pfizer drugs discontinued from pap final

Cost Analysis for Discontinued PAP Meds

Pfizer Drugs

SHARED CARE FREE CLINIC

July 14, 2013

Authored by: Hang Truong

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Table of Contents Page

Background………………………………………………………….. 2

Objective……………………………………………………………… 2-3

Methods………………………………………………………………. 3

Results…………………………………………………………………. 4-18

Quinapril……………………………………………. 5

Lisinopril…………………………………………….. 6

Spironolactone………………………………….. 7

Sulfasalazine………………………………………. 8

Doxazosin…………………………………………… 9

Ziprasidone………………………………………… 10

Glipizide……………………………………………… 11

Glipizide XL, ER…………………………………… 12

Atorvastatin……………………………………….. 13-14

Gabapentin………………………………………… 15

Amlodipine…………………………………………. 16

Sertraline……………………………………………. 17-18

Conclusion…………………………………………………………… 19-21

References…………………………………………………………… 22

Appendix……………………………………………………………… 23

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Background

Due to the removal of 25 Pfizer drugs from the patient assistance program (PAP), the Shared Care Free

Clinic will need to analyze different avenues for providing medications to its patients. There is a

significant need to replace these medications for the patients of the Shared Care Free Clinic. Over 500

ninety day prescriptions were filled in 2012 for various chronic disease states (e.g., high blood pressure,

high cholesterol, diabetes, depression, and other mental health issues).

Of the 25 drugs that will be discontinued, the following drugs are the ones that will have an impact on

the clinic:

1. Accupril (Quinapril)

2. Aldactone (Spironolactone)

3. Alzulfidine (Sulfasalazine)

4. Cardura (Doxazosin)

5. Geodon (Ziprasidone)

6. Glucotrol (Glipizide)

7. Glucotrol XL (Glipizide XL, ER)

8. Lipitor (Atorvastatin)

9. Neurontin (Gabapentin)

10. Norvasc (Amlodipine)

11. Zoloft (Sertraline)

Objective

The goal of this report is to give a cost analysis of the different options available to replace the 11

medications being removed from the Pfizer PAP. We will be evaluating the most economical

alternatives for replacing these medications and the alternatives include:

50 Plus Pharmacy

Rx Outreach1

Auburn Pharmacy2

Walmart3, Target4, and Hyvee5

There will be some advantages and disadvantages to each of these alternatives. If the clinic wanted to

only include options that relieves patients’ financial burden, then they would only consider: 50 Plus

Pharmacy, Auburn Pharmacy, and Rx Outreach. In all three of these alternative medication sources, the

clinic will be paying for the cost of medications. However, with each of these options they will have

different issues to consider. If the clinic orders from 50 Plus Pharmacy, then they will need to consider

the additional burden to the dispensary to fill those extra prescriptions. If they chose Auburn Pharmacy,

they would still need to utilize 50 Plus Pharmacy because Auburn Pharmacy does not have a

comprehensive list of medications. If they chose Rx Outreach, they will have the same issues as Auburn

(limited medication list), but they would also have a possible fluctuation in pricing. Rx Outreach does

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not have a set or constant pricing scheme available. Meaning, if the market prices for certain

medications increase, so will the costs they charge to the clinic.

If the clinic chose to place the financial burden on patients, patients would have to get their

prescriptions filled at Walmart, Target, Hyvee, or Auburn Pharmacy for the most economical option.

Walmart, Target, and Hyvee pharmacies have $4 prescriptions for a 30 days supply, or $10 prescriptions

for a 90 days supply. Auburn Pharmacy has $12 prescriptions for a 90 days supply. On top of financial

burden, many of these discount prices also have a limited medication list and do not include all of the 11

medications being discontinued from the Pfizer PAP. If patients went to Walmart, Target, Hyvee, or

Auburn Pharmacy, the clinic would still have to consider purchasing some medications from 50 Plus

Pharmacy due to the limited selection of drugs on their discount lists. Some advantages and

disadvantages to utilizing each alternative are listed in the tables below.

