Price Check! Antipsychotics.

It is a good idea to check on the current price of medications once in a while.  When I do this, I am invariably surprised by price changes since the last time I looked.  On the one hand, once a medication goes generic, the price will fall to a small fraction of what it used to cost.  This process can occur quickly, say over 6 months, or may take a couple of years until it hits bottom.  On the other hand, sometimes drugs that had been cheap, quickly and inexplicably become expensive.  The current prices for antipschotics show both trends.

There are two ways to check current pharmaceutical prices, and I have done both.  The first is to give a list to your pharmacy and ask for their current acquisition cost.  The second is to just look the acquisition cost yourself.  I use this website, The Idaho Actual Acquisition Cost List.

Using this website, I have compiled the current prices of several antipsychotic, both old and “atypical” (though I prefer the terms “first generation” and “second generation”). I have only listed one dosage strength for most–but comparing dosage strength prices can sometimes be valuable.

Here is the list. The price listed is for one single pill.

First Generation Antipsychotics:

Chlorpromazine (Thorazine) 100mg $1.41
Thiothixene (Navane) 5mg $0.29
Thioridazine (Mellaril) 100mg $0.20
Trifluoperazine (Stelazine) 5mg $0.38
Perphenazine (Trilafon) 8mg $1.02
Fluphenazine (Prolixin) 5mg $0.09
Haloperidol (Haldol) 2mg $0.10
5mg $0.11
10mg $0.66

Second Generation Antipsychotics

Risperidone (Risperdal) 1mg $0.10
2mg $0.13
3mg $0.15
4mg $0.17
Olanzapine (Zyprexa) 10mg $0.34
15mg $0.52
20mg $0.69
Quetiapine (Seroquel) 100mg $0.23
200mg $0.35
300mg $0.45
400mg $0.64
Abilify 20mg $26.60
Geodon 60mg $9.89
Invega 6mg $17.13
Fanapt 8mg $10.31
Clozaril 100mg $0.92

These are my observations (in no particular order) after going through these current acquisition costs:

1.  Chlorpromazine (Thorazine) is no longer inexpensive, as it used to be.  It is now the most expensive first generation antipsychotic–by far.  Back when all second generation antipsychotics were hopelessly expensive, many of us turned to Thorazine as a replacement.  No more!  There are three (count ’em, three!) atypical antipsychotics much less expensive than is Thorazine.  I can see no particular reason to continue to use Thorazine on a routine basis, which means removing it from the formulary (or, if you prefer, the “Pre-approved List”).

2.   Haloperidol (Haldol) and fluphenazine (Prolixin) are the least expensive of all of the first generation antipsychotics.  Notice, also, that if you are giving a dose of 10mg of Haldol, it is less expensive to use two 5mg tablets than one 10mg tablet.

3.  If you consider all dosage strengths, Risperidone (Risperdal)is the least expensive of all antipsychotics, no matter which class.  Unless there is a compelling reason not to use it, at this time, risperidone is my “Go To” antipsychotic.

4.  Olanzapine (Zyprexa) is falling in price and is now not too expensive.  It will probably continue to fall in price over the next 6 months to a year until it is as cheap as Risperidone.

5.  Ditto Quetiapine (Seroquel).  However, there are serious safety and security issues with the use of Seroquel in correctional facilities.  I don’t care how inexpensive it gets; I do not like it and will not use it.  In my opinion, the problem of Seroquel abuse almost always outweighs any potential benefit of using it in my jails.  Trazodone is cheap, too, but I similarly do not like to use it.

6.  Abilify?  $26.60 a pill?  Really?  Really?  I know that Squibb is really proud of this drug, but does anyone (other than Squibb) actually believe that Abilify is not only better than risperidone, but 133 times better?

7.  How about Invega?  Invega IS basically risperidone.  It has been renamed and remarketed but is essentially the same thing.  Why would anyone, inside or outside of corrections prescribe Invega?  I don’t get it.

Well, that’s it.  It is a good idea to price check comparable meds from time to time.  I have inserted some of my own opinions but I freely acknowledge that I could be wrong!

Do you routinely check medication prices?  Do you have a pharmacist who does this for you?  Please comment!

6 thoughts on “Price Check! Antipsychotics.

  1. Great article , we should get monthly updates about medications price at our monthly staff meetings. Thank you
    LRodriguez, MD Staff psychiatrist at miamidade county jail

  2. Bravo! It is nice to be reminded of the cost of these antipsychotics periodically. Maybe the days of using Haldol, Thorazine, and Prolixin are mostly over. They actually are quite good drugs and will have a place in corrections medicine for awhile I’m sure.

    Those of you out there receiving your drugs on contract from large commercial pharmacy providers, don’t think that a price drop in acquisition cost means they will pass it on to you. You have to be vigilant. They will continue to charge you the same for the length of your contract unless you call and confront them.

    The disparity between dosage strengths is also quite common. I would recommend and have demanded price bids on every strength of pill in our formulary on the Request For Proposal. I also try to get in writing that they will lower their price as these drugs become cheaper and generic. Always, always ask the acquisition price. AWP or average wholesale price means absolutely nothing. It’s a jungle out there.

    • Thanks, John. I agree with you that the “old” antipsychotics were unjustly vilified for many years. With the advent of inexpensive antipsychotics, the issue now is appropriate usage–the evolving trend of using antipsychotics for non psychiatric reasons (or pseudo-psychiatric reasons).

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