How does/can Walmart offer such inexpensive prescriptions?

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dm200
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How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

I have (in my opinion) a very good Medicare plan (medicare cost - like advantage - with drug coverage). I take a drug (will need to take for the rest of my life) and now pay $30 for a 90 day supply (refill US Mail). I see this same drug available at Walmart for much less (I have a friend who gets that same drug at Walmart) - cash price, not through any insurance.

How do they do this (profitably)??

I also see it at Rite-Aid for $16. How do they do it?
Last edited by dm200 on Sat Oct 21, 2017 2:13 pm, edited 1 time in total.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

I will hazard a guess.

My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc. If it is losing money on prescriptions, it can make it up, probably, in other areas of the store. The theory might be that if people come in to buy low cost prescriptions, they will buy other stuff before they leave, net profit.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

mouses wrote: Sat Oct 21, 2017 2:13 pm I will hazard a guess.
My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc. If it is losing money on prescriptions, it can make it up, probably, in other areas of the store. The theory might be that if people come in to buy low cost prescriptions, they will buy other stuff before they leave, net profit.
My guess as well. However, do that many more folks then shop at Walmart than would already be there?
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Re: How does/can Walmart offer such inexpensive prescriptions?

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OP, You are probably lucky that you have a generic drug. A relative uses Walmart with a Medicare drug plan D and takes several brand name meds (no generics available), which put her in the donut hole and cost enough to allow her to come out.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by itstoomuch »

My guess is that the cost to manufacture is low and the distributors and retailers are passing on the savings. Blood pressure pills are probably at cost of dispensing or less.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by arcticpineapplecorp. »

I'll add a thought (just a guess though, I have no special knowledge of this subject). Just because they're "losing" money on the cash purchases, don't you think they're probably getting more from those WITH insurance? Not from the customers, but from the insurers.

I just bought a 3 month prescription for $15 (at CVS, where my insurer insists I go to get the lowest price. Yes, if I went to Walmart WITH my insurance it would cost me MORE at Walmart than CVS). Anyway, don't you suspect that just because I'm getting a deal at $15 for three months...the insurer is paying the difference to CVS? So if the insurance says they'll reimburse CVS up to $100 for the medicine and I pay $15, then they're getting the other $85 from my insurer. (Numbers used as to what insurer pays are not actual).

I think they can make up any losses because they're getting a ton of money from the insurers. We get a ton of coupons every week or two from CVS (because one of us has a chronic condition and requires 6 different prescriptions a month. That makes 9 between us). The other month CVS sent an email saying we were in the top 3% of savers in our state (based on our usage habits of the coupons they give us and what's left over...what we actually spend after saving due to the coupons). As an example, last week we got $48 worth of stuff for $4.10 (and I used a .10 reward from discover so it only cost $4 in the end). We do that all the time. I wonder how can they lose so much money from these coupons they're giving away. They're not. They're making it up on money they get from the insurers. They don't want customers who get prescriptions to go somewhere else, so they entice you with generous coupons for lots of other stuff. They're not losing money believe me. If they were, they'd go out of business.

Remember when they decided to get out of the cigarette business? Some "experts" said it'd be the death of CVS. Not even close. They make they're money from the pharmaceutical/insurance industry.

Now you might say, well then why doesn't everyone just pay cash? The medicine I get for $15 with my insurance probably would cost me more out of pocket. That's my guess.
Last edited by arcticpineapplecorp. on Sat Oct 21, 2017 2:31 pm, edited 3 times in total.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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celia wrote: Sat Oct 21, 2017 2:23 pm OP, You are probably lucky that you have a generic drug. A relative uses Walmart with a Medicare drug plan D and takes several brand name meds (no generics available), which put her in the donut hole and cost enough to allow her to come out.
Oh, yes - this drug (at $10/month - what I now pay) is very inexpensive. From my reading of the details (price, etc.) of the refills on my plan, it seems that the $30 is identical to the cash price and my "plan" absorbs nothing.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by retiredjg »

Do they still have those $4 prescriptions?