50 Plus Pharmacy

Advantages

Disadvantages

•No charge for patients

•Clinic pays the cost •Greater work load for the dispensary

Walmart, Target, Hyvee

Advantages

Disadvantages

•No extra burden on the dispensary

•Patients must pay the $4 for 30 days supply or $10 for 90 days supply •Prices will stay constant •Med list may change

Auburn Pharmacy

Advantages

Disadvantages

•No charge for patients •No extra burden on the dispensary •Patients have more convenient times to pick up medications

•Clinic pays cost •Prices will stay constant at $12 for a 90 days supply* •Med list may change *Rx Outreach and 50 Plus Pharmacy~Prices may fluctuate with the market prices.

Rx Outreach

Advantages

Disadvantages

•No charge for patients •No extra burden on the dispensary

•Clinic pays cost •Prices may fluctuate if market prices fluctuate •Med list may change

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Methods

The 2012 report of medications filled through PAP was used to analyze how many of the discontinued

Pfizer prescriptions were filled throughout the year. The report was formatted in Excel and the sort

option was utilized to filter out the 11 Pfizer drugs of interest. For each drug, the number of 90 day

prescriptions was tallied. Results were all recorded into Excel sheets and costs of each alternative

source (50 Plus Pharmacy, Auburn Pharmacy, Rx Outreach, Walmart, Target, and Hyvee) were calculated

and annualized.

Results

From the data that was analyzed, results were annualized and placed into chart format. A few

discussion points were included to provide a more comprehensive view of each alternative (50 Plus

Pharmacy, Auburn Pharmacy, Rx Outreach, Walmart, Target, and Hyvee) if chosen.

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Pfizer drug: Accupril

Number of 90 day fills in 2012: 160

Possible substitutes: Quinapril or Lisinopril

Quinapril is not available at Auburn Pharmacy, Walmart, Target, or Hyvee. The only two options are

either 50 Plus Pharmacy or Rx Outreach. The annual cost of ordering from Rx Outreach ($17,600.00)

exceeds that of 50 Plus Pharmacy ($3,442.30). The additional script volume for the dispensary is 160

annually.

The other drug option for replacing Accupril is to switch patients to Lisinopril.

Quinapril

50 Plus Pharmacy: $3,442.30

Rx Outreach

o 90 days supply: $19,200.00

o 180 days supply: $17,600.00

50 Plus Pharmacy: $11.87 per 90 tablet bottle Rx Outreach: $30 for a 90 days supply $55 for a 180 days supply

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Lisinopril


Rx Outreach: $5,760.00

Auburn Pharmacy: $7,680.00


o 30 days supply: $11,424.00

o 90 days supply: $9,520.00

50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $9 for a 90 days supply, $18 for a 180 days supply Auburn Pharmacy: $12 for a 90 days supply Walmart, Target, Hyvee: $4 for a 30 days supply, $10 for a 90 days supply

• Pfizer drug: Accupril

• Number of 90 day fills in 2012: 160

• Possible substitutes: Quinapril or Lisinopril

To avoid placing financial burden on patients, the clinic can order Lisinopril from 50 Plus Pharmacy,

Auburn Pharmacy, or Rx Outreach. The annual cost of ordering Lisinopril from 50 Plus Pharmacy will be

$1,075.62 and an additional 160 scripts for the dispensary to fill per year. The annual cost of ordering

Lisinopril from Auburn Pharmacy would be $7,680.00. At Auburn Pharmacy, the clinic can forward 90

day prescriptions for the cost of $12 each. If Rx Outreach was utilized, the annual cost would be

$5,760.00. For both of the Auburn Pharmacy and Rx Outreach options, there would be no additional

burden on the dispensary.

If patients are able to purchase Lisinopril, the options will be: Walmart, Target, or Hyvee. Patients can

fill a 30 days supply for $4 or a 90 days supply for $10. The total annual cost for patients would be either

$11,424.00 (30 days supply) or $9,520.00 (90 days supply).

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Pfizer drug: Aldactone


Possible substitute: Spironolactone

To avoid placing financial burden on patients, the clinic can order Spironolactone from 50 Plus

Pharmacy, Auburn Pharmacy, or Rx Outreach. The annual cost of ordering Spironolactone from 50 Plus

Pharmacy will range between $370.10 and $484.33 (depending on bottle size ordered) and an additional

33 scripts for the dispensary to fill per year. The annual cost, if ordering from Auburn Pharmacy, will be

$1,632.00. At Auburn Pharmacy, the clinic can forward 90 day prescriptions for the cost of $12 each. If

Outreach was utilized, the annual cost would be $1,360.00. For both of the Auburn Pharmacy and Rx

Outreach options, there would be no additional burden on the dispensary.

