Today, the amount consumers have to pay out of pocket for prescribed drugs is rapidly escalating, from about $25 billion in 2000 to a projected $67 billion in 2025. (1) To make matters worse, more than 8.6 percent of American adults, or roughly 28 million people, do not have health insurance and must pay for all prescription medications themselves. (2) But there are ways that you can minimize the effect that the accelerating prescription drug crisis has on your healthcare. This guide to drug pricing and discounts provides the answers to common questions and offers practical information that every consumer needs to know. No doubt, we have benefited from innovations in the management of diseases for which there were few or no treatment options before. But opponents of the pharmaceutical companies argue that just a small percentage of the drug companies’ costs are used for R&D, with most of the money spent on administration and brand-name drug marketing. Drug companies don’t tell the whole story behind the rising cost of prescriptions. There are third-party administrators known as pharmacy benefit managers (PBMs), who are paid to negotiate prices between pharmacies and large insurers. These PBMs charge pharmacy providers either a percentage or a flat fee for every prescription filled, which contributes to higher drug prices. (5) First, if you aren’t shopping around for medications at local pharmacies, using online coupons, or joining buyers’ clubs at drugstores, you’re probably paying way too much. Just because your pharmacist quotes you a price does not mean that’s the lowest price for that prescription. Comparison shopping for prescription medications can be as quick and easy as following the helpful tips below, reviewing a few websites, and printing some money-saving coupons.
1. Try Generic Drug Options
More than 80 percent of all drugs today are generics, which use the same active ingredients as brand-name medicines and work the same way but tend to cost a lot less than their pricey brand-name counterparts. The cost-saving news is that manufacturers of generic drugs do not have to repeat the animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness. Also, the competition among multiple companies producing a generic version of a drug helps keep the prices low for consumers. According to the Food and Drug Administration (FDA), to gain approval a generic drug must be the same as the brand-name product in the following ways: Generics may differ from brand-name counterparts in terms of other characteristics that don’t affect the drug’s performance or safety, like flavorings. What you should do Talk to your physician and pharmacist about generic equivalents of your brand-name drugs and consider switching.
2. Search for Discount Coupons Online
A simple Google search of your prescription drug, over-the-counter medicine, or healthcare supplies will bring up pages of websites offering money-saving coupons. Drug coupons cannot lower your copay, but your pharmacist may apply the coupon to your drug purchase to lower the price. Scroll through the available sites online to find rebates for your medicine, too. Because pharmacists may run prescriptions through insurance first, make sure the pharmacist is aware of the discount coupon or rebate before you pay the final cost. What you should do Before you head to the pharmacy to fill a prescription, do a quick Google search to check for money-saving coupons and rebates.
3. Use an App to Compare Local Drug Prices
There are several websites and mobile applications that can help you find the best price available for a prescription drug. One of the most widely used is GoodRx, which allows you to comparison shop and get coupons toward medications. GoodRx collects and compares prices and discounts that you didn’t know existed from more than 70,000 U.S. pharmacies, including CVS, Rite Aid, and Walgreens. (6) It allows you to print free discounted coupons or send them to your phone by email or text message. You can then use a GoodRx discount instead of your health insurance or Medicare Part D or Advantage plan if the cost is lower than your copay. When you go to GoodRx.com, they will ask for the name of the drug, the dosage, the number of pills, and your zip code. Click the “Find the Lowest Price” button. You will see what you might pay at different chain pharmacies with a GoodRx discount coupon or voucher. You can then print or download the generated coupons and vouchers to your smartphone and show your pharmacist to get savings on your drug purchase. (1,8) Similarly, Blink Health lets users browse local prices by simply searching for a prescription drug’s name. It also offers the option of having your medication delivered or ready for pickup. RetailMeNot Rx Saver is a popular and easy-to-use app and program. Here you can search for prices on brand-name and generic drugs. Their coupons can be used an unlimited number of times at retail pharmacies such as Walgreens and CVS. Other websites and mobile apps that offer drug coupons and rebates include ScriptSave WellRx, Easy Drug Card, and Optum Perks. What you should do Check out these and other no-cost prescription pricing services to see what pharmacies in your area charge for your medications.
