Heart Failure Generic Drug Pricing Variability May Affect Adherence

Cost-Effectiveness Analyses Recommendations
Cost-Effectiveness Analyses Recommendations
The cost of low-dose digoxin + lisinopril + carvedilol ranged from $20.19 to $256.77 while a high dose ranged from $12.00 to $397.58.

NEW ORLEANS — Wide variability in pricing was seen for common generic drugs used to treat heart failure, according to a study presented at the 2016 American Heart Association Scientific Sessions in New Orleans.1

The researchers, led by Paul J. Hauptman, MD, professor of medicine and cardiologist specializing in heart failure at Saint Louis University School of Medicine in Missouri, collected data on pricing for 2 doses of digoxin, lisinopril, and carvedilol for 30- and 90-day prescriptions in a telephone survey of retail pharmacies across 55 ZIP codes.

“The idea for the study originated with one of our patients, a 25-year-old man with heart failure, who called the office and said he could not afford to fill a prescription for digoxin,” Dr Hauptman said in a statement.2 “When I found out a month’s supply was going to cost him $100, I couldn’t believe it. Like me, I think a lot of doctors assume that if you’re writing a prescription for a generic drug that it will be affordable — and that’s not necessarily the case.”

Pricing data was obtained from 175 pharmacies (153 chain stores). The number of generic drug manufacturers varied by agent (digoxin: 7, lisinoporil: 9, carvedilol: 8) and the range was significant. The cost of low-dose digoxin + lisinopril + carvedilol ranged from $20.19 to $256.77 (median: $67.98) while a high dose ranged from $12.00 to $397.58 (median: $70.68). Digoxin was the most consistently expensive drug.

It appeared that variability was unrelated to pharmacy type, ZIP code, region, or median income ($53,122; range: $10,491-$112,017). Of 3 major pharmacy chains, only 1 had consistent pricing across all of its stores.

In a research letter3 published in JAMA Internal Medicine, Dr Hauptman and fellow investigators noted that recent cost increases for generic drugs may have an effect on uninsured and underinsured patients whose options may be limited to retail pharmacies within a certain geographic region. An estimated 7.3 million Americans with cardiovascular disease are uninsured.

“Variability remained with all 3 [heart failure] drugs were bundled in a single purchase within a given pharmacy,” the authors wrote. “Digoxin, the oldest cardiovascular medication available, was paradoxically the most expensive.”

Some limitations include the small number of drugs (3), not being able to obtain data on pharmacy volumes for individual stores because sales figures are considered proprietary, and not including mail-order pharmacies, since most uninsured and underinsured patients do not have access to this option.3

“Our findings suggest that location does not matter,” the authors concluded. “However, patients in low-income areas, who may be at the highest risk of readmissions for and complications from [heart failure] may not have convenient access to multiple pharmacies with competitive pricing, increasing vulnerability to lapses in adherence.”3 

Disclosures: The researchers report no relevant financial disclosures.


  1. Hauptman PJ. Variability in pricing of generic drugs for heart failure: caveat emptor. Poster T2134. Presented at the American Heart Association Scientific Sessions: November 12-16, 2016; New Orleans, LA.
  2. Prices for generic heart failure drugs vary widely [news release]. Dallas, TX: American Heart Association/American Stroke Association Newsroom; November 15, 2016. Accessed November 15, 2016.
  3. Hauptman PJ, Goff ZD, Vidic A, Chibnall JT, Bleske BE. Research letter. Variability in retail pricing of generic drugs for heart failure. JAMA Intern Med. 2016 Nov 15. doi:10.1001/jamainternmed.2016.6955 [Epub ahead of print].