Price and Effectiveness: Nasonex vs Nasacort Or Flonase

My wife gets seasonal allergy in the spring. Her doctor prescribed a nasal spray Mometasone (brand name Nasonex) last year. She asked for a refill. The doctor’s office sent the refill prescription electronically to the pharmacy.

How much will it cost? Our insurance plan shows the drug is covered, and it’s on the preferred list. It will be $239 for one bottle from a retail pharmacy or $641 for three bottles by mail order.

Before we meet the deductible on our high deductible health plan, we will be paying 100% of this price.

Because it’s still a brand-name drug with no generic, if we don’t go through insurance, the discount program GoodRx doesn’t give much of a discount either.

Meanwhile, similar drugs Nasacort and Flonase went OTC in recent years. Their prices are much lower.  Nasacort is $18 for one bottle at Amazon, $35 for a 3-pack at Costco. Flonase is $21 for one bottle at Amazon, $54 for a 3-pack at Costco.

Hmm, under $20 for OTC versus over $200 for prescription, is the prescription drug Nasonex that much better? I asked my wife if she wanted to send a message to her doctor and ask if the OTC drugs would be just as effective. She said she’d be a fool if she didn’t try the OTC drugs first. Whatever works the best will be the one she will use regardless the price.

This is another example of how a high deductible health plan helps lower the cost for everyone. If we only had to pay a $25 copay under a PPO plan, we wouldn’t have considered the lower cost OTC drugs. We would actually feel good about having it covered by insurance. However, mindlessly paying the higher cost through insurance would unnecessarily raise the cost for everyone, including eventually ourselves through higher premiums.

Price and effectiveness aren’t necessarily directly related. Considering that the two OTC drugs were prescription drugs only a few years ago, we fully expect them to work just as well at 1/10th the cost. Stop the mindless spending on health care.

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  1. abc says

    Two questions come to mind. First, does the doctor get a kickback from the drug company? Second, why doesn’t the doctor just give the nonprescription alternatives to the patient?

    • Harry Sit says

      At the time the doctor gave the prescription, the other two drugs already went OTC. The doctor did not say “if your co-pay is high get these OTC drugs.” It could be just operating under the old habit of never considering the price because the co-pay masks any price difference. As more and more people get on high deductible plans, doctors need to get up to speed on considering both price and effectiveness when prescribing.

      We often blast financial salesmen/women for steering people to expensive investments. We should also expose doctors for prescribing expensive treatment if they get a kickback in doing so.

  2. financeBuffReader says

    The scenario described in the post is both a pro and a con. Yes, consumers will be more exposed to the high costs of care and may take actions to mitigate the cost, putting downward market pressure on medical costs. On the other hand, consumers will be rationing their health to save money. That could lead to devastating health consequences for the consumer if they choose poorly.

    • brooklynjon says

      Doctor here. There is no kickback, certainly not anymore. We generally have no idea how expensive the drugs we prescribe are, partly for ethical reasons, and partly because there are so many variables that go into how much a particular medication costs a particular patient at a particular pharmacy, there’s no way to keep it all straight. That being said, pharmaceutical companies use marketing strategies on us, and the beauty of marketing is that it works on people who are unaware that they are being marketed to.

  3. Wahine says

    I suggest she try the generic prescription Flonase (Fluticasone Propionate). Where I live, it is less expensive than the OTC Flonase if I use After trying both, I find that I like the sprayer on the generic bottle better and it seems to work just as well.

    I love your newsletters. I found your site in a search for how to do the darn backdoor IRA in TurboTax and I’ve been a faithful reader ever since. 🙂 Keep up the good work!

  4. vi says

    enjoy your columns.
    This happens a lot. ran into this with Doryx (acne medication) for son . insurance company will only cover for generics or older formulations of the drug. So pharma companies game it by offering coupons to slightly different variations e.g. extended release. Dermatologist has to approve you for coupon which will whack off 100s of dollars from price. These dermatologists seem to be very popular and you can locate them by word of mouth or internet searches.

    • vi says

      wanted to complete editing my previous comment.
      the gaming comes in because the pre-discount price is applied to deductible. so after 3 refills your deductible is up and you only pay the copay price but insurance company is forced to pay for the highly inflated brand name price since that is what the dermatologist prescribed. So I am sure dermatologists benefit in some form.

    • Harry Sit says

      I would refuse to aid and abet in this scheme on principle. It feels like insurance fraud — claiming a higher loss than the actual cost. I heard it’s illegal to give coupons to Medicare patients. It should be made illegal for private insurance as well.

    • $iddhartha says

      Epipen is another drug that costs hundreds of dollars and preys on parents who have no choice but to pay whatever is asked. They generally have a coupon to knock of $100 dollars as well. If you don’t have a High Deductible plan, they may give you a reasonable copay of say $50, $100, or so.

      My understanding is that EpiPen is much cheaper in countries like Canada. Also, they expire within a year and parents are asked to buy multiple boxes (one for home, one for school, etc.). So essentially following this advice, we as parents are expected to allocate well over $1000 annually because we have a kid with a severe allergy.

  5. Sankar Ganesan says

    Here is my recommendation. Usually, I suffer a lot due to allergies during this time. This year I am trying out Neilmed Sinus Rinse Allergy And Sinus Regular Premixed Sachets which is about $15 in Amazon and a lot cheaper at Costco for a 2 pack one. Natural and no side effects. I did not have any issue this year though living in Texas. I would recommend this to everybody.

    • Nick says

      Second that.
      I have used the nasal rinse therapy/method for a few years now and it has worked for me. Used to have terrible allergy issues and suffered every spring and fall for weeks at a time. However, this nasal rinse method works for me only if my nose is not already clogged up and I do the rinse on a daily basis. I missed out on doing that for a few weeks when on travel and now Im all clogged up and chemical warfare (mucinex, zyrtec, claritin, flonase.. whatever) is the only way out for some relief despite the fact that all the remedies have some sort of undesirable side effect. Once my nasal passages are clear, back to nasal rinse again.

  6. Eric says

    Another MD chiming in:
    Very unlikely that kickbacks of any kind are involved; and as someone who has worked a couple of years in outpatient settings I’ll mention that most patients want the convenience of Walgreens at their low co-payment. Attempts to educate people to shop for low cost generics is often received poorly, sometimes with suspicion, and it always takes time away from other discussion. That said, if a patient broached the topic I was always happy to suggest the least expensive good alternative I was aware of and I can probably count on two thumbs the number of times I have prescribed a non-generic medicine for an Internal Medicine practice.

    Second, Harry’s approach was reasonable and rational though my preference for personal supply of generic allergy and asthma medicines (yes, me too) as someone with high deductible insurance is to buy through the internet at international pharmacies that sell drugs made in the UK, New Zealand or Israel. I avoid India due to an unfortunate counterfeit supply in that country, and I avoid Turkey due to lack of information.

    Fluticasone is a fantastic medicine, although there is not much to differentiate one anti-inflammatory corticosteroid from another other than the amount required for equivalent effect (the potency,) and those differences are usually accounted for in the unit or dose packaging. or in the prescription. A patient may prefer or better handle a particular delivery system over another (particularly asthma medications) but so far as the medicines go — find the least expensive.

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