Sponsored by Medicure’s Marley Drug. All thoughts & opinions are my own.
As patients, have you ever wondered if forgoing health insurance could perhaps save us money on prescription drugs? I honestly hadn’t considered it and this concept blew my mind when I first heard about it. For me, it always seemed like a no-brainer: go through my insurance policy to get access to prescription medications so I can contribute towards deductibles and meet my out-of-pocket costs many months later.
But that can take forever and cost quite a lot of money…The reality is we might not have to do that and it might sometimes save us money to bypass insurance. I recently sat down with pharmaceutical company Medicure’s President & COO, Dr. Neil Owens. Medicure owns an online pharmacy, Marley Drug, which is devoted to making prescription drugs more affordable for us as patients.
Background of Marley Drug
So how did Marley Drug come to be? One of the reasons why I wanted to share this blog post with my readers is because of what I observed to be humanitarian qualities of both Medicure and Marley Drug. Marley Drug started as a mom and pop pharmacy in Winston Salem, NC, run by husband and wife pharmacists (Dave and Elizabeth). And Medicure is a small pharmaceutical company based out of Winnipeg, Canada. The company is run by Dr. Owens and employs approximately 30 employees and manufactures three medications.
In speaking to Dr. Owens, he shared that when Medicure was seeking to acquire Marley Drug, Dave and Elizabeth were thrilled because their views were so synergistic in ensuring that patient quality of life comes first and doesn’t have to come at a high financial cost to the patient. To me personally, that meant a lot. As patients we take on a lot of costs – financially and also socially, emotionally, physically – so I am excited to see change finally start to take place.
How Does Marley Drug Work?
As an online pharmacy, Marley Drug dispenses quality generic medications for a variety of conditions to all over the 50 U.S. states and Puerto Rico. The company offers a wide supply of medications at often lower costs than going through insurance. So how do they go about doing that? By bypassing pharmacy benefits managers (PBMs) and health insurance companies.
Something that is often not discussed in patient communities is the role of PBMs. PBMs are companies that manage prescription drug benefits for health insurance companies, Medicare Part D plans, large employers, and various other payers. They negotiate with pharmaceutical companies and pharmacies to determine medication pricing; PBMs are usually offered rebates by pharma, which are supposed to be passed on to insurance companies in order to get passed on to us as patients in the form of premium, deductible and coinsurance reductions.[1]
Pharmaceutical companies, such as Medicure, argue that the amount they pay PBMs in negotiations is growing and driving drug prices up, meanwhile PBMs are not required to disclose how much they’re collecting as intermediaries between insurance companies and drug manufacturers. According to numbers published by the Commonwealth Fund, “manufacturer rebates to PBMs increased from $39.7 billion in 2012 to $89.5 billion in 2016, partially offsetting list price increases.”[2] PBMs counter that they have been passing along a larger share of the rebates to insurers, which insurance companies say they haven’t been receiving and we as patients certainly don’t appear to be receiving.
The end result? Drug pricing is still so high and the process of PBM negotiations is unfortunately still shrouded in so much secrecy. This is where Marley Drug comes in and why Medicure acquired Marley Drug to bring cost savings to patients like ourselves.
