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The System

Generic but Not Cheap

A Weekly Check on Health Care Costs and Coverage

Tuesday, April 19, 2005; Page HE02

Think your gas bill is rising too fast? Don't tell that to Shirley Siegel.

Six months ago, she paid about $16 at the Costco pharmacy in Gaithersburg for a 90-day supply of pills to control hypertension. Three months later, the price had risen to about $25. Last month, Costco said her 270 hydralazine tablets would cost $81.

"I said there has to be a mistake," Siegel said, but the Costco pharmacist told her "there is now only one pharmaceutical place that is making this, whereas before there was competition." Siegel said the pharmacist suggested that "maybe some other pharmacies have some left from the old producer."

Siegel said she is not enrolled in the Medicare drug discount program or similar plans that offer cut-rate prices. "I always wind up getting everything at Costco because the [price] difference is enormous," she said. But the advice to check other drugstores paid off: Siegel filled her prescription at the Giant pharmacy at Leisure World Plaza for $32.

A call to that pharmacy Wednesday confirmed the volatility of hydralazine's retail price and showed that Siegel got a bargain -- comparatively, anyway -- when she made that $32 purchase.

The System initially was told Siegel's three-month supply would cost $45.55. A moment later, a Giant staffer said that quote was erroneous, explaining that "we don't carry that manufacturer anymore." The accurate price was $112.67. Other retailers cited similar prices, for both mail-order and in-person purchases, although CVS.com offered a quote of $67.59 for an online order.

"Over time in the last few years, the number of manufacturers that make this generic product have dwindled, down to at last count I think there were only two; there may only be one now," said Vic Curtis, a spokesman for Costco Wholesale. "The other thing is that the price has gone up quite a bit because of supply and demand."

Hydralazine, which has been on the U.S. market for decades, "is not being used very commonly," said Arnold Lear, a health insurance counselor in Montgomery County. "With the very old drugs, it's happening more often" that suppliers become scarce and that prices rise.

This trend may not be occurring among other generic drugs. AARP's Public Policy Institute reported this week that the manufacturer list prices of 75 popular generics rose 0.5 percent in 2004, a rate far lower than the institute calculated for the three preceding years.

Pliva, the Croatian firm cited by both Giant and Costco as its supplier of hydralazine, did not respond to a request for comment.

"I don't feel that this pharmaceutical company should be able to get away with it," said Siegel. "It's bad enough that I have a couple of very expensive medications."

Now she's got one more.

-- Tom Graham

The System welcomes comments from patients, providers, insurers and others about the delivery of health care. While we cannot advocate on behalf of individuals, we are looking for examples of problems and solutions that may direct our reporting. Contact us by U.S. Mail at the address that appears below or by e-mail at thesystem@washpost.com. Do not send original documents.


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