Variable medication costs

[Lacessit]

I take Codiphen once a week for a good night's sleep. I take Finasteride daily for benign prostatic hyperplasia.

 

In Chiang Mai, I buy Codiphen at an independent pharmacy for 50 baht a pack of ten. In Chiang Rai, one of the pharmacy chains sells the same pack for 130 baht.

 

With Finasteride, the same pharmacy chain sells a 30-pill pack for 555 baht. An independent pharmacy sells the identical pack for 900 baht.

 

I can accept a plus or minus price variation of 10% between pharmacies, but these differences are ridiculous. IMO it's too much to say bulk buying causes the discrepancies. Can anyone explain why?

[internationalism]

different supply chains.

in the large towns would be cheaper, so shop around in CM. Go to many pharmacies.

Sometimes short expiry date would be discounted and new production higher

[rwill]

If you are talking about chains like Boots and Watsons they charge more than the local pharmacies.  Part of it probably has to do with having to pay more for their space in a mall.

[Bigz]

I find that small rural village pharmacies are much cheaper. I take anti histamine tablets for my allergy. In the nearest town to me they charge around 120 bahts for a dozen pills in the shopping centres and fancy pharmacies. 20km from the town I get 10 dozen pills for 150 bahts from a small private local pharmacy. Worth to check outside town.

[NoshowJones]

Just pure greed, pharmacies and hospitals, mainly private. Most of them are at it IMO.

[NoshowJones]

3 hours ago, rwill said:

If you are talking about chains like Boots and Watsons they charge more than the local pharmacies.  Part of it probably has to do with having to pay more for their space in a mall.

You have missed out greed. That has to be part of it too.

[xylophone]

8 minutes ago, possum1931 said:

Just pure greed, pharmacies and hospitals, mainly private. Most of them are at it IMO.

IMO, pure greed as far as the private hospitals are concerned, and I got a wake-up call on this when I had to go to see the doctor yesterday about my terrible sinus problems and the fact I hadn't had more than a couple of hours sleep a night for a week.

 

I was a total of six minutes in front of the doctor where she poked a light up my nose and said that I had congestion (no kidding) and a slight infection and said she would give me a prescription for some tablets, which she did, and when I got to the payment counter I looked at the bill and it was just over 5000 baht, which was a helluva surprise.

 

I asked for the checklist of items and noticed that the Augmentin prescription came to 1400 baht, so I told the cashier that she should remove that item from the list because I could buy the same tablets locally for around half the price, which I later did.

 

So that's one hell of a markup on the tablets I already knew about, and as I didn't know the price of the others, and I was feeling lousy, I just paid the remainder and went.

 

I have health insurance for the inpatient costs, but all of the others I pay myself, so I was extremely annoyed at this rort. Plain and simple GREED.

[Captor]

What hospital?

[cdemundo]

I wonder about the range of prescription prices as well.

I am in the US, I checked on GoodRX (a discount prescription service) for 30 tablets of 1 mg Finasteride.

The range for this from local pharmacies all using the GoodRx coupon was from $5.85 to $45.74.

 

I am currently taking a prescription for sleep apnea. Also pricing through GoodRX the price for 30 tablets of 100 mg range as follows.

Lowest is $12.41 and highest is $673.41, again all prices for using the coupons from GoodRX.

 

The prices are a curiosity that seems inexplicable, I am just happy it is possible to shop around for the best price.

 

 

 

Edited July 16, 2022 by cdemundo
correction in phrasing for clarity

[hioctane]

1 hour ago, cdemundo said:

I wonder about the range of prescription prices as well.

I am in the US, I checked on GoodRX (a discount prescription service) for 30 tablets of 1 mg Finasteride.

The range for this from local pharmacies all using the GoodRx coupon was from $5.85 to $45.74.

 

I am currently taking a prescription for sleep apnea. Also pricing through GoodRX the price for 30 tablets of 100 mg range as follows.

Lowest is $12.41 and highest is $673.41, again all prices for using the coupons from GoodRX.

 

The prices are a curiosity that seems inexplicable, I am just happy it is possible to shop around for the best price.

 

 

 

The varying  prices is all about making the most money they possibly can. The low end is for cash patients. The high end is for insurance companies that only pay a fraction of it anyway.

[cdemundo]

6 hours ago, hioctane said:

The varying  prices is all about making the most money they possibly can. The low end is for cash patients. The high end is for insurance companies that only pay a fraction of it anyway.

That is not really explanatory for the pricing through GoodRX where no insurance is involved.

