Drug prices LESS than your co-pay? INCONCEIVABLE!
Consumerism / By Daniel Sherer / April 8, 2022
OK, you went thru “Open Enrollment” a few months ago and picked-out a health-plan that was perfect for your family (you did right?) Or, if you didn’t follow our free guides on selecting your health plan, at least you got something. And part of that plan is that you can get prescription medications for “Only the cost of your Co-Pay”. In fact, you might have actually taken that co-pay amount into consideration when selecting the plan (you did, right?)
But did you know that, especially for common generic medications, your co-pay might actually be higher than just paying the regular price at some stores.
Below we’ll show you some real-world examples, for some prescriptions you might have heard of, or be using. And we’ll give you a worksheet for you to calculate your own potential savings.
Read all the way to the end for some practical tips and honest advice on the trade-offs but enough talk...
Let’s do the numbers
First of all, here’s my receipt from Walgreens, with some personal info redacted.
While their receipts aren’t as long as those from CVS, they’re still long, but they don’t bother to include the drug name on the receipt, so I scribbled them in.
As you can see, I picked up four prescriptions. Our current insurance offers $10 co-pay on most generic drugs. However, you’ll note that for two drugs, Walgreen’s chose to charge slightly less.
We CANNOT see, from this receipt, how much the pharmacy actually BILLED our insurance. That’s a story for another day, but so you know, the amount that is paid by you, at the register, is likely NOT the amount the pharmacy gets. They might charge you $10, but then bill another $65 back to your insurance.
At first, I patted myself on the back at selecting such a great plan! $10/month/drug is the best! Um, wait a second tho… As I drove home, I wondered, “Is it really? Maybe I should be a good consumer and check.”
There are many websites that can help you compare prices. This isn’t my first rodeo so I already had some favorites bookmarked. In addition to the ones I show below, you might also consider going directly to your pharmacy’s site, Walmart.com or Target.com. Shop around to make sure who has the best prices. But a word of caution, some sites purport to show you what all their competitors charge. I’ve found that to be deceptive er, “out of date”. If one site tells you what their competitor is charging, you still should check that competitor’s site. I’ve found they don’t always show the actual/best price from their competition. (It’s inconceivable!). Since it gets a little bit detailed, we have a spreadsheet, (Click here to request a free blank worksheet) to help you. This is what mine looked like:
In the first example, Levothyroxine (a thyroid medication), you’ll see that my insurance co-pay of $10 matches what I’d pay, without insurance, over at Sam’s Club. No potential savings there. Hmm, but I see that GoodRx was able to find it for only $6.41/month! Not a huge savings, only $43/year, but still. Then there’s Costco. They’re a “warehouse club” and would prefer to sell you stuff in bulk. Larger quantities at once can be cheaper. So, if you were to go back to your doctor/PA/nurse and ask “Would you please re-write this for the same dose, but 90-days at a time?” they most likely would say “Sure.” (at least they might if it’s not something like an opioid or something short-term, like a 10-day antibiotic.) If you did get a new “script”, then Costco could fill it (without your health insurance) for $9.79 for three months! That’s a savings of $80.84 for the whole year! It’s actually enough to pay for your entire $60/year Costco membership, in just one med!
Ok, sure, I like saving money at Costco, but they are not always the best deal. Let’s look at a couple more meds. Next up, Famotidine (the generic version of Pepcid AC). My copay is, again, $10. Costco could save me $48/year, but I could almost match that thru GoodRx (no membership)! Oh wait! What’s this? Sam’s Club “Plus” membership could save me $72. Nice. (more about this plan in a second…)
These options look tempting, but are starting to get complicated, what with all the “membership” costs you might have. And that’s why we created a free spreadsheet to get you started. But let’s keep going.
Things get interesting here. Montelukast is generic for the allergy medication “Singulair”. Walgreen’s only charged $9.22 (a 78¢ savings). Nice, I guess, but I could still cover the entire cost of a Costco membership just with the savings on this one drug…. Except, is that a mistake? Is this medicine FREE at Sam’s Club?!?! Yes! If you have the “Plus” membership from Sam’s, there are medicines which are available for free. This is one of them. Now, even the $4/month price (with the regular $45 membership) at Sam’s would be better than my Insurance Co-pay, but now I’m really starting to get interested!
Both my wife and I take Atorvastatin (generic Lipitor), both for its cholesterol-controlling properties as well as other side-effects (ask your doctor). Our dosages differ, but let’s check the savings. (I don’t have the receipt from my last fill on this, so I defaulted my cost to the co-pay. But I believe it WAS less.) What’s interesting here is the impact of the dosage, which does make sense. The 10mg dosage is only $4 at Sams ($15 at Walmart). My wife’s 20mg dose costs about twice as much, $8.16. And the savings at Costco are a measly $1.44 per year (not worth the cost of gas to pick that one up). But for me, at the 10mg dose, I could save $72/year.
Co-Pay is NOT ALWAYS bad…
Up to this point, the numbers make co-pay prices look like a scam (or at least a serious waste of your hard-earned money) but that’s not always true. To show this, I included a couple types of insulin. Many patients with diabetes depend on multiple doses of TWO types of insulin every day. Long-acting insulin, like Lantus or Insulin-yfgn provide a slow-release that helps maintain your body throughout the day. Fast-acting insulin, like Humalog or Lispro, are generally taken before meals to help your body absorb the energy from carbohydrates. If you fail to shop around, the “list price for EACH of these insulins is around $300/vial/month (that’s $600/month for a person who only needs one vial of each). If you need two, or more, multiply by $300… But as you see from the spreadsheet, with some price-comparison, you could obtain a vial of long-acting insulin for as little as $56 and the fast-acting version for $43. That beats the hell out of paying $300, but it is still not as good as the co-pay of $10 and $35. Again, those are MY insurance co-pays. If you’re insulin dependent, what are yours?
Because some of these options require a “membership” (and so do many other prescription plans) I wanted to show the total savings for a family, accounting for the fees. In our case, even after paying $60 for a Costco membership, we can still save $193/year, just on these meds. Time to take the bottles over and switch pharmacies.
There is another “cost” to consider and that is the hassle of running around to multiple pharmacies every month just to chase the “best price”. Convenience and your time should be factors too! Also, programs like “GoodRx” can require you to get a new “coupon” every time you get the prescription filled. For some drugs, it might not be worth the hassle.
Comment below, or send us an email if you have a question. We’re not pharmacists or doctors, but we might be able to recommend some additional resources.
If you’d like a free (blank) copy of our spreadsheet to help you compare costs, just send an email to: firstname.lastname@example.org and mention “free spreadsheet for prescription drug shopping.”