How to pay less for prescriptions: a complete guide

Why the same prescription costs different amounts

Each pharmacy sets its own price for a cash sale, and nothing requires two pharmacies to charge the same amount for the same prescription. That is why quotes for the same drug, strength and quantity can differ between pharmacies, including stores in the same town, and why it is worth asking more than one pharmacy before you fill.

Insurance works differently. Your plan, or a pharmacy benefit manager (PBM) working for it, agrees a rate with each pharmacy in its network, and you pay a copay or coinsurance based on that rate and your plan’s rules. Discount cards add a third route: a processor sets a price the pharmacy has agreed to accept. The result is that a prescription can have several possible prices, and the lowest is not always the one you are charged unless you ask.

For brand-only drugs, check your coverage, manufacturer programs and assistance programs alongside pharmacy quotes; each of these routes is covered below, with the questions to ask.

Start with what your coverage pays

If you have insurance, find out where your drug sits on your plan’s formulary and which phase of the year you are in. In a deductible phase you may be paying the plan’s full negotiated rate, which can be higher or lower than a pharmacy’s cash price for the same prescription. Ask the pharmacy to tell you both your insurance price and its cash price for the same prescription, then choose.

A cash purchase is not processed through your plan, so it counts toward your deductible or out-of-pocket maximum only if your plan accepts the receipt when you submit it; ask yours. For a medicine you take all year, weigh how each fill counts toward those limits as well as the price at the counter.

Medicare Part D has an annual cap on out-of-pocket spending for covered drugs, and the Medicare Prescription Payment Plan lets you spread those costs into monthly payments. Extra Help, a federal program run with Social Security, lowers Part D premiums and copays for people with limited income and resources. Medicaid also covers prescriptions, with copays and rules that vary by state. Money in a health savings account or flexible spending account can pay for prescriptions with pre-tax dollars.

Ask about generics, alternatives and the form of the drug

An FDA-approved generic has the same active ingredient, strength, dosage form and effect as the brand, and the FDA reports that greater competition among generic makers is associated with lower generic prices. The FDA’s Orange Book lists which generics are rated as equivalent. If your prescription says dispense as written or brand medically necessary, the pharmacist cannot substitute; ask your prescriber whether a generic would be suitable.

If your drug has no generic, ask whether another drug in the same class has one; your prescriber can say whether it would suit you, and telling them that cost matters helps them choose. A combination pill can sometimes be replaced by its separate ingredients, and an extended-release version sometimes has an immediate-release alternative taken more often. Different forms and strengths of the same drug can be quoted at different prices, so ask for quotes on each option your prescriber is comfortable with.

• Ask: is there a generic, or a generic alternative in the same class?
• Ask: would the separate generic ingredients work instead of a combination pill?
• Ask: is there another form that would suit me, such as a capsule instead of a tablet, or immediate-release instead of extended-release, and how do their quotes compare?
• Ask: can this be written for a ninety-day supply, and how does its quote per day compare with a thirty-day fill?
• Split tablets only when the tablet is scored for splitting and your prescriber has written the dose that way.

Compare pharmacies before you fill

Because each pharmacy sets its own cash price, comparing pharmacies helps, especially for generics. Independent, chain, grocery, warehouse-club and mail-order pharmacies can all quote, and any of them may be higher or lower for a given prescription. If you are considering a warehouse-club pharmacy, ask whether it fills prescriptions for people who are not members. Cash prices can change over time, so a price you checked months ago may be out of date.

You can call pharmacies, check their posted prices, or ask several to quote at once. On Script Unlock you upload your prescription and licensed pharmacies can reply with their own cash price for that exact drug, strength and quantity; you choose one and pay the pharmacy directly. Whichever way you compare, ask for the price of the exact quantity on your prescription, since the price per pill can differ between quantities.

Discount cards versus the pharmacy’s own cash price

Discount cards and coupon sites give you a price a pharmacy has agreed to accept through the card’s processor. That price can be higher or lower than an insurance copay or the pharmacy’s own cash price for the same fill. A discount card is not insurance: the purchase is not processed by your plan, so it counts toward a deductible only if your plan accepts the receipt, and Medicare.gov notes that discount card purchases made instead of using a Medicare drug plan do not count toward that plan’s deductible or out-of-pocket maximum.

The practical approach is to ask the pharmacy for the lowest of its own cash price, the discount card price and your insurance price, and to remember that you can use only one of them for a given fill.

Manufacturer programs and assistance programs

For brand-only drugs, check what the manufacturer offers. Copay cards can lower what eligible commercially insured patients pay, but federal rules bar using them with Medicare, Medicaid or other government coverage. Some manufacturers also sell brands directly to self-paying patients at a published cash price, and the government’s TrumpRx website lists some of those offers.

Patient assistance programs, run by manufacturers or their foundations, can provide brand medicines at no cost or reduced cost to people who meet their income and other rules, through an application your prescriber may need to help complete. Directories such as NeedyMeds list programs by drug. Some states run pharmaceutical assistance programs for older adults or people with certain conditions, and some community health centers take part in the federal 340B Drug Pricing Program; ask a local center whether its pharmacy can help with your medicine.

If your plan will not cover the drug

When a plan denies a drug or requires prior authorization, your prescriber can submit the clinical reasons, and you can ask for a formulary exception if the covered alternatives have not worked or are not suitable. A clear statement from your prescriber of why the drug is needed gives the plan what it needs to review the request. Ask the plan which alternatives it covers and what you would pay for each; one of them may suit you.

Saving safely

Rationing medicine by skipping doses or stretching a supply can be dangerous with drugs for heart disease, diabetes, seizures, mental health and many other conditions; tell your prescriber if cost is the problem, because there may be another option, such as a generic, a different drug or an assistance program. Buy only from licensed pharmacies: websites that sell prescription drugs without a prescription, or at prices that look too good to be true, are a known source of counterfeit and contaminated medicines. The NABP’s Safe.Pharmacy site helps check whether an online pharmacy is legitimate. When you switch pharmacies, make sure the new one has your full medicine list and allergies so it can check for interactions.