William Comanor, head of pharmaceutical economics and policy studies at UCLA, said this was a ridiculous distinction.
"Doxycycline is always going to be the same in terms of active ingredients," he said. "The inert compounds may be different, but not the active ingredients. They have to be consistent."
A CVS pharmacist in Los Angeles, who asked that his name by withheld because of fear of retaliation by the company, shared with me the average wholesale price of different makers' doxycycline, as made available to pharmacists by the McKesson Connect online ordering system.
The system shows that the average wholesale price of 100 doxycycline pills made by Watson with a strength of 100 milligrams is $328.20. The same number of doxycycline pills at the same strength made by Mylan cost $1,314.83.
But the average wholesale price, or AWP, as it's known in the industry, may have little, if any, correlation with what a drugstore charges customers.
"The AWP prices are as made up as the prices that come out of hospitals," said USC's McCombs. "It's not the price that CVS or other drugstores pay."
In other words, drugstores negotiate their own prices with manufacturers of generic drugs, as do the pharmacy benefit managers who often serve as intermediaries in wholesale drug transactions. They may be able to cut sweetheart deals based on the volume of medicine they can move to retail customers.
"Pharmacies make much more on generics than they do on name-brand drugs," McCombs said. "They have a lot more wiggle room for pricing."
Shattuck's experience raises questions about the responsibility of pharmacies to ensure that customers are receiving if not the best possible price, then at least a fair price for their meds.
It appears to me that Mylan prices its generic doxycycline at an absurdly high level because it can get away with it. Why not, if drugstores willingly enable such blatant gouging?
At the very least, drugstores should routinely make clear whether a customer is receiving the lowest-priced generic available, and if not, why. Customers can then make informed decisions about where to take their business.
Shattuck said she returned to CVS this week and was finally informed about the refilled order of Watson-made doxycycline. Only now, it wouldn't cost her $4.30. It would cost $35.
Apparently Watson and CVS had decided their respective profits on this drug just weren't high enough.