To better understand how PBMs work visually, check out this video created by Marley Drug: https://www.youtube.com/watch?v=g7revP_oQRk&t=5s
Cost Savings with Marley Drug
In order to showcase the cost savings of ordering medications via Marley Drug, take a look below for some examples of medications used to treat immune-mediated inflammatory diseases (IMIDs):
Take a commonly used immunosuppressant in the IBD space (as well rheumatoid arthritis, Sjögren’s, autoimmune hepatitis, organ transplant): Mercaptopurine (6mp). At a 50mg dose per day, Mercaptopurine would cost $42.78 per month and if we were to order in bulk, that price would come down significantly to $19.11 per month for a 6-month supply and $16.94 per month for a 12-month supply. The average retail price of this medication is $105.70 per month.[3]
Same thing goes for another immunosuppressant known as Methotrexate, which is used often for rheumatoid arthritis, psoriasis and Crohn’s disease among others. In the case of Methotrexate (2.5mg tablet), the price per month bypassing insurance is $24.75. For a 6-month and 12-month supply, this medication costs $10.42 per month and $7.92 per month, respectively. Methotrexate retails for over $61 on average per month.[4]
If we think about how much we are paying in deductibles, copays and coinsurance, Mercaptopurine and Methotrexate will likely work out to be cheaper by bypassing insurance. The same goes for many other medications available via Marley Drug, including antibiotic Vancomycin, anti-emetic Ondansetron as well as generic forms of 5-ASA drugs, Mesalamine and Sulfasalazine. This is something for us to really think about and consider as patients.
Another thing to consider outside the IMID space is the flagship drug Marley Drug offers cost savings for, which is a statin drug called Zypitamag (pitavastatin). This medication is an alternative to the very expensive branded medication, Livalo at $1,000/90 days. Marley Drug offers Zypitamag at a deep discount of $1.15/day. For me, as a South Asian woman with significant cardiovascular disease running in my family (and with high prevalence in our community), this kind of pricing for a statin drug is reassuring to see. To this end, Dr. Owens said, “What’s amazing to us is that we get the same profit by selling Zypitamag at $1.15/day directly to patients through Marley Drug, as when we sell through PBM’s at $7.74/day – we don’t see any difference because the PBM and insurance companies keep most of the difference, while patients are the ones paying. Additionally, through our approach, there’s no prior authorization or hurdles to getting access. It’s something we hope to repeat with other medications in the future.”
When looking for cost savings for patients like us with chronic illnesses, it’s important to consider all these factors and in particular, ordering 6- or 12-month supplies if we know we will be on certain medications long-term. Not only does this save time, but also long-term mail-order prescriptions arguably decrease costs, increase medication compliance, thereby improving our patient outcomes and overall quality of life.[5],[6]
Some Closing Thoughts
In talking to Dr. Neil Owens, I learned a lot about how pharmacies price drugs and what Medicure’s vision is for the future. One thing that struck me during our conversation is that he and his company have a vision to start negotiating with employers directly to offer reduced drug pricing to company employees. By bypassing pharmacy benefit plans offered by health insurance companies, employers would bypass PBMs too and there may be a cost savings to companies and their employees. I think this would be an interesting alternative to explore in addition to seeing what kind of regulations can be put in place to ensure transparency in PBM negotiations.
Patients like us need change when it comes to drug pricing and I feel that it’s important for us to take some of this into our own hands by doing our own research on how we can save the most money. I also find that the more competition there is in the space to pharmacies such as Mark Cuban’s Cost Plus Drugs and others, the more prices will have to be brought down, which can only benefit us as patients.
So, own your Crohn’s, own your chronic illness, and shop around for what might be the best price for the medications we need for the better quality of life. Check out Marley Drug’s website today and see if you might be able to get your medications for less!
As always, thank you for your readership! I hope you found this blog post useful and eye-opening! If you have any further questions about Marley Drug and their offering, please visit their website or call their toll-free number (800-810-7790).
Marley Drug supports the IBD community! Check out Medicure’s Senior Medical Affairs Manager’s IBD story: https://www.marleydrug.com/blog/living-with-a-chronic-illness-my-challenges-with-crohns-disease
[1] https://www.commonwealthfund.org/publications/explainer/2019/apr/pharmacy-benefit-managers-and-their-role-drug-spending
[2] https://www.pewtrusts.org/en/research-and-analysis/reports/2019/03/08/the-prescription-drug-landscape-explored
[3] https://www.goodrx.com/mercaptopurine
[4] https://www.goodrx.com/methotrexate
[5] https://www.ahajournals.org/doi/10.1161/JAHA.119.016215
[6] https://link.springer.com/article/10.1007/s11606-020-06237-8