I think it is a loss leader. People want to use 1 pharmacy, not several. So if they get their ____ for $4 a month, they will use the same pharmacy for the more expensive Rx's because they don't want to go all over town to pick them up.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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Without getting into the medical weeds, while there are several "generic" versions, it is important to stay on the same "generic", if possible, and if the generic "version" changes, it is advised to have the Physician retest your levels, etc. I have decided to pay the $20/month and I know:

1. I am taking the same generic "version" every month and my Physician know exactly what I am taking.

2. All prescriptions I take are online

3. The monthly savings are small
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

retiredjg wrote: Sat Oct 21, 2017 2:29 pm Do they still have those $4 prescriptions?
I think it is a loss leader. People want to use 1 pharmacy, not several. So if they get their ____ for $4 a month, they will use the same pharmacy for the more expensive Rx's because they don't want to go all over town to pick them up.
Yes -

This friend, though, gets this drug at Walmart, but gets her other prescriptions at other places where her Medicare drug plan gives her the best prices.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by CppCoder »

My guess is that Walmart makes money on prescriptions the same way they make money on everything else: huge volume (supplier discounts and leverage), low costs, efficient supply chain, and lower margins than many would tolerate.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by celia »

retiredjg wrote: Sat Oct 21, 2017 2:29 pm Do they still have those $4 prescriptions?

I think it is a loss leader. People want to use 1 pharmacy, not several. So if they get their ____ for $4 a month, they will use the same pharmacy for the more expensive Rx's because they don't want to go all over town to pick them up.
We have some $4 prescriptions, that are the same price with or without the insurance. We also have a couple that are less than that.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by yatesd »

CppCoder wrote: Sat Oct 21, 2017 2:42 pm My guess is that Walmart makes money on prescriptions the same way they make money on everything else: huge volume (supplier discounts and leverage), low costs, efficient supply chain, and lower margins than many would tolerate.
I agree...don't buy the wage issue, or made in China concern. No one has ever proven to me that they pay less than competitive salary compared to other similar retail companies...or sells more Chinese made goods compared to Amazon or Target.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Big Dog »

Do they still have those $4 prescriptions?

I think it is a loss leader.
Exactly. Individual items maybe sold below cost, but on average the Rx dept is a big money maker per sq.ft. of floor space. Remember, the margins on groceries and other items is <5%, so even a 10% margin on Rx is huge to the bottom line.
Without getting into the medical weeds, while there are several "generic" versions, it is important to stay on the same "generic", if possible, and if the generic "version" changes, it is advised to have the Physician retest your levels, etc.
With all due respect, I'd love to get down in the weeds. As far as I know, to be a certified generic in the US, the FDA requires the exact same active ingredients. Now, a manufacturer may change the non-active fillers, but those should have no medical effect.

https://www.fda.gov/Drugs/ResourcesForY ... 567297.htm
Last edited by Big Dog on Sat Oct 21, 2017 3:14 pm, edited 1 time in total.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.
I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
Great idea!

Look out that "Big Pharma" may track you down and have you severly punished for lowering their profits! :D
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Spirit Rider »

It is not just Walmart. Target and mostly all pharmacies have their own $4/30 days and $10/90 days generic drug programs.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mmcmonster »

I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If you're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
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Re: How does/can Walmart offer such inexpensive prescriptions?

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With all due respect, I'd love to get down in the weeds. As far as I know, to be a certified generic in the US, the FDA requires the exact same active ingredients. Now, a manufacturer may change the non-active fillers, but those should have no medical effect.
OK. I do agree that for true "generics" - it should not make any difference.

This drug is Synthroid or Levoxyl or Levothroid or Levothyroxine Sodium. According to what I read and have been told, the generics, while equally effective, should not be mized or switched unless you have the regular thyroid hormone blood tests. When my health plan refilled my 90 day prescription last year, there was an insert in the refill to consult with the prescribing physician that the supplier of the generic had changed and the Physician may want to run more tests.

