Recently, I gave a patient a prescription for Abilify. I wrote for 30 tablets of the lowest dose, 2 mg. While I knew it was expensive, I was shocked when the patient returned a few days later and told me it had cost $1,100 to fill the prescription; he not yet met the deductible for his health insurance and he had paid cash for the medication.
According to Medscape (and Twitter, too), Abilify is the medication that grosses more money than any other pharmaceutical in the United States. In the 12-month period from July 2013 to June 2014, sales of Abilify totaled $7.2 billion. An atypical antipsychotic medication that is widely marketed to TV viewers as an augmenting agent to treat major depression, Abilify is the 14th most-prescribed medication in the United States. If you’re wondering, the most prescribed medications are Synthroid, Crestor, and Nexium. Abilify has been available in this country since 2002, initially with an indication for schizophrenia. Since then, indications have expanded to include bipolar disorder, irritability in autism, as well as augmentation for major depression.
Still, $1,100 for 30 tablets? I wondered if the high cost was attributed to where the patient went – a boutique independent pharmacy. I decided to make some calls to local pharmacists (see the table), and queried druggists at CVS, Walmart, and Lykos, an independent pharmacy in Towson, Md. I also checked with a Walmart in Vermont to see if the prices were the same in another part of the country, and they were. Let me share with you what I learned.
For the three pharmacies I called, a single 2-mg tablet of Abilify cost between $30 and $33. There is no discount for buying in bulk, and the price per pill stays the same whether a patient buys 1 pill, 30 pills, or 90 pills – at least at Walmart. I checked with two pharmacies, and the price for a tablet is the same for the dosages of 2 mg, 5 mg, 10 mg, and 15 mg. The price rises to $38-$47 per pill for the 20-mg and 30-mg dose.
As physicians in a health care system where resources are limited, it is incumbent upon us to at least consider the cost of the tests and treatments we order, but we often have no way of knowing what these costs actually are. Was I missing something? Is everyone else aware that Abilify is this costly? I did a quick survey of a handful of psychiatrists by text message (please don’t count this as science), requesting a guess for the cost of a single 2-mg tablet of Abilify. The responses I received ranged from $7 to $20, and a lone respondent answered $40. For the most part, the cost of medications remains opaque to the prescriber.
If I had to do it again, I still would have prescribed Abilify to this particular patient. I would have suggested he buy only a few tablets to start, and I would have prescribed the 5-mg dose and recommended splitting the pills to halve the cost. In a December 2006 article in Current Psychiatry, “Pros and cons of pill splitting,” Dr. Rakesh Jain and Dr. Shailesh Jain note that it is safe to divide Abilify tablets. Filling only a few tablets seems like the prudent thing to do with such an expensive medication, at least until it is clear that it is tolerable to the patient, but as we know, filling less than a month’s supply often creates hurdles and increased copays when health insurance is paying for the prescription. And with requirements for preauthorization, I’m not certain if it’s even possible for a patient to take home just a few to try.
When I informed the psychiatrists I queried that Abilify costs $30-$33 per 2-mg dose, they expressed their surprise. One friend, however, put it most aptly with her reply of simply, “Good grief.”
Dr. Miller is a coauthor of “Shrink Rap: Three Psychiatrists Explain Their Work” (Baltimore: Johns Hopkins University Press, 2011).
