Variation in Drug Prices at Pharmacies: Are Prices Higher in Poorer Areas?

Low-income individuals often face higher prices for goods and services: pertaining to prescription coverage, those with no coverage pay full retail prices while those with prescription drug coverage benefit from lower prices negotiated by their insurance plans.  The authors of this study explored whether uninsured customers also face higher retail prices on average due to their geographic location (similar to other goods and services that tend to be more expensive in poorer neighborhoods). 

The following prescription prices for a 1-month supply were analyzed for several Florida ZIP codes: esomeprazole for peptic ulcer disease, fluticasone/salmeterol for asthma, clopidogrel for cardiovascular disease, and azithromycin for bacterial infections.  Median household income within each zip code was used as a measure of wealth. 

Overall, the mean price in the poorest ZIP codes for all four drugs was 9 percent above the statewide average.  In addition, at each income level, chain pharmacies were less expensive and less variable in price than independent pharmacies.  Prices at the independent pharmacies were 15 percent higher than the statewide average in the poorest areas, as compared to those at large chain pharmacies that showed little price variation.

Commentary:

This study gives further credence to the health disparities noted between underserved and well-resourced areas.  Not only are poorer areas often deprived of clinical medical services, but as consumers, poorer individuals face higher prices for the same medications.  Independent pharmacies may preserve small business and are sometimes able to provide a personalization that larger chain stores cannot.  However, larger chain stores are better equipped to offer both the brand name and mass-supplied generic drugs at more favorable prices. Of note, the four above-mentioned drugs were not available as generic at the time of this study.  As in other areas of social policy (e.g. grocery store distribution for nutrition or safe walking communities for physical activity), future health policy should concentrate on these “retail deserts” that have deprived poorer individuals of equitable consumer options.

Health Services Research. 2009. 44(2 Pt 1):606-17.

by 

Kameron Leigh Matthews, MD, Esq.