So, in this one case, there are these "issues" with different generic suppliers.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

mmcmonster wrote: Sat Oct 21, 2017 3:20 pm You should see the look on their eyes!!!
Not just in the "eyes" :)
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Re: How does/can Walmart offer such inexpensive prescriptions?

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me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I agree, but I also think we need increased reform in the medical industry overall. Most people in the medical industry are overpaid compared to services rendered (including doctors). Some of this is due to the inherent greed of medical staff and other factors that limit participation in the industry. One of the few businesses without published price lists (or any real transparency). At least if I go to walmart.com, tirerack.com or 1800contacts, I can see a price list.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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dm200 wrote: Sat Oct 21, 2017 3:25 pmThis drug is Synthroid or Levoxyl or Levothroid or Levothyroxine Sodium. According to what I read and have been told, the generics, while equally effective, should not be mized or switched unless you have the regular thyroid hormone blood tests. When my health plan refilled my 90 day prescription last year, there was an insert in the refill to consult with the prescribing physician that the supplier of the generic had changed and the Physician may want to run more tests.
The active ingredient in all of the above is the same. That being said, everyone on thyroid replacement hormone should have their levels checked yearly regardless (for changes in the person's metabolism, not changes in the medication).

The only time it should make a difference is if an individual is allergic to one of the stabilizers or coloring agents in the pills. If that's the case, you're probably going to be allergic to a lot of medications (and likely foods as well) and should consider an allergist consultation and desensitization.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Majormajor78 »

How about that, I actually know an answer. And my pharmacist wife thinks I never listen to her :D

The reason for this is called the pharmacy benefits manager or PBM. This is a middle man in the pharmacy logistics/administrative chain that fills the role of a non-fiduciary financial planner combined with a stock exchange market maker. They are hired by the pharmaceutical companies (sometimes subsidiaries) to negotiate and set rates with the individual pharmacies like CVS or Walgreens. These agreements make the prospectuses of variable rate annuities look like children's bedtime stories.

The argument for PBM's is that they help stabalize prices. What they actually end up doing is buying the drug form the manufacturer and then dictating how much the customer must be charged and how much the pharmacy can be re-reimbursed while pocketing the spread. Sometimes this can be pretty egregious especially for common maintenance medications that people take everyday for blood pressure, thyroid, ect. Here's an excerpt and a link to an article from USA today.

https://www.usatoday.com/story/money/pe ... s/5495317/
In fact, the PBMs' cut of transactions can double drug costs for consumers or employers. A month's supply of a 20 milligram dose of Lipitor cost consumers or their employers $21.60, according to an audit of a PBM contract done recently by Pharmacy Outcomes Specialists, which represents companies, managed care organizations, unions and government agencies. The drugstore was reimbursed $10.83, so the PBM kept $10.77. For a month's supply of a 10 mg dose of Ambien, the consumer/company cost was $5.65, the pharmacy got $1.88 and the PBM retained $3.77.
The consumer paid $21.60 and the pharmacy got $10.83

This is how Walmart's generic drug program can sell you a 90 supply of some meds for $10 or a 30 day supply for $4 and still make an honest profit. The program gives the pharmacy benefits manager a metaphorical finger, bypasses insurance completely and the PBM gets zip. I'm sure Walmart still has to deal with PBM's quite a bit and any agreements with them are laced with iron clad non-disclosure agreements. And I mean iron clad. One whisper from the pharmacist or technician behind the counter and they get fired or a flock of lawyers descend from the clouds and destroy their livelihoods (fired, lost licenses, sued, ect.)

The end around of this is that pharmasicts can answer your questions, so if you ask them about ways of reducing costs or alternative generics that may be cheaper you may be shocked at how helpful they suddenly become as this bypasses the gag orders. They still can't talk about the PBM's but they can sure talk about alternative options once you ask.