If patients are able to purchase Spironolactone, the options will be: Walmart, Target, or Hyvee. Patients

can fill a 30 days supply for $4 or a 90 days supply for $10. The total annual cost for patients would be

either $1,632.00 (30 days supply) or $1,360.00 (90 days supply).

Spironolactone

50 Plus Pharmacy: $370.10






50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $20 for a 180 days supply Auburn Pharmacy: $12 for a 90 days supply Walmart, Target, Hyvee: $4 for a 30 days supply, $10 for a 90 days supply

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Pfizer drug: Alzulfidine


Possible substitutes: Sulfasalazine

Sulfasalazine is not available at Auburn Pharmacy, Walmart, Target, or Hyvee. The two options are 50

Plus Pharmacy and Rx Outreach. When ordering from 50 Plus Pharmacy, the annual cost will range

between $32.32 and $58.60. There will be a minimal additional workload for the dispensary. Rx

Outreach will have an annual cost of about $200.00 and no additional burden on the dispensary. The

most economical option will be to order Sulfasalazine from 50 Plus Pharmacy.

Sulfasalazine


Rx Outreach

o 90 days supply: $200.00


50 Plus Pharmacy: Price varies depending on bottle size Rx Outreach: $50 for a 90 days supply $95 for a 180 days supply

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Pfizer drug: Cardura


Possible substitutes: Doxazosin

To avoid placing financial burden on patients, the clinic can order Doxazosin from 50 Plus Pharmacy,

Auburn Pharmacy, or Rx Outreach. The annual cost of ordering Doxazosin from 50 Plus Pharmacy will be

$468.62 and an additional 28 scripts for the dispensary to fill per year. The annual cost of ordering from

Auburn Pharmacy will be $1,344.00. At Auburn Pharmacy, the clinic can forward 90 day prescriptions

for the cost of $12 each. If Rx Outreach was utilized, the annual cost would be $1,120.00. For both of

the Auburn Pharmacy and Rx Outreach options, there would be no additional burden on the dispensary.

If patients are able to purchase Doxazosin, the options will be: Walmart, Target, or Hyvee. Patients can

fill a 30 days supply for $4 or a 90 days supply for $10. The total annual cost for patients would be either

$1,344.00 (30 days supply) or $1,120.00 (90 days supply).

Doxazosin







50 Plus Pharmacy: Prices vary depending on strength but approximately $12 per 100 count bottle Rx Outreach: $20 for a 180 days supply Auburn Pharmacy: $12 for a 90 days supply Walmart, Target, Hyvee: $4 for a 30 days supply, $10 for a 90 days supply

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Pfizer drug: Geodon


Possible substitutes: Ziprasidone

Ziprasidone is not available at Auburn Pharmacy, Walmart, Target, Hyvee, or Rx Outreach. The only

option is 50 Plus Pharmacy. When ordering from 50 Plus Pharmacy, the annual cost will be $2,039.04

and an additional four scripts to fill in the dispensary.

Ziprasidone


50 Plus Pharmacy: Cost of one 60 count bottle is $254.88.

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Pfizer drug: Glucotrol


Possible substitutes: Glipizide

To avoid placing financial burden on patients, the clinic can order Glipizide from 50 Plus Pharmacy,

Auburn Pharmacy, or Rx Outreach. The annual cost of ordering Glipizide from 50 Plus Pharmacy ranges

between $9.60 and $25.20 (depending on bottle size ordered) and an additional one script for the

dispensary to fill per year. The annual cost if ordering from Auburn Pharmacy will be $48.00. At Auburn

Pharmacy, the clinic can forward 90 day prescriptions for the cost of $12 each. If Rx Outreach was

utilized, the annual cost will be $40.00. For both of the Auburn Pharmacy and Rx Outreach options,

there would be no additional burden on the dispensary.

