Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Urology. 2021 Feb;148:224-229. doi: 10.1016/j.urology.2020.08.054. Epub 2020 Sep 19.
To examine the geographic and pharmacy-type variation in costs for generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and reduce health disparities. Medical therapy for BPH can be expensive, having significant implications for uninsured and underinsured patients.
We generated a 20% random sample of all pharmacies in Pennsylvania and queried each for the uninsured cash price of a 30-day prescription of tamsulosin 0.4mg daily, finasteride 5mg daily, oxybutynin immediate release 5mg TID and oxybutynin XL 10mg daily. Our primary objectives were to identify price variation based on pharmacy type (i.e., big chain and independent) and between geographic regions (predetermined by the Pennsylvania Health Care Cost Containment Council Database). We fit multivariable quantile regression models to test for an association between drug price and region after controlling for pharmacy type.
Among 575 retail pharmacies contacted, 473 responded (82% response rate). The median cash price was significantly higher for big chain pharmacies than for independent pharmacies for tamsulosin ($66 vs. $15), finasteride ($68 vs. $15), oxybutynin immediate release ($49 vs. $35), and oxybutynin XL ($79 vs. $31) (all p < 0.05). When controlling for region, the median and 75 percentile price of all drugs was significantly higher for big chain pharmacies. When controlling for pharmacy type, regional variation was noted in all four drugs at the 75 percentile price and was greater for independent pharmacies.
Compared to independent pharmacies, big chain pharmacies charged significantly more for generic BPH medications to uninsured patients. However, independent pharmacies demonstrated more regional variation in their pricing.
研究通用良性前列腺增生症（BPH）药物成本的地理和药房类型差异，以提高药品价格透明度并减少健康差距。BPH 的医疗治疗费用昂贵，对没有保险和保险不足的患者有重大影响。
我们生成了宾夕法尼亚州所有药房的 20%随机样本，并向每家药房查询了 30 天剂量的坦索罗辛 0.4mg 每日、非那雄胺 5mg 每日、奥昔布宁即时释放 5mg TID 和奥昔布宁 XL 10mg 每日的无保险现金价格。我们的主要目标是根据药房类型（即大型连锁店和独立药房）和地理区域（宾夕法尼亚州医疗保健成本控制委员会数据库预先确定）确定价格差异。我们拟合了多变量分位数回归模型，以在控制药房类型后检验药物价格与地区之间的关联。
在联系的 575 家零售药房中，有 473 家（82%的回复率）做出了回应。坦索罗辛（$66 对 $15）、非那雄胺（$68 对 $15）、奥昔布宁即时释放（$49 对 $35）和奥昔布宁 XL（$79 对 $31），大型连锁店药房的现金价格中位数明显高于独立药房（均<0.05）。在控制地区因素后，所有药物的中位数和 75 百分位数价格均显著更高。在控制药房类型后，四种药物在 75 百分位数价格上均存在区域差异，独立药房的差异更大。
与独立药房相比，大型连锁店药房向无保险患者收取的通用 BPH 药物费用明显更高。然而，独立药房的定价存在更大的区域差异。
