• A pharmaceutical story

    About 2 years ago, the health insurance that Duke University provides to employees instituted a mandatory policy that you had to use a mail order pharmacy for recurring medicines, or pay a very large penalty (on the order of $100/prescription). So, I switched the one pharmaceutical I take to this service (Fexophenadine 180mg/once per day [generic for Allegra, a seasonal allergy medicine]). I could obtain a 90 day supply of Fexofenadine for $20 via mail order under this year’s benefit structure.

    When I went to fill this prescription a few weeks ago, it was denied because Allegra is now available as an over-the-counter medicine. The other day I went and bought a 90 day supply of the medication, but could only find name-brand Allegra. I bought it from Sam’s Club and it cost $32.50, a great deal more than the generic did as a prescription medicine (found OTC Allegra at several other places for a higher price). I did not find generic Fexofenadine 180/mg per day anywhere.

    Is this unusual? Was it just Allegra brand name that is available over the counter? Is it typical for the price of newly-over-the-counter meds to be higher than their prescription generic price under insurance? Or does this just mean that Duke has very nice benefits? Obviously the mail order company will receive volume discounts. Will the generic brands also sell over the counter? Can they?

    • Generic Fexofenadine is available at Walgreens (Wal-Fex), as well as Costco (90 pills around $11.50) Me and my two sons are on it, so we buy in bulk. I have not, however, been able to find the “D” version with psuedofedrine decongestant in it.

    • Don,

      I can buy generic Fexofenadine 180mg at Walmart here in New Jersey. I believe I saw it at one or more other pharmacies as well. A few months ago, however, all I could find OTC was name-brand Allegra. If you haven’t checked local pharmacies recently, you might want to take another look.

    • @Marty @Avi
      I need to do some more shopping….if not, you guys mail me some and I will set up in the parking lot! thanks for info

    • Marty,

      You might want to buy 12 hour pseudoephedrine (which you should be able to buy OTC by showing your driver’s license at the pharmacy) and then take it with the fexofenadine. That’s what I do with loratadine (generic Claritin).

    • Don:
      It’s a very common maneuver by pharmaceutical companies. As they face (among other scenarios) shrinking market share by being excluded from preferred drugs lists or loss of patent, they ask for and generally receive (at least for common ailments such as allergies or heartburn relief) permission to market OTC. Interestingly, the very generous health benefit plans will often pay for a generic version of approved OTC s when the drug application is approved by the FDA under legend drug status. Case in point, until recently most Medicare D plans paid for ranitidine (Zantac) and omperazole (Prilosec).
      Best regards….

    • You are also comparing apples to oranges on cost. Your prescription did not cost $20; that was merely your cost-sharing amount. The health plan (or Duke, if they are self-insured) paid the balance of the cost. If you have an old statement from one of your mail orders, it is most likely listed: you pay: $20; insurance pays $XX.

      To address coverage issues, let’s say your 90-day script cost $0.50/pill, for a total of $45 cost (note – I have NO IDEA if this is accurate, I just picked a price for illustrative purposes). You would pay $20, your plan/Duke would pay $25. So each Allegra prescription filled costs the plan $25. Now multiply that out by all the patients in your group who fill Allegra prescriptions, and you can get a sense of the magnitude of costs to the plan. Overall drug spending drives premiums, so everyone else was essentially subsidizing your prescription. You are now absorbing the full cost of your medicine. Fair? Appropriate? That’s up to you to decide.

      As far as OTC costs are concerned, generics should hit the market at some point, and the OTC price should drop. The same thing happened with generic Prilosec and Claritin.

      • @Melissa
        it was a completely self interested bleg…is there a way to get generic Fexofendine over the counter and apparently answer is yes. Agree you could ask other questions about the story I wrote