If patients are able to purchase Glipizide, the options will be: Walmart, Target, or Hyvee. Patients can

fill a 30 day supply for $4 or a 90 day supply for $10. The total annual cost for patients would be either

$48.00 (30 days supply) or $40.00 (90 days supply).

Glipizide


Rx Outreach: $40.00

Auburn Pharmacy: $40.00




50 Plus Pharmacy: Prices vary depending on bottle size. $4.80 per 100 count bottle and $25.20 per 500 count bottle Rx Outreach: $20 for a 180 days supply Auburn Pharmacy: $12 for a 90 days supply Walmart, Target, Hyvee: $4 for a 30 days supply, $10 for a 90 days supply

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Pfizer drug: Glucotrol XL


Possible substitutes: Glipizide XL, ER

Similar to Accupril (Quinapril), the clinic can only order the Glipizide XL, ER from 50 Plus Pharmacy or Rx

Outreach. This drug is not available through Auburn Pharmacy, Walmart, Target, or Hyvee. The annual

cost of ordering Glipizide from 50 Plus Pharmacy ranges between $313.93 and $323.00 (depending on

strength and bottle size ordered) and an additional 8 scripts for the dispensary to fill per year. If Rx

Outreach is utilized, the annual cost would be $1,120.00 (90 days supply) and $1,040.00 (180 days

supply), but there will be no additional burden on the dispensary to fill extra scripts.

Glipizide XL, ER


Rx Outreach


o 180 days supply: $1,040.00

50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $35 for a 90 days supply, $65 for a 180 days supply

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Pfizer drug: Lipitor


Possible substitutes: Atorvastatin,

Crestor, or Pravastatin

The options for replacing Lipitor include ordering Atorvastatin from 50 Plus Pharmacy or Rx Outreach.

And an alternative option is switching patients to therapeutically equivalent high cholesterol drugs like

Crestor or Pravastatin. Atorvastatin is not available at Auburn Pharmacy, Walmart, Target, or Hyvee.

The annual cost of Atorvastatin from 50 Plus Pharmacy will be $2,228.92 plus an additional 127 scripts

for the dispensary to fill per year. The annual cost of Atorvastatin from Rx Outreach will be $12,700 (90

days supply) and $11,430 (180 days supply).

Atorvastatin


Rx Outreach

o 90 days supply: $12,700.00

o 180 days supply: $11,430.00

50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $25 for a 90 days supply, $45 for a 180 days supply

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If switching to Crestor, there will be no additional cost. Crestor is available on the Astra Zeneca PAP.

The following list of equivalencies can be used to convert patients from Lipitor to Crestor6. See Table 1

in the Appendix for conversion chart.

Lipitor 20mg= Crestor 5mg (n=61)

Lipitor 40mg=Crestor 10mg (n=8)

Lipitor 80mg=Crestor 20mg (n=3)

However, this conversion to Crestor would not include the patients currently prescribed Lipitor 10mg,

unless they are switched to ½ tablet of the Crestor 5mg (n=55). Another conversion that can be utilized

is to convert the Lipitor 10mg patients to Pravastatin 40mg. The following list of equivalencies can be

used to convert patients from Lipitor to Pravastatin:

Lipitor 10mg=Pravastatin 40mg (n=55)

If patients were converted to an equivalent dose of Pravastatin 40mg, they will be able to purchase their

scripts on the $4 discount list for a 30 days supply and $10 for a 90 days supply. The annual cost for

patients to switch from Lipitor 10mg to Pravastatin 40mg would be $2,640.00 (30 days supply) and

$2,200.00 (90 days supply). These annual costs are for Walmart, Target, and Hyvee. Results are

displayed in the table below. One strategy is to convert patients on Lipitor 20mg, 40mg, and 80mg to

Crestor 5mg, 10mg, and 20mg, respectively and to convert the Lipitor 10mg patients to Pravastatin

40mg. However, the most economical strategy would be to convert all patients currently being

prescribed Lipitor to Crestor.

Since Lipitor has several options, the following table summarizes the data discussed on pages 13 and 14.

