As of the moment, despite higher price, I use a drugstore [Walgreen] chain for my ’scrips – not for any real reason, just seems more comfortable.

This may change, though, as an online supplier [NOT a "re-import" house] charges roughly forty per cent less than the brick-and-mortar. For ten percent I would not change, the convenience and turn-around time at the local facilities would keep me there. But FORTY? Roughly $110/month, or eight percent of monthly income?

And again, I suspect the difference is largely in overhead other than price-from-manufacturer. Heck, go to any for-profit hospital and look at what they charge for aspirin or Tylenol vs the local drugstore: the difference can be amazing, and it is not because the hospital pays more than the drugstore.

I am a bit leery of on-line, as the local pharmacist also acts as a sort of synthesist checking that prescriptions from different doctors unaware of each other’s scrips have not inadvertently interfered with each other.

On a broader perspective, I was told by my marketing prof that people will buy goods or services based on perceived value. How can Bayer sell aspirin for a higher cost than the generic? It is EXACTLY the same chemical. Well, it is in the perceived value of having that Bayer name. It would probably work the same with non-OTC drugs. Clever marketers can add some value to their me-too drug regardless of it’s efficacy. However, information on head to head comparisons would allow some of us to make better choices. This would only really be worth it for expensive drugs. And like choosing a Lexus over a Lincoln, based on the consumer reports stats, personal preferences would play a huge role.

One answer: Much of pharma’s institutional advertising might be redirected to influencing the few hundred honchos who have to sign off on the One Price. Ditto for the AARP’s influence effort.

Another point: How would differential pricing for drugs in the same class be determined? (Derek Lowe recently mentioned that one of the me-too statins caused an entirely-unexpected improvement in CRP.) The safety/efficacy battle would become a political battle in D.C. Sounds like a bad idea to me. (The me-too drugs already have multiple purposes anyway. Absent price fixing collusion, they drive the cost down to what the market will bear. They also give another chance to people who cannot tolerate one drug.)

Re. DTC advertising: I’m all for it. Otherwise it is difficult to get the word out on important new drugs. Take the non-sedating antihistamines. Without advertising, a lot of people would have continued to self-treat with the sedating kind, with major impact on quality of life, job and school performance, and safety while operating machinery. As another example, I bet a lot of people who have given up on their diabetic neuropathy will give it another try once the Cymbalta advertising hits.

How big of a problem is it anway with the people who insist on some drug they have seen on TV? I understand it must be incredibly annoying for the poor doctor, but what is the actual economic cost? How many people would you have to “treat” by detoxifying them from advertising to prevent one adverse outcome?