A moment of honesty. Like you I have a generic med that insurance wants me to pay $30 for but I get it from Walmart for $10. A little over a year ago I got an infection from one of those super-bugs that are resistant to antibiotics. After I finally got out of the hospital I had a prescription for a restricted and very expensive antibiotic. The full price for a ten day supply of the med was $1800, I paid $30 due to the PBM I'm sure. Like financial advisors, they can be helpful at times. In this case my meds were subsidized by the PBM overcharging everybody else for their cheap generics. The system is pretty messed up but that's what we have to deal with as patients/consumers. I go to Walmart for my daily generic.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by partner »

I don't go to Walmart for drugs anymore because of all their screwups. The last two episodes I can remember was they lost my prescription (more than once) and switched labels on my two medications. Most of the work is done by minimum wage employees that started yesterday. Yes, I know a licensed pharmacist has to be on duty but that one person can't do it all. In my store there must be at least a dozen persons back there. My ins co went to 0 co-pay this year for generics but before they changed it would tell me that the co-pay was the same everywhere. It would tell me (on website) that my co-pay for a particular med would be $20 (at walmart) but when I picked it up it would be $10.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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dm200 wrote: Sat Oct 21, 2017 3:25 pm
With all due respect, I'd love to get down in the weeds. As far as I know, to be a certified generic in the US, the FDA requires the exact same active ingredients. Now, a manufacturer may change the non-active fillers, but those should have no medical effect.
OK. I do agree that for true "generics" - it should not make any difference.

This drug is Synthroid or Levoxyl or Levothroid or Levothyroxine Sodium. According to what I read and have been told, the generics, while equally effective, should not be mized or switched unless you have the regular thyroid hormone blood tests. When my health plan refilled my 90 day prescription last year, there was an insert in the refill to consult with the prescribing physician that the supplier of the generic had changed and the Physician may want to run more tests.

So, in this one case, there are these "issues" with different generic suppliers.
This is what we've been told, since the early '80's.

Every few years, I check again with an endocrinologist, expecting them to say, "Oh, that's old; it's okay to take any of them nowadays", but nooooo!
They still (as of about a year ago) tell us that we should stick with (in our case what we've been using) Synthroid, and "accept no substitutes" [what is that phrase originally from!?].
I still find that very surprising.

In our case, with our Rx coverage and Rx usage, this doesn't add to our annual Rx costs, so the fact that this happens to be the "brand name" doesn't matter (to us), and it's not expensive anyway.

But there is another med that is recently >$1k/month. "Nice".
It used to be MUCH less, but then mfg came out with an XL (long acting) version, and apparently we cannot get that anymore (not made? or no longer on the insurance formulary!?), so ONLY the XL version is available. At something like 10x the "non-XL" monthly cost. :shock:

But because of this thread, I just looked at online info on the pricing, and there seems to be easy availability at about 1/4 the cost (still ridiculous, given the lower priced non-XL).
Our Employer self insures, and is a "good Employer".
I'm not sure whether to "start some sort of trouble" by questioning this...?
I'm not sure it would ever matter if we did...

RM
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

yatesd wrote: Sat Oct 21, 2017 3:27 pm
me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I agree, but I also think we need increased reform in the medical industry overall. Most people in the medical industry are overpaid compared to services rendered (including doctors). Some of this is due to the inherent greed of medical staff and other factors that limit participation in the industry. One of the few businesses without published price lists (or any real transparency). At least if I go to walmart.com, tirerack.com or 1800contacts, I can see a price list.

The lack of transparency in pricing for medical goods and services goes deep. Furthermore, there is a lack of transparency of what physicians truly earn. If you look at MGMA data the figures look pretty high. But they don’t account for huge variation that exists, often within a given demographic are. As an example, Medicare will pay a family physician 34$ to clean ear wax out of a patients ear. An ENT, using the same instruments for the same job, is payed considerably more. Yes they have more training but really, they should be fairly paid for the procedure that other physicians are not trained to do. The lack of transparency is worse now than when I began in medicine 23 years ago.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Big Dog »

OK. I do agree that for true "generics" - it should not make any difference.
Not sure your use of quotes is fair. Every generic approved to be sold in the US is a "true generic."

