PharmacyChecker Blog

Helping Americans Get The Truth About Prescription Drug Savings
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CEO of PharmacyChecker On People’s Pharmacy Radio Talking Safety and Savings on Narrow Therapeutic Index Drugs

Tod Cooperman, MD CEO of

Joe and Terry Graedon have been helping Americans make better health decisions for the last 40 years, including through their syndicated radio show on National Public Radio called The People’s Pharmacy. As you can imagine, their listeners are interested in prescription drug safety and savings. Our CEO was on their show this past Saturday and I’d like to tell you about it, especially if you want to learn how to save money on brand name drugs.

The CEO of, Tod Cooperman, MD, is also the founder and president of, the leading evaluator of health and wellness products. has worked with The People’s Pharmacy in the past to test prescription medications. While I believe that generics sold in the U.S. are usually of the highest quality, equal to or better than generics in most other countries,’s findings show that some generic medications in the U.S. are not always equal to the brand. Due to his expertise is drug quality and his knowledge about drug prices, The People’s Pharmacy brought Dr. Cooperman on to their show last week to talk about Narrow Therapeutic Index (NTI) drugs. Listen to the show! (See minutes 6:50-18:00).

For NTI medications, it’s even more important that the active pharmaceutical ingredient is present in the exact amount required. When NTI medications have too much of the active pharmaceutical ingredient, it can be toxic; but those that have too little may not be adequately efficacious. Most NTI drugs are available in generic form, which usually means they are low cost, even without insurance, and usually lower-priced than in Canada and other countries, too! The opposite holds true for brands.

Some providers are deciding that it’s important for their patients stick with the brand for NTI drugs for the reasons stated above.  But the prices here are often too high. In the radio show, Dr. Cooperman recommends looking internationally for those who can’t afford the brand locally. Americans can often find discounts averaging 80% internationally on Brand name NTI drugs. Last summer, when we read The Graedon’s Guide to Saving Money on Medicines, we noticed the list of NTI drugs and wanted to compare drug prices domestically and internationally. Our research from Fall 2016 is below.

Narrow Therapeutic Index (NTI) Drugs: Brand Name Price Comparison (U.S., Canada, International*)

Per Pill Cost[i] Potential Savings
Medication Name: Brand (Generic) Strength U.S[ii] Canada[iii] NZ/UK[iv] Canada Other Int’l Overall
Tegretol (Carbamazepine) 200mg $2.87 $0.77 $0.57 73% 80% 80%
Cleocin HCl (Clindamycin) [v] 300mg caps $24.00 $3.38  NA 86% NA 86%
Catapres (Clonidine HCl) 0.1mg $3.34 $0.45  NA 86% NA 86%
Sandimmune (Cyclosporine) 100mg /mL  50mL $664.84 $327.98  NA 51% NA 51%
Lanoxin (Digoxin)[vi] 0.125mg $12.54 $0.75  NA 94% NA 94%
Depakote (Divalproex)[vii] 250mg $5.73 $0.90  NA 84% NA 84%
Zarontin (Ethosuximide) 250mg $4.51 $0.66  NA 85% NA 85%
Synthroid (Levothyroxine) 100 mcg (0.1mg) $1.87 $0.35 $0.63 81% 66% 81%
Dilantin (Phenytoin) 100mg $1.45 $0.33 $0.48 77% 67% 77%
Depakene (Valproic acid) 250mg $5.76 $0.93  NA 84% NA 84%
Coumadin (Warfarin) 5mg $3.69 $0.60 NA 84% NA 84%
 Average Savings 81%

[i] Based on three month supply of medication.

[ii] Walgreens, NYC, December 2016

[iii] Prices of international online pharmacies verified by

[iv] Prices of international online pharmacies verified by

[v] Marketed as Dalacin C in Canad

[vi] Marketed as Toloxin in Canada

[vii] Marketed as Epival in Canada


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Nation’s Largest PBM Using Anti-Big Pharma Language in New Report Showing Brand Drug Prices Double

Pills and Money

Each week I try to come up with a new and compelling blog post to discuss issues involving drug prices and problems Americans are having affording medications. I often find myself resoundingly critical of the pharmaceutical industry and this week I was intrigued but curiously put off to be joined by a pharmacy corporation that made over $100 billion last year.

Express Scripts, the nation’s largest pharmacy benefit manager, reported that brand name drugs in the U.S. cost 98.2% (about twice) more on average today than they did in 2011. Last year, brand name drug prices were up 16%. As I read in the Chicago Tribune, Express Scripts used hostile, downright anti-big pharma (and pharmacy) language blaming “opportunistic manufacturers” and “scheming pharmacies.” Rising drug prices of this magnitude are no laughing matter as cash-strapped Americans bear the brunt of these increases, either in higher insurance premiums, co-payments, co-insurance and full cash prices for uninsured (still almost 30 million Americans), or when plans don’t cover certain drugs.