Drug and Strength Switch To Source Annual Cost Payor

Lipitor 10mg, 20mg, 40mg, 80mg

Atorvastatin 10mg, 20mg, 40mg, 80mg

50 Plus Pharmacy $2,228.92 Clinic

Lipitor 10mg, 20mg, 40mg, 80mg

Atorvastatin 10mg, 20mg, 40mg, 80mg

Rx Outreach $11,430.00 to $12,700.00

Clinic

Lipitor 20mg, 40mg, 80mg

Crestor 5mg, 10mg, 20mg

Astra Zeneca PAP $0.00 -------

Lipitor 10mg Pravastatin 40mg Walmart, Target, Hyvee

$2,200.00 to $2,640.00

Patient

Lipitor 10mg Pravastatin 40mg 50 Plus Pharmacy *still need to call for price

Clinic

Lipitor 10mg Pravastatin 40mg Rx Outreach $2,200.00 Clinic

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Pfizer drug: Neurontin


Possible substitute: Gabapentin

There are two options for replacing Neurontin. The clinic can order Gabapentin through either 50 Plus

Pharmacy or Rx Outreach. The annual cost of ordering Gabapentin from 50 Plus Pharmacy will range

between $1,446.65 and $1,822.54 (depending on strength and bottle size ordered) and an additional 34

scripts for the dispensary to fill per year. The annual cost for Rx Outreach will be $4,920.00, but only for

up to 270 tablets (90 days supply). For patients that exceed the maximum 270 tablets per 90 days, the

prices will be higher.

Gabapentin


Rx Outreach


o Up to 270 tablets

50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $25 for 300mg and $45 for 600mg and 800mg

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Pfizer drug: Norvasc


Possible substitute: Amlodipine

To avoid placing financial burden on patients, the clinic can order Amlodipine from 50 Plus Pharmacy,

Auburn Pharmacy, or Rx Outreach. Amlodipine is not available at Walmart, Target, or Hyvee. The

annual cost of ordering Amlodipine from 50 Plus Pharmacy ranges between $136.57 and $156.66

(depending on bottle size ordered) and an additional 58 scripts for the dispensary to fill per year. The

annual cost, if ordering from Auburn Pharmacy will be $2,784.00. At Auburn Pharmacy, the clinic can

forward 90 day prescriptions for the cost of $12 each. If Rx Outreach is utilized, the annual cost would

be $4,640.00. For both of the Auburn Pharmacy and Rx Outreach options, there would be no additional

burden on the dispensary.

Amlodipine




50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $20 for 90 days supply and $40 for 180 days supply Auburn Pharmacy: $12 for a 90 days supply

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Pfizer drug: Zoloft


Possible substitute: Sertraline

There are two options for replacing Zoloft. The clinic can order Sertraline either from 50 Plus Pharmacy

or Rx Outreach. The annual cost when ordering from 50 Plus Pharmacy will range between $462.83 and

$558.03 (depending on strength and bottle size) and an additional 52 scripts for the dispensary fill per

year. The annual cost for Rx Outreach will be $5,200.00 with no additional burden on the dispensary.

Sertraline



50 Plus Pharmacy: Prices vary depending on strength and bottle size. Rx Outreach: $25 for a 90 days supply

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Options for patients to purchase scripts on their own do not exist for Sertraline, but there are some

other anti-depressants that are on discount lists; Citalopram and Fluoxetine. Both of these are available

with Auburn Pharmacy, Walmart, Target, Hyvee, and Rx Outreach. Annual costs for changing to either

Citalopram or Fluoxetine will be:

Rx Outreach:

o Citalopram 10mg, 20mg, 40mg: $4,160.00 (90 days supply)

o Fluoxetine 10mg, 20mg, 40mg: $3,120.00 (90 days supply)

Auburn Pharmacy: About $2,496

o Citalopram 10mg, 20mg, 40mg (90 days supply)

o Fluoxetine 10mg, 20mg (90 days supply)

Walmart, Target, Hyvee: Between $2,080.00 and $2,496.00

o Citalopram 20mg, 40mg

o Fluoxetine 10mg, 20mg, 40mg

o $4 for 30 days supply

o $10 for 90 days supply

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Conclusion

With this cost analysis for each of the alternative sources, the clinic can make some decisions about

which method will be the most economical. Different scenarios can be mapped out and decisions can

be made upon factors such as: clinic costs, patient costs, and impact on the dispensary. There are two

different scenarios that map out choices across the spectrum. Scenario 1 places all of the cost on the

clinic and scenario 2 places the least amount of cost on the clinic.