That being said, you are exactly correct in that all generics do not react exactly the same in the body as the branded Rx. Partly that is due to the fact that the FDA only requires that the generic come close to 100% of the brand -- it could be +/-. But also, the binders and fillers are different and maybe digested faster or slower.

And yes, switching drugs when you have a condition which requires blood levels be kept on an even keel (thyroid, blood thinners, antidepressants and the like) requires more blood testing. But that would also be true if you changed from one branded drug to another for your condition.

Point being that if you do try and find a generic that works for you (after additional blood testing?) you can save money on the refills.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

As an example, Medicare will pay a family physician 34$ to clean ear wax out of a patients ear. An ENT, using the same instruments for the same job, is payed considerably more. Yes they have more training but really, they should be fairly paid for the procedure that other physicians are not trained to do. The lack of transparency is worse now than when I began in medicine 23 years ago.
Not surprising. May or may not makes any sense. Depending on the specialties/subspecialties involved, there may be some overlap (and different fees)

I had my earwax removed by a technician - no extra charge to me
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by rxtra8 »

I was in the RX business for many years and now retired. I worked for a megacorp HMO and ran a $15mil inventory. Most generic drugs cost very little; even less than 1 penny per tablet for quite a few. It is easy to make money on $4 generic RXs.

I am of the opinion that generics are basically the same as the brand name in almost all cases. The only exception is for NTI drugs; narrow therapeutic index...such as warfarin, seizure meds, thyroid meds. These should always be monitored after a change of mfg. If there is a difference it is usually very little, but remember the bell shaped curve for response; some will be on the tail end. We once changed a brand name seizure med and the generic actually gave better bioavailability. When you are in the ER and your life is in the balance, most likely you are being treated with generic drugs.

Also if you are in the situation where the drug company has changed your brand medication for the "XL" (probably because the non-XL was going generic) you should ask for pharmacist/MD for cheaper alternatives that will provide the same result. Megacorp spend a lot of $$$ to determine which drugs were most effective for the least cost...many times we stuck with the "older" med as it did just fine for a lot less money.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by downshiftme »

Without getting into the medical weeds, while there are several "generic" versions, it is important to stay on the same "generic", if possible, and if the generic "version" changes, it is advised to have the Physician retest your levels, etc. I have decided to pay the $20/month
I have not used Walmart for prescriptions, but I can tell you that at my regular pharmacy it is impossible to stay on the "same" generic. They switch suppliers all the time and I typically get pills from 3 different suppliers (same medication in same dosage) in three different color/markings because of the different manufacturers within a year.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

rxtra8 wrote: Sat Oct 21, 2017 4:10 pm I was in the RX business for many years and now retired. I worked for a megacorp HMO and ran a $15mil inventory. Most generic drugs cost very little; even less than 1 penny per tablet for quite a few. It is easy to make money on $4 generic RXs.

I am of the opinion that generics are basically the same as the brand name in almost all cases. The only exception is for NTI drugs; narrow therapeutic index...such as warfarin, seizure meds, thyroid meds. These should always be monitored after a change of mfg. If there is a difference it is usually very little, but remember the bell shaped curve for response; some will be on the tail end. We once changed a brand name seizure med and the generic actually gave better bioavailability. When you are in the ER and your life is in the balance, most likely you are being treated with generic drugs.

Also if you are in the situation where the drug company has changed your brand medication for the "XL" (probably because the non-XL was going generic) you should ask for pharmacist/MD for cheaper alternatives that will provide the same result. Megacorp spend a lot of $$$ to determine which drugs were most effective for the least cost...many times we stuck with the "older" med as it did just fine for a lot less money.
Thank you so much for your candor and insight. I agree completely with your assessment of generics. I would throw something else out there for discussion. Why is the same drug available in Canada, manufactured by the same company, but at a third of the cost. If the pharma companies were not making a profit there, they would not sell there. Pharma is too deep into the pocket of lobbyists and politicians.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by SlowMovingInvestor »

retiredjg wrote: Sat Oct 21, 2017 2:29 pm Do they still have those $4 prescriptions?

