so that you can also take that into account when making your choice.

This is why it is crucial that price display and transparency on dispensing fees etc is introduced for prescription medicine. In this regard the NCA has written to the Pharmaceutical Society of Ireland (PSI) and are calling for an inclusion of a specific reference to the display of dispensing fee policy by pharmacists at their premises in the PSI Code of Conduct or other relevant guidelines. Even so, displaying a dispensing fee or flat rate alone will not tell the consumer what the end price to them will be.

  • Don’t assume any pharmacy is cheaper, either independent or chain, so make sure that you include all pharmacies in your local area when looking for the best price for your prescription medicine.
  • If you have a good relationship with your local pharmacist, try negotiating and ask for a discount. Some pharmacists reduce the overall cost for their customers by not applying the dispensing fee, or by applying just one dispensing fee on a number of prescribed products for example. In addition if you found a lower price elsewhere say so, and see will your pharmacist match it.

Also, if you buy say, six months worth of medicine at one time rather than one month’s worth, you’ll save on dispensing fees. Bear in mind that it would most likely not be appropriate for pharmacists to dispense in this way for some medicines like anti-depressants or sleeping pills for example.

  • Remember that generic medicines can be cheaper, for example if the specific medicine is just free from patent and relatively recent to the market. It isn’t always the case that generic is cheaper, but ask your GP to specify generic rather than brand on your prescription if relevant.
  • You are entitled to have your prescription filled in other EU countries, so if you are a regular visitor to Northern Ireland, where medicine can be cheaper or to Spain for example, where medicine is subsidised resulting in prices being up to 75% cheaper that here, then you are free to shop there instead to you choose.
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