Doesn't explain why the GoodRX prices would vary so much as they are all cash pay using the GoodRX coupons.

[Sheryl]

I suspect the extreme variation reported has to do with the date on which the retail outlet purchased the drug. In recent months increased fuel prices have led to increased costs for just about everything including pharmaceuticals. Drugs that have been in the store since before the rate hike will be sold at price reflecting prior wholesale cost. Drugs recently purchased will have been at a much higher wholesale cost and this gets reflected in the retail price.

 

Now would be a good time to stock up on meds at lower prices (provided  you can use before expiration).

[xylophone]

8 hours ago, Captor said:

What hospital?

Bangkok Phuket Hospital.

[lopburi3]

As said price has gone up - baht has gone down - expect that to mean higher prices, if not now, soon.

 

As for small pharmacy selling at low price - there may be reasons for such - such as expired or near expiration date and actual fake medications in a few cases.  And in almost all such cases poor storage (high temps at night and often 24 hours a day).  That said there is a rather large price difference between pharmacies - just as between hospital pharmacies.  

 

Sheryl will advise to just get the medication name at hospital and buy elsewhere for savings - and this is true and in most cases safe.  But there is a valid reason for higher hospital charges as the medication will be fresh/stored properly and dispensed by pharmacists that will check patient medication records and question doctor if they feel in error (been there and pharmacists have had final word).  

[Lacessit]

1 hour ago, Sheryl said:

I suspect the extreme variation reported has to do with the date on which the retail outlet purchased the drug. In recent months increased fuel prices have led to increased costs for just about everything including pharmaceuticals. Drugs that have been in the store since before the rate hike will be sold at price reflecting prior wholesale cost. Drugs recently purchased will have been at a much higher wholesale cost and this gets reflected in the retail price.

 

Now would be a good time to stock up on meds at lower prices (provided  you can use before expiration).

I am a firm believer the expiration date of medications can be extended substantially by storing them in a refrigerator at 4 degrees C. All my training in chemistry and degradation indicates lower temperatures = slower chemical reactions. It's why most people store butter, cheese and yoghurt in a refrigerator. And why most vaccines are stored under refrigeration, some down to -70 C.

 

I am still using Antroquoril cream for the occasional crotch itching, and it works. I have always kept it in  the refrigerator. Its expiry date is May 2017.

 

The Firide packet I bought for 555 baht shows a manufacturing date of March 22, and an expiration date of March 25.

 

Pharmaceutical manufacturers specify an expiry date, and storage at 15 -30 C. I do have to ask the question - cui bono?

Edited July 17, 2022 by Lacessit

[Sheryl]

1 hour ago, Lacessit said:

I am a firm believer the expiration date of medications can be extended substantially by storing them in a refrigerator at 4 degrees C. All my training in chemistry and degradation indicates lower temperatures = slower chemical reactions. It's why most people store butter, cheese and yoghurt in a refrigerator. And why most vaccines are stored under refrigeration, some down to -70 C.

 

I am still using Antroquoril cream for the occasional crotch itching, and it works. I have always kept it in  the refrigerator. Its expiry date is May 2017.

 

The Firide packet I bought for 555 baht shows a manufacturing date of March 22, and an expiration date of March 25.

 

Pharmaceutical manufacturers specify an expiry date, and storage at 15 -30 C. I do have to ask the question - cui bono?

Expiration ates are the date through which tests have shown the drug is still effective. Think of it as a sort of warranty. That does nto mean the drug turns bad the secind that date has passed, often it is just that there is nio clear data on efficcay past that point, And indeed, storage conditions matter.

 

The 15 - 30 C (which is not all meds, but it is most) is likewise the temperature which has been shown to be safe for extended periods and there is usually a lack of data on the effects of storing above or below those temps. Where data does exit (e.g. for vaccines which by their nature need to be moved from place to place, and sometimes used in outdoor settings,  so storage temp is a significant issue) it generally shows that the duration of exposure to higher temperatures is important in whether degradation occurs.

 

I store all my meds in the refrigerator and like you use many well past the stated expiration date, but pharmacies do nto sell beyond that date.

 

However I do not think expiration  dates have anything much to do with the large price differences you mention. Some price variation among stores s normal but the magnitude of what you report is not and I believe reflects the price at which the lot being sold was purchased.

