High Blood Pressure? Understanding Your Drug Costs

Check out this great link that explains why there is so much variation in generic drug costs. Most of us believe that using a generic drug saves money and that is all we need to worry about. I was surprised to learn that there is huge variation in the cost of generic drugs in the same category.

In the last post, I presented the specific drugs that are in our protocol for hypertension. Our first step is losartan 50 mg. combined with hydrochlorothiazide. By combining losartan with a diuretic, you can get both drugs for $4 at Walmart with a Good Rx coupon. Combining those drugs provides better blood pressure control with fewer side effects.

Losartan belongs to a class of drugs for hypertension and related heart conditions called angiotensin receptor blockers (ARBs). The generic name for these drugs ends with -sartan. That is how you can identify them. They all do the same thing. They precisely block the receptor for angiotensin II on the cell surface. They interfere directly with a hormone effect that causes high blood pressure.

Careful design of your protocol to treat hypertension can save money. Notice that Losartan alone costs $9 a month. Hydrochlorothiazide costs $4 a month and so buying them separately would cost $13, which is over three times the cost of buying the combination. Losartan is the 4^th most commonly prescribed drug in the country.

This chart provides the prices of angiotensin receptor blockers. These are first step drugs in our protocol. As you can see easily from the chart below, there is huge variation in the cost of generic drugs in the same class. The use rank is where the medication ranks of all medicines prescribed in the United States. # Patients is the number of patients who take the drug.

Azilsartan is also a generic drug, but it is thirty times as expensive as losartan and it has the same benefits. That cost difference is crazy. Don’t pay it.

The next chart provides the prices of angiotensin converting enzyme inhibitors. These are alternate first step drugs in our protocol. They have additional side effects like cough and angioedema. (swelling of the larynx or -voice box). You can identify drugs in this category by their -pril ending.

These ACE inhibitor drugs are all in the same class. They all block the production of angiotensin II, a key hormone that causes high blood pressure. They are precision medicines. Moexepril is 22 times as expensive as lisinopril, benazepril, and ramipril. Cost effective drug selection is critical to better health at lower cost.

There are more calcium channel blockers than are in this list, but they have more side effects. They slow the heart rate, reduce the pumping function of the heart, and cause constipation. The other calcium channel blockers are not in our protocol.

Amlodipine is the 5^th most prescribed in the country. Isradipine is 43 times more expensive. Amlodipine is a better drug than isradipine. It does not cause a faster heart rate and it has important antioxidant and anti-inflammatory properties. It is the best drug in the class. Paying more for Isradipine makes no sense.

Our protocol calls for ACE inhibitors or ARBs, thiazide type diuretics, and amlodipine as the first three steps.

Here again with the fluid pills or diuretics, there is huge variation in price. Chlorothiazide is ten times as expensive as hydrochlorothiazide. Indapamide and chlorthalidone both are more powerful diuretics and can be used to lower the blood pressure more, but they have more issues with low potassium. We use hydrochlorothiazide and would consider indapamide if hydrochlorothiazide is not adequate to control the blood pressure. We would switch hydrochlorothiazide to indapamide if the blood pressure is not controlled after adding a medication in the category below, the aldosterone blockers. These are known by clinicians as mineralocorticoid receptor (MR) blockers.

Eplerenone costs more than spironolactone, but it has fewer side effects in men than spironolactone in higher doses. Spironolactone may cause impotence and breast enlargement in men—again in higher doses. Most men can take 25 mg of spironolactone with no side effects. These are great drugs that precisely block the effects of aldosterone which is a root cause of high blood pressure. Eplerenone is worth a few extra dollars for men. Kerendia is a very expensive new MR blocker that may be more useful in patients with more advanced chronic kidney disease but eplerenone and spironolactone are the drugs we use in our protocol.

If you use our first-choice drug in each class, you can control high blood pressure for $45 a month, even if you use all four categories of drugs. If you use the most expensive generic drug in each class, the cost would be $908. Our protocol is not only much more effective in preventing cardiovascular events, it is much more cost effective. Many families are struggling with increased costs for eggs and gasoline. Medical costs are some of the greatest strains on family budgets. Can you really afford not to know what these medications cost? This piece helps you understand the best practice, lowest cost approach to your high blood pressure.