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Amitriptyline generic cost of 500 tablets was $5.67 for a 30 pack; generic divalproex was $45.98 for 30 capsules; and generic fluoxetine was $42.96 for 30 tablets. In contrast, prices for two major brand-name medications (fluvoxamine 80 mg and paroxetine Drugstore coupon code cyber monday 20 mg) could vary by more than 15% between manufacturers on average. The data set has a large collection of different brands ranging in quality; with all brands, prices for some medications could exceed $6 a capsule for either of the major brand-name medications. As a group, these results of the pharmacy benefit manager data set may be expected to represent a much larger number of pharmacies than those considered in this review. However, the relative price variability of some prescription drugs with a much wider range in price could provide important insights to providers and patients as they enter into the prescription drug market, including those of people who may be unfamiliar with the drugs, especially those a high risk of medical mistakes. The data set has a relatively high percentage of brand-name medications (77%), such that some pharmacies may end up with multiple medications in their patient's prescription drugs. These products vary in quality and quantity could increase variations in price across pharmacies. Although the quality and quantity of some medications with brand names may vary across pharmacies, the results of this analysis suggests that prices and quality of medications for some brand-name could be associated with variations across pharmacies even after controlling for the variables considered in analysis. It is difficult to discern whether the variation across pharmacies in pharmacy benefit manager prices reflects differences in drug content across pharmacies, differences in prices or another factor(s). Additionally, pharmacies that used the benefit manager to reduce cost of medications and/or increase the quantities sold may have been less concerned about ensuring price transparency in their transactions with the benefit manager (15, 18). This analysis suggests that pharmacy benefit managers themselves may be unable or unwilling to track and document the amounts being exchanged between them and pharmacies for their prescription drugs. It is possible that the variation in prices across pharmacies reflects the ability of some pharmacies to negotiate different prices with benefit managers. In some geographic and specialty areas of the United States, price disclosure laws are not always enforced and health care professionals may not be aware of how pharmacies negotiate between themselves (19). The extent to which price transparency in pharmacy benefit manager transactions is considered by pharmacies, and to what extent pharmacies are willing to participate in such transactions, varies by pharmacy, geographic region, specialty, and state laws. For example, one study reported that only 15% of pharmacies knew that their patients were eligible for discounts or free medications through pharmacy benefit managers in comparison to 60% of consumers who were unaware that such discounts existed for certain prescription drugs (19). Pharmacy benefit managers may not monitor adherence to the rules and regulations of each state. A survey 2,800 pharmacies found that 18% of customers reported paying by benefit check (20); even though this method allows for the collection of information on discounts, pharmacy benefit managers do not track adherence of such programs. Finally, price transparency among pharmacies in different jurisdictions is a challenge (21). Some benefit managers may not be concerned with adherence to state laws regarding prescription drug cost transparency. For example, a recent study found that fewer than half of state pharmacy benefit managers were willing to disclose.

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