GoodRx Quarterly Report: Q3 2019
Amidst the growing frustration over healthcare costs, there was a lot of talk about drug prices during the third quarter of 2019. Nancy Pelosi, the Speaker of the U.S. House of Representatives, introduced a proposal to lower prescription drug prices, and Illinois announced that it would require insurance companies to cover EpiPen for kids.
Yet patients still struggle to pay for their medications and their healthcare in general. This past quarter alone, 125 drugs increased in price, GoodRx research showed that patients with certain conditions were exposed to more drug price increases than others, and Kaiser Family Foundation published research showing that families pay an average of $20,000 per year for their insurance premiums.
So, what is going to move the mark? Here at GoodRx, we believe that price transparency is a powerful tool we can use to shed light on drug prices and healthcare costs overall. This is the true motivator behind our research, and we are excited to present our third quarterly report, which focuses on drug pricing and fill trends that occurred during Q3 of 2019.
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The following report identifies the most expensive prescription drugs, noteworthy state-by-state and city-by-city trends, and drugs that have seen large price increases over the last quarter. It also includes analysis on the following key takeaways:
Myalept, Ravicti, and Actimmune were the 3 most expensive prescription medications in the U.S. during Q3.
The average list price for all prescription drugs dropped by 0.6%, but 125 drugs saw an increase in list price during Q3.
Humalog went generic back in March, but since then, pickup for the new generic has been slow, and most patients are still filling for the expensive brand.
Prescription drugs were the most expensive in San Francisco, Los Angeles, and New York during Q3. Get a more in-depth look at the most and least expensive cities for prescription drugs here.
Fills for EpiPen (epinephrine) peaked during August of Q3 as kids went back to school, but the peak was a little different this year. We’ll explain why.
It goes without saying, but we’ll continue to monitor drug prices—both what’s happening in D.C. and what’s going on in your local pharmacy. And we’ll always be looking for ways to help you save.
For a full PDF of this report, including a complete breakdown of the methodology, download our white paper here.
Most expensive prescription medications in the U.S.
The following 20 drugs were the most expensive medications during Q3 based on their list price (the official price assigned by the manufacturer), and all have a monthly list price of over $25,000.
In past quarters, new generics, rising prices, and newly approved expensive drugs resulted in some shuffling among the drugs on this list. However, we saw little movement this quarter, except for one change—Tibsovo increased in list price by 5%, bringing it up to the 17th most expensive drug.
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All of these medications are available in pharmacies, and we’ve excluded drugs that can only be administered by a healthcare provider. The list price is based on the most common monthly supply.
While these drugs showcase how high drug prices can be, few people take these medications, and most are shielded from the high list price by their insurance. However, it is important to note that as insurance plans continue to provide less coverage, patients will be on the hook for higher out-of-pocket costs for these drugs.
For more on the most expensive prescription medications in the country, read our in-depth analysis here.
Increases in list price
According to the GoodRx list price index, a model that tracks list price changes, the average list price for brand and generic medications dropped in Q3, by 0.6%. This is in line with past years’ trends—typically most of the growth in list price occurs at the beginning of the year, when manufacturers raise prices for their medications.
But while average list prices remained flat, 63 manufacturers increased the price of their drugs. In total, 125 drugs increased in price by an average of 6.7%, with the majority of the changes happening on July 1. While unfortunate, these price increases are expected. Every year, some manufacturers increase the price of their drugs at the beginning and middle of the year—around January 1 and July 1.
Below are 14 medications that increased in list price this past quarter.
Most prescribed medications, city by city
The most popular drugs nationwide provides a snapshot of the conditions that plague the U.S., but what do things look like on a city level? In general, atorvastatin (Lipitor), lisinopril (Zestril, Prinivil), amlodipine (Norvasc), and levothyroxine (Synthroid) are popular in most cities, a trend that is in line with nationwide prescription fills.
However, noteworthy differences in fill patterns highlight conditions that some cities may be grappling with more than others.
While trends are relatively similar in each city, there are some telling differences. Albuterol (Proair, Proventil, Ventolin), used to treat bronchospasm and symptoms of allergies, was the most popular medication in Chicago during Q3, and it makes sense. According to some news outlets, Chicago had an abnormally rough allergy season this summer, likely forcing patients to fill their albuterol inhaler. Metformin (Glucophage), used to treat type 2 diabetes, was only popular in San Diego, San Francisco, and Los Angeles. While there doesn’t seem to be a good explanation for this trend, it’s interesting to note that metformin does seem to be more popular on the West Coast.
Fills for new generics
In a world where drugs can cost upwards of $50,000 per month, many rely on generics to afford their prescription medications. But what happens when a generic drug is approved, but not accessible to patients?
This past quarter, 2 popular brand drugs, Lyrica and Humalog, went generic, and many people were hopeful for drug savings. But things haven’t turned out as expected, and these 2 new generics follow opposite trajectories in terms of fill patterns.
Take Lyrica, a brand drug used to control seizures and treat nerve pain. Lyrica went generic in July, and after only 2 weeks, nearly all patients had switched over to pregabalin, the more affordable generic. What’s more, overall fills for both Lyrica and pregabalin together have increased by more than 5%, indicating that more patients are filling for the drug now that it is more affordable.
This is a typical fill pattern, and one we have seen for other blockbuster drugs like Viagra. But the same can’t be said for Humalog, a short-acting insulin used to help control blood sugar levels in people with diabetes. Back in March, insulin lispro (the generic counterpart to Humalog) was approved by the FDA, but more than 6 months later the majority of fills are still for the expensive brand drug.
Notice that during Q3, fills for Admelog increased by around 7%, indicating that patients may be switching over to alternatives that are more affordable. What’s more, total fills for insulin lispro and Admelog have also dropped, a concerning trend that may reveal that patients are abandoning their insulin prescriptions.
So why isn’t insulin lispro being filled? Much of the low fill count is likely a result of shortages of the medication in certain areas and spotty insurance coverage. Even so, the lack of accessibility has caused a dip in overall fills for Humalog, possibly caused by patients abandoning their lispro prescription at the pharmacy, and an increase in insulin alternatives like Admelog.
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Co-contributors: Diane Li and Jeroen van Meijgaard, PhD
For a full PDF of this report, including a complete breakdown of the methodology, download our white paper here.
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