 

Pharmacies are businesses, just like any other store. They buy the products they sell from a wholesaler and then resell at a higher price - they must do so if they are to cover their own operating costs (rent, utilities, staff etc) and still make a profit. Nothing wrong with any of that.  Operating costs vary by shop as do profit margins,  but only by so much -- The biggest cost driver is the wholesale price.  The higher prices you found were likely meds bought recently, after price hikes set in, and the lower prices likely were in stock longer. Which also means that in time the lower prices will cease to exist at those stores as they exhaust existing stock and buy more from distributors at what are now much higher prices.

[Sheryl]

P.S. on expiration issue one important caveat - for most drugs, the worst that will happen if expired is that they will lose potency/effectiveness. However tetracyline and related drugs (doxycycline etc) are an important exception. This class of drug, when past expiration, breaks up into toxic chemicals which can cause serious illness and death. (I know someone who died as a result of raking expired tetra). NEVER us this class of drug past the stated expiration, too risky.

[Lacessit]

1 minute ago, Sheryl said:

P.S. on expiration issue one important caveat - for most drugs, the worst that will happen if expired is that they will lose potency/effectiveness. However tetracyline and related drugs (doxycycline etc) are an important exception. This class of drug, when past expiration, breaks up into toxic chemicals which can cause serious illness and death. (I know someone who died as a result of raking expired tetra). NEVER us this class of drug past the stated expiration, too risky.

Good point. I am avoiding antibiotics as much as I can. I was taking doxycycline as an anti-malarial. I am convinced it caused a recurrence of my bladder cancer 3 years ago, as it suppresses the immune system.

[Lacessit]

19 minutes ago, Sheryl said:

 

However I do not think expiration  dates have anything much to do with the large price differences you mention. Some price variation among stores s normal but the magnitude of what you report is not and I believe reflects the price at which the lot being sold was purchased.

 

 

That's what I don't understand, the price differential on Codiphen between Chiang Mai and Chiang Rai has been around for two years, well before Ukraine happened.

Although you may be right, the manufacturing date on the Codiphen I bought in CM recently is March 21, expiry March 24.

[gt162]

11 hours ago, cdemundo said:

I wonder about the range of prescription prices as well.

I am in the US, I checked on GoodRX (a discount prescription service) for 30 tablets of 1 mg Finasteride.

The range for this from local pharmacies all using the GoodRx coupon was from $5.85 to $45.74.

 

I am currently taking a prescription for sleep apnea. Also pricing through GoodRX the price for 30 tablets of 100 mg range as follows.

Lowest is $12.41 and highest is $673.41, again all prices for using the coupons from GoodRX.

 

The prices are a curiosity that seems inexplicable, I am just happy it is possible to shop around for the best price.

 

 

 

GoodRx is good tool.  Best common genetic medication prices are at Cost Plus Drugs Company in the USA. 

 

https://costplusdrugs.com/

 

https://www.msn.com/en-us/sports/nba/dallas-billionaire-mark-cuban-sells-cheaper-drugs-e2-80-94-shaking-up-pharmaceutical-industry/ar-AAZA7AN

 

https://en.wikipedia.org/wiki/Cost_Plus_Drugs

Edited July 17, 2022 by gt162

[internationalism]

1 hour ago, Lacessit said:

Good point. I am avoiding antibiotics as much as I can. I was taking doxycycline as an anti-malarial. I am convinced it caused a recurrence of my bladder cancer 3 years ago, as it suppresses the immune system.

check for "doxycycline cancer" - used experimentally in London clinic for brain (together with metformin, mebendazole and statin).

other anti-malaria medicines (chloroquine, hydroxychloroquine, quinine) suppress immune system, that's why used for SLE, lupus. I haven't heard about doxy. But all oral antibiotics do kill gut friendly bacteria, hinder natural defence, if taken for long (as in case of malaria prophylactic for minimum 30 days). 

https://www.economist.com/international/2019/02/28/repurposing-off-patent-drugs-offers-big-hopes-of-new-treatments

[Lacessit]

3 hours ago, internationalism said:

check for "doxycycline cancer" - used experimentally in London clinic for brain (together with metformin, mebendazole and statin).

other anti-malaria medicines (chloroquine, hydroxychloroquine, quinine) suppress immune system, that's why used for SLE, lupus. I haven't heard about doxy. But all oral antibiotics do kill gut friendly bacteria, hinder natural defence, if taken for long (as in case of malaria prophylactic for minimum 30 days). 

https://www.economist.com/international/2019/02/28/repurposing-off-patent-drugs-offers-big-hopes-of-new-treatments

The big question is, how would anyone know the cocktail worked, which component did the trick, and how it can be distinguished from natural remission?

