(Updated, 2021) 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 try this: For each medication you are taking, follow these simple steps. It won’t take too long, and you might save a ton of money.
1. Ask the pharmacist “How much will this cost me, on my insurance? And what is 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.
They may not give you a clear answer, but we want to encourage everyone to ask the question — this is fundamentally know-able in advance, even if someone or several someones tell you they don’t know.
Don’t assume that your insurance gives you the best price. We hear over and over again, and have experienced cases ourselves, in which the insured price is actually HIGHER than the cash price, especially for generics.
2. Ask several pharmacies the same question — a chain, a local independent, a big-box store. Prices vary, a lot. Take notes, take names, take numbers. Without getting too far into the weeds, we should note here: Often the pharmacist will say, “We don’t know what that will cost — ask your insurance company.” Then the insurance company may say, “We don’t know what that will cost — ask your pharmacy.”
Keep in mind that there is almost certainly a pharmacy benefit manager (PBM) in the mix. The PBM is a middleman that will manage medications for your insurer — arranging formulary lists, administrative fees, buying in bulk (with a discount), collecting rebates, establishing “step therapy” protocols for steering you towards one med and away from another, and so on. The PBM has enormous power in making decisions for the insurer — and for you.
3. Ask “Is there a generic? Is there an over-the-counter variant?”
A generic might be cheaper. But do not assume that a generic will automatically be cheaper. Over-the-counter can be cheaper, or it can be more expensive — it’s worth asking, so you can compare.
4. Check websites like GoodRx.com and BlinkHealth.com to see if there’s a better deal. Again, take notes. Take screenshots if you can for proof. Again, we have heard frequently that generics may be cheaper on cash — without using your insurance, which might have a hefty co-pay.
5. Don’t forget Costco. We hear often that Costco has low prices, but most people don’t realize Costco has a pharmacy. You don’t have to be a Costco member to use their pharmacy, although at mine they said that members get better prices than non-members. My Costco is marginally cheaper than my local independent pharmacy for the one regular medication I take — but I like supporting my local independent.
6. Amazon has started to move aggressively into selling prescriptions, and Walmart is too. “Today, Amazon announced that Prime members can receive a six-month supply of several widely prescribed drugs, starting at $6. Many drugs are pricier but are still discounted relative to typical cash prices. And yesterday, Walmart said it would be adding new discounts of up to 85 percent on prescription drugs purchased through its Walmart+ RX service, with an average savings of about 65 percent,” Ars Technica reported in June 2021.
7. Do you have a coupon, or a discount card? Don’t assume that either is giving you a better deal. Sometimes they help, but quite often you can do better on cash without a coupon or a discount card. Think about it — with a coupon, there’s another mouth to feed. Also, many pharmacies won’t accept discount coupons or cards.
8. Patient assistance programs exist for some drugs. These are run by foundations or nonprofits (the Johnson & Johnson Patient Assistance Foundation, the Merck Patient Assistance Program Inc., for example) that have programs reducing out-of-pocket payments for patients, sometimes by a lot.
To find them: Google “patient assistance program” and the name of the drug.
Beware: They can be hard to access, and many have restrictions.
Also, the drug companies use these as a fig leaf: “Oh, we have patient assistance programs to help those in true need.” But the companies also use spending from these programs as a tax writeoff — inflating the drug prices, then giving a “patient assistance coupon” for a discount to the patient, and taking a hefty writeoff from the wildly inflated sticker price.
Meanwhile, the insurance company is paying its portion of the price.
9. If you still find it unaffordable, tell your doctor. Ask if there’s another medication. Ask the doctor to help you make your case if the insurance company is being difficult.
More resources for buying prescriptions
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.
The existing system is byzantine. Here’s the best explanation of how it works that I’ve seen, by Maitreyee Joshi.
Goodrx is 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. Why the prices are not listed from low to high we can only guess — maybe the businesses listed first pay a premium to be up top.
GoodRx used to omit prices from Costco, but now they are included in the list.
Do not overlook Costco as an option, if there’s one in your area. We find on spot-checking that Costco prices tend to be the lowest or among the lowest in many metro areas. 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? Without?”
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.
Does that discount prescription card really give a discount?
Maybe not. We mentioned this in No. 6 above, but want to amplify: We have seen and heard of dozens of such cards, issued by businesses, by trade groups, by on-line suppliers of cards, even by my local county government.
But be careful: Pharmacies do not universally take these cards. And even if they do, the discount card may not give a discount that’s deeper than a cash price. We have done spot checks of these cards and don’t have a universal assessment of them, other than to say: Do your homework. Ask the questions above.
Ask “How much is it with this discount card? How much is it with cash?” Ask this for every medication, and for every purchase: It might be better for one medication at one pharmacy, and much worse at another.
One friend told us: “One other question I started to ask is whether there’s a rebate (as well as coupon) and if it can be applied immediately. Not sure of other pharmacies’ policies, but the CVS near me was great about digging up any and applying them to the price I paid. I ended up saving a considerable amount on one medication.
“Asking about discounts for buying in bulk (e.g. 90-day supply) or by mail order can also net some savings.”
Another friend told us what worked for here in the New York area when her CVS told her that the medicine she’d been getting for years for $5 was going up to $385.
“My doctor called the RX into Central Pharmacy in Brooklyn (and sister pharmacy Pro Pharmacy in Queens). They partner with Zero Co-Pay Program on a number of meds. Bottom line: I now get my RX for free — and they deliver, also for free. I know this sounds too good to be true.”
I wrote about it here.
Another friend wrote: “I used Jeanne’s tip about GoodRX a couple years back and found that by getting my husband’s prescription at the supermarket instead of Walgreen’s, we could save $75ish/month. Thousands of dollars later, I remain a Jeanne Pinder superfan.”
Keep an eye on things like timely refills. This piece by a man who has ADHD and works as a pharmacy tech tells some useful ways to stay on track.
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.
We hear not frequently that people travel abroad expressly to buy medications. Recently some Americans made headlines by driving to Canada to buy insulin because insulin prices are so high here.
This Philadelphia man travels to buy his son’s prescriptions.
This practice is particularly common for U.S. citizens who live close to the Canadian or Mexican borders. Others find the prices cheap enough to fly from their U.S. cities to Canada or Mexico, buy prescriptions and fly back. Still others buy while they’re on vacation, or visiting relatives in other countries.
This particularly came across our radar recently in an online conversation about fertility medications, which can be extremely expensive — women talked about buying medications overseas, which the fertility clinics frown on. Here’s our blog post about that.
We do not make medical recommendations here, so we’re not recommending any of these courses. But if you do decide to try to buy abroad, make sure you know if you need a prescription, and what import restrictions there might be. Here’s a page from the U.S. Food and Drug Administration website referring to the current state of affairs. On the state level, several states are seeking to import drugs directly. But as it stands right now, anyone planning to import drugs from overseas, either by traveling abroad and bringing them back or by ordering online should know that there may be legal issues involved.
The same import restrictions apparently apply to buying from online pharmacies, including the Canadian online pharmacies that advertise so heavily. In addition to import restrictions, you should attempt to establish if the online pharmacy is legit. Here are some resources.
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.
Beyond that, here are a few posts from the blog.