But it is a little funny to hear Express Scripts go after Big Pharma using the rhetoric of greed. After all, PBMs, particularly Express Scripts, are often criticized for their lack of drug pricing transparency and profit-seeking practices, kind of like drug companies and big pharmacies, such as Walgreens and CVS.

While the focus of Express Scripts’ ire is on brand name drug prices, most of the prescription sales it administers and profits from are generics. On that note, buying generic medication without using your insurance’s PBM is often less expensive than your co-payments. But don’t expect Express Scripts to tell you that.

So that Express Scripts doesn’t feel singled out, we’ve reported on the antics of Big Pharmacy before, including Express Scripts’ biggest competitor. PharmacyChecker CEO Tod Cooperman, MD, was on Fox and Friends not so long ago discussing an investigation of CVS Caremark in which the company was accused of price gouging. The allegation: by not informing its customers that the cash price using CVS’ own discount card program would be lower than co-payments using PBMs, such as CVS Caremark or Express Scripts, hundreds of thousands of customers were overcharged.

On that note: the nuts and bolts message is DON’T BE SHY and ask for the lowest possible price at your local pharmacy.

In defense of Express Scripts, and even CVS Caremark, PBMs and large pharmacy corporations do not yield profit margins even close to those of the biggest drug companies. Furthermore, the pharmacy corporate giant, Express Scripts, is right: the blame for ever increasing drug prices falls on opportunistic manufacturers and scheming pharmacies.

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What do Donald Trump, Hillary Clinton, and Bernie Sanders have in common? Support for Drug Importation.

Donald Trump, Hilary Clinton and Bernie Sanders

Yesterday, our CEO, Tod Cooperman, MD, applauded leading presidential candidates for supporting legal reforms to make it easier for Americans to buy lower cost medications from other countries.

“With millions of Americans doing this safely for more than a dozen years, it’s time for our government to stop threatening and scaring consumers and simply do what’s right: Make personal drug importation fully legal. Every presidential candidate should support this,” says Dr. Cooperman.

To read the full press release, go here:

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Finding the Lowest Drug Prices is a Real Headache – the Story of Rizatriptan

Woman with Migraine
Migraine” by Sasha Wolff from Grand Rapids – Can’t Concentrate: 14/365. Licensed under CC BY 2.0 via Wikimedia Commons.

Dr. David Belk, a practicing physician in California, healthcare cost research guru and Huffington Post blogger, recently wrote a story about the huge difference in price faced by one of his patients when trying to fill a prescription for the migraine medication called Maxalt (rizatriptan). Since my daughter suffers from migraines, I know how debilitating migraine headache can be and how important it is to have the medication when you need it.

Essentially, Dr. Belk discovered that Walgreens, a big chain pharmacy, was charging much more money than another pharmacy – in this case Costco. The price for the generic at Walgreens without insurance was $1,490 for 40 pills, or $37 a pill, and even with insurance the price was almost $17 dollars a pill. But Dr. Belk’s patient ended up getting the medication at Costco for $1.03 per pill!!

Now ordinarily here’s where we’d write about how you might consider PharmacyChecker- verified international online pharmacies to purchase Maxalt or rizatriptin if you don’t have insurance – but you would not need to. According to Dr. Belk’s post, Costco’s price was the cash price! None of the online pharmacies in our program sell it for just over a buck a pill. It’s the cheapest in the U.S.A.!

A few months back, Tod Cooperman, MD, founder of was on Fox and Friends talking about another big chain pharmacy, one accused of overcharging consumers for generic medications. It seems that the problem is not just Big Pharma but Big Pharmacy.

Drug prices these days seem to be all over the place. The moral of this story: shop around as much as possible and don’t trust your friendly neighborhood chain pharmacy or assume that international online pharmacies are cheapest. I know it’s enough to give you a headache, even a migraine, but finding the lowest drug prices will help lessen the pain.


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Are All Generic Prescription Drugs Created Equal? PharmacyChecker President Says No.

As we all know, an unaffordable drug is neither safe nor effective. No less true, an ineffective drug, whether dirt cheap or super expensive, can have hazardous health consequences, even death. That’s why consumers seeking low cost medication online look to avoid bad meds by finding accredited online pharmacies with a PharmacyChecker or VIPPS seal. But that might not always be good enough…

People don’t like to talk about it but sometimes switching from a brand name med to an “equivalent” generic can lead to serious health problems. And this happens at your local U.S. pharmacy, not just online. Tod Cooperman, MD, president of, knows about this more than most people. In his capacity as president of, he participated on an expert panel at a Congressional briefing this past Wednesday, organized by a new group called the Safe Medicines Coalition led by economist and counterfeit drug expert Roger Bate, PhD. The panelists and others are authors of a new paper called “Drug Inequality: Allowable Variations and Illegal Underperformance in Off-Patent Drugs.”