Scenario 1 ---50 Plus Pharmacy Only

In scenario 1, if the clinic chooses to provide all medications by ordering from 50 Plus Pharmacy and

having the dispensary fill the extra 506 (90 days supply) prescriptions, the overall impact would be:

Drug Annual Cost

Accupril (Quinapril)/(Lisinopril) $3,442.30/ $1,075.62

Aldactone (Spironolactone) $370.10

Alzulfidine (Sulfasalazine) $32.32

Cardura (Doxazosin) $468.62

Geodon (Ziprasidone) $2,039.04

Glucotrol (Glipizide) $9.60

Glucotrol XL (Glipizide XL, ER) $313.93

Lipitor (Atorvastatin) $2,228.92

Neurontin (Gabapentin) $1,446.65

Norvasc (Amlodipine) $136.57

Zoloft (Sertraline) $462.83

Total Annual Cost $10,950.88/ $8,584.20

The total annual cost for the clinic to order all medications being removed from the Pfizer PAP would be

$10,950.88. The total number of 90 day prescriptions to fill would be 506. Since the data used to tally

this number included all patients that filled these 11 medications, it accounts for the annual count of

506 prescriptions filled. In 2012, the dispensary filled about 1262 prescriptions and the additional 506

prescriptions would lead to an increase in work load of about 40%. Since the dispensary is open only on

Tuesday nights, these additional 506 prescriptions would average out to be an additional 10

prescriptions per week.

If the Quinapril was replaced with Lisinopril, then the clinic could save a significant amount. The annual

cost of Lisinopril is $1,075.62. The new total cost to order all medications from 50 Plus Pharmacy would

be $8,584.20.

If the clinic wanted to avoid placing any financial burden on patients, then scenario 1 would be the

option to choose.

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Scenario 2 ---Discount drug list for Walmart, Target, and Hyvee + 50 Plus Pharmacy+ Therapeutic

Equivalent Conversions

In scenario 2, the clinic would send prescriptions to Walmart, Target, or Hyvee for the medications that

were available on the discount drug lists and order in the rest of the medications from 50 Plus

Pharmacy. In this scenario, the clinic would also try and convert patients to a therapeutic equivalent or

similar drug category medication to provide the most savings for the clinic. Some of these conversions

include:

Accupril (Quinapril; n=160)---Lisinopril

Lipitor 20mg, 40mg, 80mg (Atorvastatin; n=72)---Crestor

Lipitor 10mg (Atorvastion; n=55)---Pravastatin

Zoloft (Sertraline; n=52)---Citalopram or Fluoxetine

The breakdown of costs is summarized in the table below. The rows highlighted in pink denote what the

patients’ annual costs would be.

Drug Switch To Number of 90 day prescriptions

Source Annual Cost

Accupril (Quinapril)

Lisinopril 5mg, 10mg, 20mg

(40mg not available) 160

Walmart, Target, Hyvee 90 day supply for $10

$9,520.00

Aldactone Spironolactone 25mg (50mg not available)

33 Walmart, Target,

Hyvee 90 day supply for $10

$1,360.00

Alzulfidine Sulfasalazine 500mg 1 50 Plus Pharmacy $32.32

Cardura Doxazosin 2mg, 4mg,

8mg 28


$1,120.00

Geodon Ziprasidone 60mg 4 50 Plus Pharmacy $2,039.04

Glucotrol Glipizide 10mg 1 Walmart, Target,


$40.00

Glucotrol XL Glipizide XL, ER 8 50 Plus Pharmacy $313.93

Lipitor 10mg Pravastatin 40mg 55 Walmart, Target,


$2,200.00

Lipitor 20mg, 40mg, 80mg

Crestor 5mg, 10mg, 20mg

72 AstraZeneca PAP $0.00

Neurontin Gabapentin 300mg,

600mg, 800mg 34 50 Plus Pharmacy $1,446.65

Norvasc Amlodipine 2.5mg

5mg, 10mg 58 50 Plus Pharmacy $136.57

Zoloft Citalopram or

Fluoxetine 52


$2,080.00

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The total costs for the clinic in scenario 2 will be $3,968.51 and an additional 105 prescriptions for the

dispensary to fill per year. This averages out to an extra 2 prescriptions to fill per week. The financial

burden for the patients adds up to $16,320 (annual cost). Scenario 2 would save the clinic the most

money, but potentially place a large burden on patients.

