(Updated 2018) Birth control pills can come at very different prices. Sometimes they’re actually more expensive if you have insurance! Covered by insurance or not, there are a few things you need to know about how pricing works, and where you’ll pay a lot or a little. It’s different depending on your insurance, on your pill and your pharmacy.
When you need to fill a prescription, it pays to shop around. Many people are surprised to find how much prices vary, not just for birth-control pills but for a lot of other prescriptions. This is true at both big chains and small neighborhood pharmacies. There’s advice about buying prescriptions on our reference page on the topic.
While birth control is supposed to be covered under the Affordable Care Act, we know a lot of people aren’t insured — or maybe they choose to buy without insurance (for example, if you don’t want your mom to know).
We did some thorough research recently on birth-control pills in the tri-state area (New York, New Jersey and Connecticut). Price differences were shocking! For example:
• One popular birth control pill, Tri-Sprintec 28, ranged from $9 to $63, depending on where you shop.
• Another common one, Yaz-28, ranged from $68 to $112.
Here is a description of the survey. We made this interactive map in partnership with New York’s award-winning radio show, WNYC, but it’s no longer available.
Insurance Can Make Things More Expensive
Here’s another thing: If you’re insured, you might be surprised to find out that prescriptions can sometimes be filled for less by paying out-of-pocket. Some stories:
• Here’s a blog post we wrote about a man who found that a prescription would cost $12.10 without insurance, and $38 with.
• Here’s an article about an internist who sends patients to Costco to buy their prescriptions without invoking their insurance.
The internist, Dr. David Belk, maintains a website with a lot of cost information; the section on medications notes that the cost of co-pays actually can have the effect of raising prices. Costco is known for buying all its goods at cost and applying a consistent markup (14 or 15 percent) so you might find that it’s less expensive to buy there than going through the co-pay insurance route. Dr. Belk practices in California, and we have anecdotal information confirming that the same is often true elsewhere — though not always.
We recommend that you always ask about discounts. We had one pharmacist in New Haven tell us that he’d bring a $30 birth-control prescription down to $20 if the uninsured customer couldn’t afford it. That’s one of the perks about your local, independent neighborhood drug store.
Ask for a cash price. Even if you’re insured.
We have heard a lot from people whose insurance policies charge them a copay for medications that might be more expensive than paying cash. For example, if your policy imposes a $25 copay for all generics, but you could buy that medication for $9, you would want to know.
Here’s some great news coverage of this from Lee Zurik, a New Orleans reporter who’s put a lot of time into reporting on this. This applies not only to birth control pills, but to other medications as well.
Yes, birth control pills are supposed to be covered under the Affordable Care Act. We hear from people who say “my pill is not on their plan” or “I’m not taking it for birth control, but for other reasons, so my insurer won’t cover it.”
If you’re comparison shopping, you could take a look at the resources on our Prescriptions page.
One place to start is goodrx.com. This easy-to-navigate website allows you to punch in the prescription you need with the city you live in. Voila — it returns a full list of price comparisons at local drug stores. The site offers discount coupons, but they’re not always accepted at your local store.
Here’s another: Blink Health. It’s dealing with generics for now.
There are other similar sites: werx.org, for example. But be cautious: These sites will tell you they are finding the lowest price, but is it really? The price that’s suggested to you with the coupon may not be available once you get there–we hear frequently that pharmacy managers don’t accept all coupons or drug discount cards given to them.
Also, as we write this, we notice that Costco prices are never listed on on any of these sites. Here is a Costco pharmacy pricing page.
Here’s a New York State website that also allows you to look up competing prescription prices. But you should use sound judgment — some of the prices we found, we just don’t believe. For example, the list includes a number of common birth-control pills for well over $1,000 at several New York pharmacies. Really?
Looking for one for your state? Here’s a somewhat dated list from the Robert Wood Johnson Foundation of state drug price lists.
These are all great resources, but they should be used with skepticism. During our phone reporting, we found several pharmacy prices listed online were outdated or inaccurate.
Price Lists from New York Pharmacies
In New York, pharmacies are required to supply price lists to consumers on request: “Every pharmacy that sells drugs at retail must make Drug Retail Price Lists available” for the top 150 sellers, according to the New York State pharmacy regulation Web site. “Pharmacies should update their lists at least weekly. Consumers may request a computer-generated list to take with them when they leave the pharmacy.”
We have consistently found that pharmacies are able to supply the list, or a price over the phone. But those lists can have mistakes. In one case, we called a Brooklyn pharmacy with a price listing of $467 for one pack of a common birth-control pill. When we asked if the cash-pay price was really that much, they checked their database and sheepishly told us the price was actually $93. Apparently their software had “miscalculated.”
A friend who’s an adolescent medicine specialist writes: “I love small-town, individually-owned pharmacies, but many of my patients use Target for Orthocylen/Sprintec/Mononessa/Prevafem or their Tri sisters for $9/pack. There aren’t many Wal-Marts around here, so I haven’t had experience with them, but their website does list it on their inexpensive med list. Both companies’ websites have long lists of generic drugs available for $4-12/month supply and even bigger discounts for 90-day supply.”
Why Does This Price Range Exist, Anyway?
Why does the price vary so much? Pill prices aren’t like the price of strawberries, which depends on a good harvest.
According to a recent story in The Los Angeles Times by David Lazarus, brand-name drugs will always carry the highest prices possible — mostly due to millions of dollars in research and development costs — while generic drugs are a little trickier.
Lazarus quoted Bob Toomajian, who worked for 16 years as Kaiser Permanente’s drug purchasing manager for Southern California, saying: “A lot of the prices for generics can’t be justified. Manufacturers are basically starting with the exorbitant prices that the branded guys charged and then setting their own prices at whatever level they think the market will bear.”
Moral of the story: prescription pricing websites are great, but it’s always best to get your quotes from the horse’s mouth. So make a phone call before rushing out the door for that $9 birth control prescription.
There’s advice about buying prescriptions on our reference page on the topic.
(Update: Since the implementation of the Affordable Care Act, spending on birth control may be dropping. See one study’s abstract here.)