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Research ArticleEthics Features

Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation

David Evans, Daniel M. Hartung, Denise Beasley and Lyle J. Fagnan
The Journal of the American Board of Family Medicine May 2013, 26 (3) 332-338; DOI: https://doi.org/10.3122/jabfm.2013.03.120268
David Evans
From the Department of Family Medicine, University of Washington School of Medicine, Seattle (DE); the Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland (DMH, DB); and the Department of Family Practice, Oregon Health & Science University School of Medicine, Oregon Rural Practice-based Research Network, Portland (LJF).
MD,
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Daniel M. Hartung
From the Department of Family Medicine, University of Washington School of Medicine, Seattle (DE); the Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland (DMH, DB); and the Department of Family Practice, Oregon Health & Science University School of Medicine, Oregon Rural Practice-based Research Network, Portland (LJF).
PharmD, MPH,
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Denise Beasley
From the Department of Family Medicine, University of Washington School of Medicine, Seattle (DE); the Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland (DMH, DB); and the Department of Family Practice, Oregon Health & Science University School of Medicine, Oregon Rural Practice-based Research Network, Portland (LJF).
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Lyle J. Fagnan
From the Department of Family Medicine, University of Washington School of Medicine, Seattle (DE); the Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland (DMH, DB); and the Department of Family Practice, Oregon Health & Science University School of Medicine, Oregon Rural Practice-based Research Network, Portland (LJF).
MD
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Article Figures & Data

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    Table 1. Inventory of Sampled Medicines, Potential Alternative Drugs, and Estimated Monthly Costs
    Sampled DrugGeneric NameAverage Monthly Cost ($)Potential Alternative DrugAverage Alternative Drug Monthly Cost ($)Difference ($)
    Psychotropic/neurologic
        CymbaltaDuloxetine107Fluoxetine10−96
        LexaproL-citalopram75Fluoxetine10−65
        Paxil CRParoxetine79Fluoxetine10−69
        ZoloftSertraline81Fluoxetine10−71
        ImitrexSumatriptan21*NA
        NamendaMemantine145NA
    Cardiovascular
        AdvicorNiacin76Niacin / lovastatin39−37
        AltaceRamipril46Lisinopril16−30
        AltoprevLovastatin89Lovastatin38−51
        AvaproIrbesartan50Lisinopril16−34
        BenicarOlmesartan50Lisinopril16−34
        Coregcarvedilol99Metoprolol7−92
        CozaarLosartan54Lisinopril16−38
        DiovanValsartan55Lisinopril16−39
        HyzaarLosartan/HCTZ59Lisinopril / HCTZ15−43
        LipitorAtorvastatin94Lovastatin38−56
        MicardisTelmisartan55Lisinopril16−38
        NiaspanNiacin Extended Release58Niacin4−54
        NorvascAmlodipine57Felodipine49−9
        PravacholPravastatin90Lovastatin38−52
        TevetenEprosartan39Lisinopril16−23
        TricorFenofibrate65Gemfibrozil19−46
        VytorinSimvastatin/ezetimibe85Lovastatin16−68
        ZocorSimvastatin94Lovastatin16−78
    Endocrine
        ActosPioglitazone155Glyburide or glipizide or metformin9−147
        AvandiaRosiglitazone103Glyburide or glipizide or metformin9−94
        StarlixNateglinide105Glyburide or glipizide or metformin9−97
        ACTOPLUS METPioglitazone/metformin150Glipizide/metformin49−101
        AvodartDutasteride81Terazosin40−41
        BonivaIbandronate60NA
        EnablexDarifenacin91Oxybutynin15−76
        FlomaxTamsulosin58Terazosin40−19
        FosamaxAlendronate84NA
        PremproEstrogen/medroxyprogesterone42NA
        SancturaTrospium45Oxybutynin15−30
        VesicareSolifenacin95Oxybutynin15−80
    Musculoskeletal
        SkelaxinMetaxalone228Baclofen31−197
        UltracetTramadol/APAP50Hydrocodone/APAP 5/5007−43
    Respiratory/allergy
        AsmanexMometasone369*Qvar™(beclomethasone)69−300
        SingulairMontelukast91NA
        SpirivaTiotropium127*Atrovent™ (ipratropium)62−65
        XopenexLevalbuterol165*Albuterol14−151
        ZyrtecCetirizine66Loratadine14−52
    Miscellaneous
        ViagraSildenafil13†NA
        ZelnormTegaserod170NA
        OmnicefCefdinir50Cefaclor24−26
    Average Difference = -$70
    • Drug costs estimated by Oregon Medicaid reimbursement data in 2005. Costs of brand-name drug costs = average wholesale price × 0.85; generic drugs = maximum allowable cost.

    • ↵* Cost per inhaler.

    • ↵† Cost per dose.

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The Journal of the American Board of Family     Medicine: 26 (3)
The Journal of the American Board of Family Medicine
Vol. 26, Issue 3
May-June 2013
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Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation
David Evans, Daniel M. Hartung, Denise Beasley, Lyle J. Fagnan
The Journal of the American Board of Family Medicine May 2013, 26 (3) 332-338; DOI: 10.3122/jabfm.2013.03.120268

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Breaking Up is Hard to Do: Lessons Learned from a Pharma-Free Practice Transformation
David Evans, Daniel M. Hartung, Denise Beasley, Lyle J. Fagnan
The Journal of the American Board of Family Medicine May 2013, 26 (3) 332-338; DOI: 10.3122/jabfm.2013.03.120268
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