Dr. Cooperman’s main contribution to the panel comes from his experience testing a generic version of the anti-depressant Wellbutrin XL. To make a long story short, in 2007 tested Teva’s FDA approved generic of the 300 mg version called Budeprion XL – an extended-release product. A generic drug that is bioequivalent to the brand name drug is supposed to work pretty much the exact same way as the brand. found that Teva’s generic did not dissolve like Wellbutrin XL – it released the drug much too quickly. It took the FDA more than 5 years but it finally conceded that the product was not bioequivalent to the brand product because it released the active ingredient much faster.

According to the People’s Pharmacy, people taking this generic were feeling more depressed, and even suicidal – until they switched back to the brand or to a different generic. The People’s Pharmacy and shared this information with the FDA back in 2007 only to be ignored.

In order for the FDA to approve a generic drug for sale in the U.S., it must be proven to be bioequivalent to the brand name drug –delivering approximately the same amount of drug over the same amount of time in a group of healthy volunteers. It turns out that Teva never did this for the 300 mg version of Budeprion XL. The FDA approved the drug anyway, based on the data and approval for a lower strength version, Budeprion XL 150mg. What’s more amazing is that generic medications, even though they are not the exact same as their brand name counterparts, under U.S. law, must have the exact same clinical data in their package inserts as the brand name drug. That is, the data shown in the insert is NOT actually the data for that generic. This is meant to give the impression that all generics are the same as the brand name product, even though that’s not the case. If that doesn’t seem to make sense then you’re thinking clearly.

In 2012, the FDA admitted had been right, and stated that Budeprion XL 300mg is was not bioequivalent to Wellbutrin XL 300mg.

Dr. Harry Lever, a cardiologist, talked about patients who were not responding well when switched to certain generic heart medications, such as beta blockers. Most interestingly, problems not only occurred when patients switched from brand to generic but even from generic to generic, which takes us back to the efforts of above and moves us into a new point: Not all generic drugs are equal to each other, and a particular generic might work better in one patient than another!

The key takeaway from Dr. Lever’s and Dr. Cooperman’s presentations is that if a certain generic drug is working for you, then try and stay on that exact same medication. You’ll find it’s not easy because pharmacies often interchange generic drugs in their dispensing practices. You can avoid this by making sure you ask for the same generic, meaning the same manufacturer, each time you visit the pharmacy.

Mr. Bate focused on the fact that drug quality, generally, is not equal from manufacturer to manufacturer, brand to generic, generic to generic, country to country, etc. Mr. Bate is not saying that most generic drugs don’t work but simply that they are not exactly the same. Dr. Preston Mason supported this by presenting data based on testing generic versions of Pfizer’s Lipitor. He found that different versions were not all equal. The lowest quality products, based on number of impurities, were made in India for export to poorer countries.

The final presenter was Dinesh Thakur, the whistleblower that outed major manufacturing problems and corruption at Indian drug manufacturer Ranbaxy. Ranbaxy was actually granted the first go at marketing generic Lipitor in the U.S., but their version was eventually recalled due to small particles of glass that may have contaminated the product. You might find FDA’s nuanced position on the recall instructive and of great interest: “Patients who have the recalled medicine can continue taking it unless directed otherwise by their physician or health care provider….To date, FDA hasn’t received any reports of injury….The possibility of adverse health problems related to the recalled atorvastatin is extremely low.” I don’t recall hearing that the drug was not effective either but its recall was precautionary.

So what the hell are average consumers and even their healthcare providers to make of all of this? I’m going to copy and paste from

  • If a generic doesn’t work like the original drug, be concerned, particularly if it is an extended release (often called “XL”) product.
  • Be aware that the labeling on a generic drug describing its performance is copied from the labeling of the original product and may not reflect the performance of the generic.  This is a deception required by the FDA, perhaps to create the perception of generics as interchangeable.
  • If a generic works for you, look carefully at the label and identify the manufacturer. Request the same manufacturer each time you refill that prescription. Other generics may not behave the same way.

From my perspective, despite the FDA debacle with generic Wellbutrin XL discussed above, the FDA is one of the best drug regulatory agencies in the world. Following the advice above, you can and should trust generic drugs sold in the United States. What about generic drugs sold over the Internet from foreign countries? Pharmaceuticals sold in the most highly regulated countries are generally equivalent in quality and efficacy to those sold in the United States. What about from Indian pharmacies? The highest quality medications sold in Indian pharmacies are on a par with those sold in the U.S., too, but there’s more deviation and far too little oversight from the Central Drugs Standards Controller Organization, India’s FDA.

For all of these reasons, if you’re buying online and getting a drug internationally stay away from websites that are not credentialed by And remember, despite crazy price increases in a good number of generic drugs, most generic medications approved for sale in the U.S., sold at local pharmacies are less expensive than International online pharmacy prices – even cheaper than India! However, brand name products are usually far less expensive outside the U.S. (and apparently sometimes safer than generics) – and you can check those prices on

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