I think it is a loss leader. People want to use 1 pharmacy, not several. So if they get their ____ for $4 a month, they will use the same pharmacy for the more expensive Rx's because they don't want to go all over town to pick them up.
My impression was that Wal Mart rarely does loss leaders. But that might vary between departments -- perhaps their pharmacy does have loss leaders.

Note that some supermarket pharmacies will offer generic antibiotics for free -- I'm sure those are loss leaders.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

SlowMovingInvestor wrote: Sat Oct 21, 2017 4:23 pm
retiredjg wrote: Sat Oct 21, 2017 2:29 pm Do they still have those $4 prescriptions?

I think it is a loss leader. People want to use 1 pharmacy, not several. So if they get their ____ for $4 a month, they will use the same pharmacy for the more expensive Rx's because they don't want to go all over town to pick them up.
My impression was that Wal Mart rarely does loss leaders. But that might vary between departments -- perhaps their pharmacy does have loss leaders.

Note that some supermarket pharmacies will offer generic antibiotics for free -- I'm sure those are loss leaders.
Yes Walmart is willing to take a loss to help people. Just ask the Great Pumpkin when Halloween comes.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

Big Dog wrote: Sat Oct 21, 2017 3:54 pm
OK. I do agree that for true "generics" - it should not make any difference.
Not sure your use of quotes is fair. Every generic approved to be sold in the US is a "true generic."
That being said, you are exactly correct in that all generics do not react exactly the same in the body as the branded Rx. Partly that is due to the fact that the FDA only requires that the generic come close to 100% of the brand -- it could be +/-. But also, the binders and fillers are different and maybe digested faster or slower.
And yes, switching drugs when you have a condition which requires blood levels be kept on an even keel (thyroid, blood thinners, antidepressants and the like) requires more blood testing. But that would also be true if you changed from one branded drug to another for your condition.
Point being that if you do try and find a generic that works for you (after additional blood testing?) you can save money on the refills.
No matter which I take (depends on insurance and Specialist), since I have been taking ir for 30 years, for this particular prescription medication, the information/advice has been the same: All versions (perhaps with very rare exceptions) are equally effective, BUT never switch version without prescribing physician running tests. In fact, there was a class action lawsuit a few years ago. The first synthetic thyroid drug was "Synthroid" and the manufacturers of Synthroid claimed it was batter than the later alternatives. To "prove" it was better, they commissioned a study to show that. However, this study showed that it was no better at all. So, they suppressed the publcation of the study. Somehow, it leaked and class action lawyers filed a lawsuit and the manufacturers lost and had to pay a lot of money (I suspect the lawyers got the biggest chunk).
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

Big Dog wrote: Sat Oct 21, 2017 3:09 pm
Without getting into the medical weeds, while there are several "generic" versions, it is important to stay on the same "generic", if possible, and if the generic "version" changes, it is advised to have the Physician retest your levels, etc.
With all due respect, I'd love to get down in the weeds. As far as I know, to be a certified generic in the US, the FDA requires the exact same active ingredients. Now, a manufacturer may change the non-active fillers, but those should have no medical effect.

https://www.fda.gov/Drugs/ResourcesForY ... 567297.htm
It is definitely not correct that in practice generics are identical. My cardiologist is adamant that his patients take the brand name Toprol rather than any of the generics. If you web search, you will find that year after year the generic manufacturers of this have recall after recall for screwing up the dosages.

Not quite the same problem, but there is apparently a shortage of sumatriptan, the Imitrex generic, and the long time manufacturer, Sandoz, whose nasal spray of it I used to get has suspended selling it indefinitely. The replacement manufacturer, Lannett, has really wretched dispensers. The Sandoz ones were easy to use, With the Lannett ones you practically need a pliers to move the pump part to get them to spray.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

Why is the same drug available in Canada, manufactured by the same company, but at a third of the cost. If the pharma companies were not making a profit there, they would not sell there.
Good question..