Other sources of replacing Pfizer PAP drugs that were not discussed in scenario 1 or 2 include Auburn

Pharmacy and Rx Outreach. An advantage to using Auburn Pharmacy is that patients may have easier

access and more convenient times to acquire their prescriptions. The only drug that was on Auburn’s

discount list ($12 for a 90 day supply) that was not on Walmart, Target, or Hyvees’ lists is Amlodipine

($2,784.00). However, it was not included in the scenarios because it is more economical to order the

Amlodipine from 50 Plus pharmacy ($136.57). To see a full comparison picture of Auburn Pharmacy

versus 50 Plus Pharmacy, please see the table below:

Drug 50 Plus Pharmacy Auburn Pharmacy

Accupril (Quinapril) $3,442.30 $7,680.00 (must switch to Lisinopril, because Quinapril not available)

Aldactone (Spironolactone) $370.10 $1,632.00

Alzulfidine (Sulfasalazine) $32.32 ***Not available

Cardura (Doxazosin) $468.62 $1,344.00

Geodon (Ziprasidone) $2,039.04 ***Not Available

Glucotrol (Glipizide) $9.60 $48.00

Glucotrol XL (Glipizide XL, ER) $313.93 ***Not Available

Lipitor (Atorvastatin) $2,228.92 ***Not Available

Neurontin (Gabapentin) $1,446.65 ***Not Available

Norvasc (Amlodipine) $136.57 $2,784.00

Zoloft (Sertraline) $462.83 ***Not Available

The same pattern occurred with medications available through Rx Outreach. The prices from 50 Plus

Pharmacy were more economical.

Drug 50 Plus Pharmacy Rx Outreach

Accupril (Quinapril) $3,442.30 $5,760.00 (switch to Lisinopril, Quinapril too expensive)

Aldactone (Spironolactone) $370.10 $1,360 .00

Alzulfidine (Sulfasalazine) $32.32 $190.00

Cardura (Doxazosin) $468.62 $1,120.00

Geodon (Ziprasidone) $2,039.04 ***Not Available

Glucotrol (Glipizide) $9.60 $40.00

Glucotrol XL (Glipizide XL, ER) $313.93 $1,040.00

Lipitor (Atorvastatin) $2,228.92 $11,430.00

Neurontin (Gabapentin) $1,446.65 $4,920.00

Norvasc (Amlodipine) $136.57 $4,640.00

Zoloft (Sertraline) $462.83 $5,200.00

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References

1Rx Outreach. Website. http://www.rxoutreach.org/medications/

2Auburn Pharmacy Discount Drug List. Pdf document.

http://www.auburnpharmacies.com/adcard_files/generic_June2013.pdf

3Walmart Discount Drug List. Pdf document.

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

4Target Discount Drug List. Pdf document.

http://static.targetimg1.com/pharmacy/pdf/06272013-RxGenerics_Condition.pdf

5Hyvee Discount Drug List. Pdf document. http://www.hy-vee.com/webres/File/400list_category90.pdf

6Therapeutic Equivalent Conversion Chart from Pharmacist Letter. Subscription required to view.

http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=student&s=P

L&pt=2&fpt=56&dd=271101&pb=PL&segment=3732

http://www.rxoutreach.org/medications/

http://www.auburnpharmacies.com/adcard_files/generic_June2013.pdf

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

http://static.targetimg1.com/pharmacy/pdf/06272013-RxGenerics_Condition.pdf

http://www.hy-vee.com/webres/File/400list_category90.pdf

http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=student&s=PL&pt=2&fpt=56&dd=271101&pb=PL&segment=3732

http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=student&s=PL&pt=2&fpt=56&dd=271101&pb=PL&segment=3732

23 | P a g e

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Appendix

Table 1. Source from Pharmacist Letter6

pfizer drugs discontinued from pap final

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