 

As an elderly person, I am tending to operate on the following principles:

 

*Most prescribed medications put an extra load on the kidneys and liver.

*Elderly people are more susceptible to the side effects of medications.

*Diet and exercise are preferable in addressing the causes of health conditions, where possible. 

 

[DJ54]

It’s nice to see someone trying to reduce medicine costs in US ….

 

Dallas Mavericks owner Mark Cuban has launched an online pharmacy that offers prescription drugs at affordable prices. In a press release, the Mark Cuban Cost Plus Drug Company said they plan to provide common medications at as low a price as possible to "bypass middlemen and outrageous markups."Jan 25, 2565 B

[Dart12]

Multiple reasons for this...some because of real economics (see the Mall pharmacies which have much higher operating costs), some is just because they think of know they can charge what they charge.

In general though...location location location always is a factor of pricing for ALL products:  coffee, food, medicines, due to rent and cost of living costs.

However, then there is just pure choices made by the biz owner.

Here in Pattaya, it took me awhile to realize how different prices were from shop to shop...even just 10 meters apart.  100 baht vs 40 baht.  200 baht vs 500 baht....etc etc all for the same exact medicines.

I eventually found my "go-to" pharmacy for most meds, or at least try them first.  they are usually half price of most other shops on most items.  But even them, I'll shop around if it's a higher priced drug like Finerade.

Best I could find on that drug here was 700 baht (I think) for 30 5mg pills.  I forget exact price because I only buy every other month.

[internationalism]

1 hour ago, Lacessit said:

The big question is, how would anyone know the cocktail worked, which component did the trick, and how it can be distinguished from natural remission?

 

As an elderly person, I am tending to operate on the following principles:

 

*Most prescribed medications put an extra load on the kidneys and liver.

*Elderly people are more susceptible to the side effects of medications.

*Diet and exercise are preferable in addressing the causes of health conditions, where possible. 

 

I just referenced to your suspicion, that doxy caused remission. 
as to the other 3 mentioned medicines, they were previously researched separately. Those well known medicines are used in some cases, when regular cancer chemotherapy has too strong side effects or just don't work at all in some cases. There are many more repurposed medicines, with known tens of years safety record. And in thailand they are cheap, in comparison to cancer specific medicines which are not generic and are imported. Cocktails  of several medicines in chemotherapy is now the rule

[Lacessit]

55 minutes ago, Dart12 said:

Multiple reasons for this...some because of real economics (see the Mall pharmacies which have much higher operating costs), some is just because they think of know they can charge what they charge.

In general though...location location location always is a factor of pricing for ALL products:  coffee, food, medicines, due to rent and cost of living costs.


Best I could find on that drug here was 700 baht (I think) for 30 5mg pills.  I forget exact price because I only buy every other month.

Does that mean you are only taking Finasteride every second day? If so, why?

[Captor]

10 hours ago, xylophone said:

Bangkok Phuket Hospital.

Thanks, yes I think they are the most greedy there are.

[GarryP]

2 hours ago, Lacessit said:

The big question is, how would anyone know the cocktail worked, which component did the trick, and how it can be distinguished from natural remission?

 

As an elderly person, I am tending to operate on the following principles:

 

*Most prescribed medications put an extra load on the kidneys and liver.

*Elderly people are more susceptible to the side effects of medications.

*Diet and exercise are preferable in addressing the causes of health conditions, where possible. 

 

Off topic. My father, who is 90, has been suffering from side effects to medicines for a number of years and the combination has led to a number of stomach issues, including gastrointestinal perforation requiring surgery. It is believed that this was a result of BPH and BP meds, including blood thinners. He's off the BPH meds now thanks to TURP nearly 2 years ago, but is still having issues with blood thinners and statins. Luckily, he gets all his meds on the NHS so not out of pocket expense.

[Mutt Daeng]

On 7/16/2022 at 3:10 PM, Bigz said:

I find that small rural village pharmacies are much cheaper. I take anti histamine tablets for my allergy. In the nearest town to me they charge around 120 bahts for a dozen pills in the shopping centres and fancy pharmacies. 20km from the town I get 10 dozen pills for 150 bahts from a small private local pharmacy. Worth to check outside town.

100 Allergy tablets for 20 baht...and they work!!!

 

[Mutt Daeng]

Rule number 1: Never buy meds from a hospital. Always just get the prescription and get it filled at a local pharmacy/clinic.