I agree with the conclusion.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

downshiftme wrote: Sat Oct 21, 2017 4:11 pm
Without getting into the medical weeds, while there are several "generic" versions, it is important to stay on the same "generic", if possible, and if the generic "version" changes, it is advised to have the Physician retest your levels, etc. I have decided to pay the $20/month
I have not used Walmart for prescriptions, but I can tell you that at my regular pharmacy it is impossible to stay on the "same" generic. They switch suppliers all the time and I typically get pills from 3 different suppliers (same medication in same dosage) in three different color/markings because of the different manufacturers within a year.
I am obsessive about this and so far mostly my pharmacy has been able to order the same one even if it is not their default.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Helo80 »

I have a few ideas...

1. Walmart buys in bulk
2. Drugs cost little to nothing to make --- it's the R&D that makes stuff so expensive
3. For older drugs, the generics clone the formulas and did not have the exorbitant R&D costs
4. I think CVS got caught up in this where paying "with insurance" sometimes was more costly than just buying with cash --- people are just convinced that "paying with insurance" is saving money.
5. It could be a loss leader, but I would say the majority of the drugs do not cost them that much.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by JGoneRiding »

Not sure it was said. But Costco/Walmart etc get better than average prices for the drugs they buy in the first place. So the pass that along. Where I know private pharmacies that make like 1-2 an rx from medicare because they can't buy the drugs as cheap to start
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

My cardiologist is adamant that his patients take the brand name Toprol rather than any of the generics.
Go to this web site https://projects.propublica.org/docdollars/ and type in your cadiologist's name and state and see how much he/she received from the manufacturer of Toprol. I typed in the name and state of a cardiologist I saw two years ago, and he got $93 (4 payments) in 2014 and $14 (one payment) in 2015. Payments include free drugs, food/beverage, speaking fees aand some others (all detailed).

Let us know what you find out.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by jcar »

Check out Publix. Free amoxicillin, lisonopril, and many other drugs. No gimmicks, pick up script at drive thru no charge. I did it today.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Big Dog »

If you web search, you will find that year after year the generic manufacturers of this have recall after recall for screwing up the dosages.
Small nit, but the one recall I found was not the dosage of acitve ingredient, but the time release aspect of it. Yes, I get that for a user, that's a distinction without a difference. Yet the FDA still claims:
Christopher C. Kelly, a spokesman for the F.D.A., acknowledged in a statement that “there have been challenges in consistently manufacturing” metoprolol succinate and said the agency had consistently monitored manufacturing of the drug to prevent problems. He said in 2013, the F.D.A. undertook a “multidisciplinary investigation” of the efficacy and quality of each of the versions of metoprolol succinate available in the United States. The agency concluded then that all of the versions, including those made by Wockhardt and Dr. Reddy’s, were bioequivalent to the brand-name version.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Lancelot »

CppCoder wrote: Sat Oct 21, 2017 2:42 pm My guess is that Walmart makes money on prescriptions the same way they make money on everything else: huge volume (supplier discounts and leverage), low costs, efficient supply chain, and lower margins than many would tolerate.
I agree. Walmart has great bargaining power with its suppliers and is very efficient.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

rxtra8 wrote: Sat Oct 21, 2017 4:10 pm I was in the RX business for many years and now retired. I worked for a megacorp HMO and ran a $15mil inventory. Most generic drugs cost very little; even less than 1 penny per tablet for quite a few. It is easy to make money on $4 generic RXs.

I am of the opinion that generics are basically the same as the brand name in almost all cases. The only exception is for NTI drugs; narrow therapeutic index...such as warfarin, seizure meds, thyroid meds. These should always be monitored after a change of mfg. If there is a difference it is usually very little, but remember the bell shaped curve for response; some will be on the tail end. We once changed a brand name seizure med and the generic actually gave better bioavailability. When you are in the ER and your life is in the balance, most likely you are being treated with generic drugs.