4. Join Your Pharmacy’s Prescription Club
No insurance or not enough coverage? You can find in-store pharmacy prescription clubs at many drugstores. These money-saving programs can lower drug and supply prices. Also, the in-store programs provide up to an 85 percent savings on thousands of prescriptions, including commonly prescribed generic medications for heart health, diabetes, asthma, mental health issues, women’s health, gastrointestinal health, and other conditions. (9) While these savings clubs are not health insurance, they can save you money at the pharmacy. (10) What you should do Compare different in-store pharmacy prescription clubs to get the best prices when checking out. In-store pharmacies at retailers like Walgreens and Kmart also offer prescription clubs.
5. Shop Local or a Preferred Pharmacy Network
Independent pharmacies may beat major chain drugstores, supermarkets, and big box discounters on price — and by an impressive margin. Independents can also easily beat membership warehouses and clubs. In contrast, the preferred pharmacy network is a group of chain pharmacies that likely give insurance plans a larger discount than other pharmacies. The point is that drugstores have different prices — they can vary by hundreds of dollars — so be sure to ask ahead before you pick a specific pharmacy. What you should do Call your local and preferred retail pharmacies before filling your prescription to find the lowest prices.
6. Use a Verified Internet Pharmacy
Verified internet pharmacies are those that have passed stringent reviews by the National Association of Boards of Pharmacy (NABP). These pharmacies often include “.pharmacy” in their URLs to show that they are in compliance with the NABP, although some verified pharmacies are .coms or .orgs. They also carry the designation VIPPS, for Verified Internet Pharmacy Practice Site. While verified internet pharmacies have passed inspection and are deemed safe, be careful not to use a rogue internet pharmacy that is not verified. Check your internet pharmacy against the Find a Safe Site list to buy safely. In a revealing 2018 study, Consumer Reports sent secret shoppers to 150 pharmacies in six cities across the country to ask for the retail cash prices for a one-month supply of five commonly prescribed drugs — essentially the prices someone without insurance might pay. The range in prices they uncovered was shocking. While the five-drug “basket” cost was just $66 at the verified internet pharmacy HealthWarehouse.com, two national chain retailers had prices closer to $900. (1) What you should do It pays to shop around, and don’t forget to check internet pharmacies like HealthWarehouse.com for greater savings.
7. Use Mail Order for Medications and Supplies
Many pharmacies offer online ordering for drugs, diabetic supplies, over-the-counter medicines, hair supplies, and even pet medications. And you don’t have to have insurance. After placing your order, you will receive the drugs and supplies in the mail. Make sure the pharmacy is VIPPS accredited and certified. Your doctor will send the Rx by e-prescription to the proper phone number. What you should do Generally, it will take one to five business days to process your mail order prescription, so it’s important to plan ahead. (11)
8. Get Free or Low-Cost Birth Control Online
Not only can you get great prices on medications online, several newer websites offer free or low-cost birth control to women in many states. Planned Parenthood Direct, Nurx, Prjkt Ruby, and Maven Clinic offer telehealth services, virtual clinics, and prescription drugs delivered right to your door — and no insurance is needed. What you should do Explore telehealth services and virtual specialty clinics that can save you time and money on birth control and other necessary medications.
9. Talk Openly With Your Doctor
Be vocal with your doctor about any financial issues you may have, and be sure to try one or more of the following five things at your next office visit:
Ask your doctor for free samples or coupons. Doctors usually have samples and coupons given to them by drug reps. It doesn’t hurt to try a free sample pack before filling a pricey prescription to make sure this drug will work for you.Ask your doctor for a 90-day supply. This gives you one copay every three months instead of one every month.Ask about mail order. If your drug plan has a mail-order option, you may be able to get the 90-day supply of medications at an even lower cost.Ask about pill-splitting. Your doctor can prescribe a higher dose of medicine at the same price of the lower dose. You can split the drug in half or fourths to save. Scored pills are easier to split, but use a pill splitter (usually between $3 and $9 at most pharmacies) to avoid crushing the medication.Ask for an exception. If you and your doctor can’t find an affordable option together, speak with your insurer about making a formulary exception and providing coverage for your drug. The formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. (12,13) Your doctor will most likely need to submit a supporting statement, detailing that your drug is medically necessary and that any alternatives would have an adverse effect.
What you should do Be open and persistent. If your insurer denies your request for an exception, file an appeal. This requires that you work with your doctor to submit an application or letter of appeal.
