Buying prescription drugs can be an adventure.
Are you insured? Is it covered? Does your plan cover not this medication, but another? was it $30 last month and now it’s $400? Yikes.
There are often not easy answers, but we always recommend: ask what it will cost.
Many people don’t pay cash for their prescriptions, but if you might find it’s cheaper on cash than with your insurance payment. We learned about this when we collected 600 price points for common pills in the New York area in a partnership with Brian Lehrer at WNYC public radio in New York City in 2013.
Here are a few resources on the topic of buying prescriptions.
Sometimes a prescription is cheaper on cash than the insured price, and sometimes it’s not. We recommend that everybody ask every time: “How much will this cost? How much will it cost me, on my insurance? What’s the cash price? Can I have that in writing?” If they won’t put it in writing, take notes, with names and numbers — it will make it easier to argue on the back end.
This goes or prescriptions and procedures too — it pays to shop around, something that many people are not used to doing in health care.
Always ask if there is an over-the-counter variant. Sometimes there is, and it can mean huge savings.
Always ask if there is a generic — it might be cheaper. But do not assume that a generic will automatically be cheaper. Again, ask: “How much will this cost? How much will it cost me, on my insurance? What’s the cash price? Can I have that in writing?”
Different drug stores can have different prices for the same medication. Ask several stores.
Doctors and patients often don’t know what’s covered under a patient’s insurance. So it can be a complicated process. Here’s an example from Martha Bebinger at WBUR public radio in Boston, of the search for insulin.
One way to think about prescription drug prices is a site called goodrx. It’s a web site with a search tool that lets you put in the name of a prescription drug and a location, then supplies a list of places that sell the drug and the prices.
Often a coupon is involved, and that means money’s changing hands somewhere. We have heard frequently that pharmacies don’t accept coupons, or may give a better price than the coupon price.
The prices aren’t the lowest we’ve seen, but it certainly gives you an idea of how to shop around.
GoodRx omits prices from Costco. We find on spot-checking that Costco prices tend to be the lowest or among the lowest in many metro areas. We surmise that GoodRx does not have a business relationship with Costco, as it does with the pharmacies whose prices it lists. I asked a GoodRx executive about this one time during a phone interview, and he ended the conversation. (Update: When this was originally written, in 2012, there were no Costco prices; now they are there, so we assume the two companies now have an agreement.)
Do not overlook Costco as an option, if there’s one in your area. The policy for many years has been that a customer at a Costco pharmacy does not need to have a Costco membership to buy there, but a Costco membership may confer additional discounts. Their prescription pricing page is here. Other big retailers may also have pricing on their sites. You may not need any GoodRx discount coupon to obtain the lowest price — so be sure to ask: “What is the price with the GoodRx coupon? What’s the price without a coupon? What’s the price with a Costco membership?”
Another site, Blink Health, lets you buy meds through them, by paying online, and then you get a coupon or voucher to take to a local store to pick up your prescription. It’s largely for generics, at least right now. The New York Times wrote about them: “The listed price for a 30-day supply of the generic version of Lipitor, for example, is $196 at Kmart, according to GoodRx, and $61 at Kroger. With a coupon obtained through GoodRx, the drug is about $12. Blink Health is offering Lipitor for $9.94.”
We don’t know where GoodRx gets the “listed price,” which it puts on its site next to the lower prices it offers — but that “listed price” is the one that drives you to believe that anything below that listed price is an improvement. That may be, but $9.94 is still better than $12.
Other sites pop up intermittently promising discounts; again the caveat applies about coupons.
There’s also prescriptionbluebook.com. The front page says: “We provide the wholesale cost (the price pharmacies pay) on your prescription medications. A yearly subscription to PrescriptionBlueBook.com reveals the wholesale cost on thousands of brand name and generic drugs… PrescriptionBlueBook.com also provides the ‘Fair Retail Price’ for each drug you access.”
So it’s a subscription, for $4 a month; with this information, the site suggests, you can shop around wisely. The site says it was launched in 2013, by a South Carolina pharmacist named Steve Patton.
Paying cash — that’s right, cash
Your medications could easily be cheaper if you pay cash, without your insurance card. That’s right: cheaper without insurance. There are a number of reasons for this, and it’s not always true, but we have been told time and again that buying on cash, depending on the medication and the pharmacy, can be cheaper.
Here’s an investigative report about the topic from Lee Zurik, an investigative reporter and anchor at WVUE/Fox8Live in New Orleans.
Always ask: How much will this cost? How much will this cost me? What’s the cash price?.
Ever wonder how much the drugstore paid for that pill? Here’s a post containing price lists compiled for the government.
Are generics always cheaper? No. Listen to our friend Leslie Ramirez from leslieslist.org.
Do you expect your co-pay to be the same every time? Well, stop it. Listen to Charles Ornstein as he tries to figure out a co-pay for a prescription.
The insurance company coverage is often governed by a formulary, or list of approved medications. Those formularies can change, and so one should always check with the insurance company or pharmacy benefits manager on coverage.
Here’s a nationwide formulary resource that we have not completely vetted, but at a glance it looks to be valuable (in my quick test it was 50 percent right). It’s free, and it lets you search any plan in any state. But! As with any information you find on the web, always check.
Are those drug discount cards really a bargain? Maybe not. Listen to Richard J. Sagall, M.D., who wrote this post for costsofcare.org.
Are manufacturers coupons a bargain? Also maybe not. Joseph S. Ross, M.D., and Aaron S. Kesselheim, M.D., J.D., M.P.H. explain in the New England Journal of Medicine.
Efforts to limit copay cards and coupons are on the rise, as Lisa Schencker of The Chicago Tribune writes in this piece. “Typically, patients with individual and employer-based plans can use the cards or coupons to save money on their insurance copays for certain prescription medications at the pharmacy,” she writes. “While a coupon can reduce all or part of a patient’s copay, the insurance company still has to pay its full portion for what might be a high-priced drug — a cost that opponents of the discounts say is ultimately passed on to all consumers in the form of higher insurance premiums.”
if you have big prescription costs, or if you’re very organized, take a look at this guest post that we ran from a woman who is extremely smart about all this. She has advice not only about shopping for the drugs she and her family use, but also medications for pets. She has a binder with printed lists, and every time she goes to the doctor, she has a conversation about medications. It’s a great example.
Thinking about buying prescriptions online? Here is a blog post about resources for checking up on whether that pharmacy’s legit.
Patient assistance programs
You might also be interested in NeedyMeds, a nonprofit helping people in need find medications. They have information about patient assistance programs, which typically help people with expensive medications.
Those patient assistance programs are offered by drug companies with differing rules, some of them through foundations and some directly through the companies. Such programs may provide meds directly to patients at little or no cost, or they might offer help with co-payments, the patient’s out-of-pocket expenses.
Quite often, this drug company assistance is either directed through a foundation, or used as a tax writeoff or something similar. Here’s a Los Angeles Times story exploring some of these issues.
This blog post links to a site that gives the average price that pharmacies are paying for every drug in every size in the U.S. — it’s a great resource.
We also love our legacy project, a crowdsourced PriceOfBC map of people’s contributions on the price of their birth-control pills. It was an early experiment (from 2011), and we are still very fond of it.
Beyond that, here are a few posts from the blog.