Drug price variation and lack of transparency with community pharmacies cause for concern in Ireland

Prescription drugs are a major source of expenditure for patients in Ireland. High prices can lead to cost-related non-adherence and adverse health outcomes. Researchers at Trinity College and RCSI University of Medicine and Health Sciences (RCSI) investigated the variation and availability of prescription drug prices in community pharmacies in Ireland. The study is recently published in the journal Research in Social and Administrative Pharmacy.

Pharmaceuticals are one of the main sources of healthcare expenditure for people, with prescription drugs described as a major cause of unaffordable expenditure for the Irish public. The question researchers sought to answer was: how much prices for commonly prescribed drugs varied between pharmacies?

The research team investigated the prices of 12 commonly prescribed drugs by calling 1,500 community pharmacies, emailing 320, and checking the website of 370. A community pharmacy is described as a retail shop which provides pharmaceutical drugs among other products to the public. Community pharmacies can include both chain pharmacies and independent pharmacies.

Key findings

• 1,529 pharmacies responded to queries, 1,362 by telephone and 167 by email.
• Despite regulatory guidance stating pharmacies should provide medicine prices to patients, no pharmacies had prices displayed on their websites and 12% of pharmacies who answered a call/email did not provide a price.
• The study found that the most expensive pharmacies can charge over double the price of the least expensive pharmacies. For example: Researchers found a typical prescription of prednisolone (a commonly prescribed steroid) costs over €5 more (88% higher price) in the most expensive pharmacies, compared to the least expensive pharmacies in Ireland.
• The mean quoted cost for each of the 12 drugs investigated was higher than the HSE reimbursement price for medical card patients. For famciclovir, the average price quoted to us was €46.00 which was €8.69 higher than the HSE reimbursement price of €37.31.
• For each drug, the average price quoted to researchers was higher than the price paid by the state for patients who can access subsidized medicines (medical card holders).
• For nine of the 12 drugs, the price was significantly higher for chain pharmacies compared to independent pharmacies.

James Larkin, Ph.D. scholar, Department of General Practice, RCSI, and lead author said:

"The large price variation for prescription drugs and the lack of transparency from pharmacies is a problem, as it may mean that some people are paying too much for their medication. Or worse, some people are not buying their medication because it costs too much. This is particularly concerning given the current cost of living crisis and resulting cost pressures that many are facing. Consideration needs to be given by Government to measures that enforce price transparency or regulating prices."

James O'Mahony, research assistant professor in cost effective analysis, Center for Health Policy Management, School of Medicine, and senior author, said:

"Awareness matters as patients can save money by shopping around. If the state were to regulate prices, or if there was more transparency on prices, it might lead to lower prices and more people taking their medications. The pharmaceutical regulator's current requirements on pharmacies to make prices transparent does not really guarantee any easy access to prices for patients. We'd like to see a greater push for transparency on behalf of the Pharmaceutical Society of Ireland."