10. Consider Patient Assistance Programs
Patient assistance programs (PAPs) are typically offered by pharmaceutical companies to provide free or low-cost prescription drugs to patients who lack health insurance or prescription drug coverage. You will need to fill out an application on the drug company’s website with your financial information. Your doctor may need to provide information about your prescribed medications. The drug company will review the application and tell you if you’re eligible for assistance. If approved, many companies will ship a supply of the drug to your home or your doctor’s office. Your doctor will need to place a new order several weeks before the supply runs out. What you should do Check out RxAssist.org, an online database of drug companies offering patient assistant programs that provide free or affordable drugs and copay assistance. (14)
11. Learn More About Medicare Part D
If you are 65 years or older and on Medicare Part D or Medicare Advantage, it’s important to understand how to get discounts on drugs. (15,16) Medicare Part D is an optional program to help Medicare beneficiaries pay for prescription drugs. Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare. The insurer’s formulary of drugs that they cover can change at any time, so be sure to check the prescription medications you take on the Medicare.gov site to find the best Part D plan that works for you. (17) While some people are able to use discounted coupons with Medicare Part D, most cannot unless they’re paying cash only. Of course, if you have a coupon for a drug not covered by your prescription drug plan, you can use this to lower your costs. (18,19) What you should do Take advantage of online education such as the Drugs.com Medicare Support Group to ask questions, share opinions, and stay up with the latest news. (20) Also, check the Medicare.gov site for more understanding on how Part D works with other insurance.
12. Get It for Free, if You Can
Some large supermarket chains, including Publix, Harris Teeter, Schnucks, Price Chopper, Walmart, Sam’s Club, Costco, and ShopRite, will fill basic antibiotic prescriptions like amoxicillin for free. Supermarket pharmacies may give prenatal vitamins, metformin, antibiotics, children’s vitamins, and other commonly taken medications and supplements for free if you have a valid prescription. These meds and antibiotics are free for as long your doctor prescribes them. You just have to ask. (21) What you should do You never know until you ask at the pharmacy to find out what drugs they provide customers for free. So be vocal! Here is a glossary of terms that you should familiarize yourself with.
Brand-name drug
A drug marketed under a proprietary, trademark-protected name.
Copay
A copay is a set rate that you pay for healthcare services and prescriptions at the time of care. For example, you may have a $25 copay every time you see your primary care physician (PCP). You may have a smaller copay for prescription drugs and a higher copay for the hospital emergency room.
Coinsurance
This is a percentage of a medical charge that you must pay, with the remainder paid by your health insurance plan, after your deductible has been met.
Deductible
The amount of money that the insured must pay before an insurance company will pay a claim.
Donut hole
This coverage gap with Medicare Part D means that after you and your drug plan have spent a certain dollar amount for prescription drugs, you have to pay all costs out of pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your prescription drug plan helps pay for covered drugs again.
Drug coupon
Offered by drug manufacturers to consumers to reduce the price of their prescription drugs.
Drug rebates
Used by payers to reduce premiums and out-of-pocket expenses.
U.S. Food and Drug Administration (FDA)
The FDA is a federal government agency that is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of the nation’s food supply, cosmetics, and products that emit radiation.
Generic drug
Drugs that use the same active ingredients as brand-name medicines and work the same way. Generic drugs are the same as brand-name drugs in dosage, safety, strength, how it is taken, quality, and intended use.
Mail order
Mail order services allow individuals to receive prescriptions conveniently through the mail.
Medicare Advantage Plan
A type of Medicare health plan offered by a private company that contracts with Medicare.
Medicare Part D
An optional program to help Medicare beneficiaries pay for prescription drugs.
Over-the-counter drug
A medicine that does not require a prescription.
Patient assistance programs (PAPs)
Offered by pharmaceutical companies, these programs provide free or low-cost prescription drugs to patients who lack health insurance or prescription drug coverage.
Pharmacy’s prescription club
A money-saving program that can lower drug and supply prices for people who don’t have insurance.
Preferred pharmacy network
A group of pharmacies that give insurance plans a larger discount.
Premium
A monthly payment you make to your health insurance carrier. Like any membership, you pay the premium each month even if you don’t use it. If you don’t pay, you will lose coverage.
Telehealth
Encompasses a wide range of technologies to deliver virtual medical and healthcare services.
Third party administrators (TPAs)
Also called pharmacy benefit managers (PBMs), they are paid to negotiate prices between pharmacies and large insurance companies.
Verified internet pharmacy
Online pharmacies that have passed rigorous reviews by the National Association of Boards of Pharmacy (NABP). Also referred to as VIPPS-Accredited. Next steps Think you now know all the ways you can save money on prescriptions? Test your knowledge by taking our quiz.
