Many people assume that because they have health insurance, it doesn’t really matter where they buy their medications – the price is the same either way.

In some cases, this may be true – for instance, if you have a plan that covers a medication with a set copay. However, many brand name drugs would be subject to the Plan deductible and coinsurance amounts, which means the retail cost of your medication will directly affect what you pay out of pocket. 

Insurance carriers are not negotiating the price a pharmacy will charge for prescriptions. Insurance carriers will try to manage costs for their members and the Plan by creating a drug formulary list, with tier levels and copay/coinsurance amounts YOU pay for specific drugs. It’s the pharmacy who determines the price for the drug. This cost will vary between pharmacies, therefore…it pays to shop around for your prescription drugs!

If you have an H.S.A. plan, it definitely impacts your out of pocket if you shop around for your medications.

Most plans that provide a prescription drug copay cost more in monthly premium. Knowing the cost of your medication (average retail – without insurance) can help you make an informed decision about your health plan coverage. Why pay more for a copay type health plan, if you can buy your medication for “cheap” by shopping your pharmacy and/or using a drug discount program such a GoodRX!

GoodRX Details

  • It’s Free.
  • GoodRx is a drug discount program – if you are a member, you can use coupons to reduce the cost of your prescriptions.
  • It cannot be combined with insurance, but it’s possible that a discount would save you money vs. using insurance.
  • It’s a great tool for knowing where to fill your prescription. You might be VERY surprised to learn the difference in costs between some well-known pharmacies. For example, Atorvastatin 40 mg. at Walgreens has an average retail price of $250 vs. at Costco with an average retail price of $10.
  • Pharmacy gag clause ban – effective 1/1/2020. Under the new legislation, pharmacists will not be required to tell patients about the lower-cost option. If they don’t, it’s up to the customer to ask.

In summary, we want share these key takeaways so you feel empowered to find the best price for your prescription needs:

  • Call around to pharmacies to find the best price for your medications or use a website like GoodRX (see below).
  • Pharmacies are not required to inform you of lower price options for prescription drugs, so don’t be afraid to advocate for your self and ASK!