Also if you are in the situation where the drug company has changed your brand medication for the "XL" (probably because the non-XL was going generic) you should ask for pharmacist/MD for cheaper alternatives that will provide the same result. Megacorp spend a lot of $$$ to determine which drugs were most effective for the least cost...many times we stuck with the "older" med as it did just fine for a lot less money.
Very interesting and timely.
I mentioned the XL switcheroo just above.

Since posting above, we've been to CVS (we both got flu shots, very convenient, no cost), and I asked the pharmacist about this. He seemed unaware (also seemed to be a young floater... whatever; he gave gentle shots :happy ), so he checked his lists.

Sure enough, mfg did away with the regular, and only offers the XL, at just about 10x the price on a mg/mg per day comparison.
BUT... it turns out that mfg still offers the non-XL in other "doses", just not *that* dose as a single pill.
It turns out it's something like $1,100+ per month on the XL tabs, but a bit over $150/month on the "plain vanilla tablets", if prescribed as a different combo of pills to total the "right amount" daily. Duh.

As a matter of principle, I'm going to have physician change dosing back to non-XL, with different mg. pill size. (Duh.)
We pay the same, either way. Insurance/Employer don't!

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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Salmon Maki »

mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If you're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
Do you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

Salmon Maki wrote: Sat Oct 21, 2017 5:55 pm
mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If yoau're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
Do you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.
No they are considerably less expensive. Check out andameds.com, an American company which sells generic sildanafil for 20$ for........are you ready, drumroll please.........90 tablets!!!!! :sharebeer let the good times roll.

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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Salmon Maki »

me112964 wrote: Sat Oct 21, 2017 6:15 pm
Salmon Maki wrote: Sat Oct 21, 2017 5:55 pm
mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If yoau're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
Do you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.
No they are considerably less expensive. Check out andameds.com, an American company which sells generic sildanafil for 20$ for........are you ready, drumroll please.........90 tablets!!!!! :sharebeer let the good times roll.

I don’t want to derail this thread, but I have serious doubts about that company, which is not a VIPPS accredited pharmacy.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by retiredjg »

rxtra8 wrote: Sat Oct 21, 2017 4:10 pm I was in the RX business for many years and now retired. I worked for a megacorp HMO and ran a $15mil inventory. Most generic drugs cost very little; even less than 1 penny per tablet for quite a few. It is easy to make money on $4 generic RXs.

I am of the opinion that generics are basically the same as the brand name in almost all cases. The only exception is for NTI drugs; narrow therapeutic index...such as warfarin, seizure meds, thyroid meds. These should always be monitored after a change of mfg. If there is a difference it is usually very little, but remember the bell shaped curve for response; some will be on the tail end. We once changed a brand name seizure med and the generic actually gave better bioavailability.
I found this interesting since I have seen something similar in a seizure drug for one of my animals. I observed a dramatic change in seizure activity when the manufacturer changed. The pharmacy says they have no control over what generic they get when they order it. This has been very frustrating.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by jcar »

Check out Publix. Free amoxicillin, lisonopril, and many other drugs. No gimmicks, pick up script at drive thru no charge. I did it today.
me112964
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

Salmon Maki wrote: Sat Oct 21, 2017 6:44 pm
me112964 wrote: Sat Oct 21, 2017 6:15 pm
Salmon Maki wrote: Sat Oct 21, 2017 5:55 pm
mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If yoau're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
Do you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.
No they are considerably less expensive. Check out andameds.com, an American company which sells generic sildanafil for 20$ for........are you ready, drumroll please.........90 tablets!!!!! :sharebeer let the good times roll.

I don’t want to derail this thread, but I have serious doubts about that company, which is not a VIPPS accredited pharmacy.
So this so called non-VIPPS accredited pharmacy (of which many many small pharmacies are in that same category) has several different generic companies offering the medication. They are the same generics found at the so called accredited pharmacies. I don’t work for the company but have used them for years. Never had a patient complain or return any meds.
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