The guide you need depends on what you want to know about drug prices
If you are looking for information about what a specific medication costs, where to find lower prices, or how insurance covers drugs, several different guides exist — and which one helps depends on your situation. There is no single guide that covers all drug payment questions, because drug costs work differently depending on whether you have insurance, which type of insurance you have, and whether the drug is brand-name or generic.
The most useful starting point is usually your pharmacy or your insurance company, because they can tell you the actual price you will pay for your specific medication. But if you want to understand how drug pricing works in general, or learn about programs that help pay for medications, several free resources exist online.
Key Takeaways
- Your pharmacy can tell you the price of a specific drug and whether your insurance covers it before you fill a prescription.
- Your insurance company's website or customer service line lists which drugs are covered and what you will pay out of pocket.
- GoodRx, SingleCare, and similar discount programs show prices at different pharmacies and can lower costs even if you have no insurance.
- Medicare.gov has a tool called the Medicare Plan Finder that shows drug costs under different Medicare plans if you are 65 or older.
- Patient information programs run by drug manufacturers can provide free or reduced-cost medications if you meet income requirements.
Using your pharmacy to find drug prices
The fastest way to learn what a drug will cost you is to call or visit your pharmacy with the prescription in hand. Tell the pharmacist the name of the medication, the dose, and the quantity. They can tell you the price before you pay, and whether your insurance will cover it.
If you do not have insurance, ask the pharmacist if they offer a discount program or if they can check prices at other nearby pharmacies. Many chains like CVS, Walgreens, and Walmart offer their own discount programs that can lower the price significantly. Some pharmacies also accept manufacturer coupons that you can print or load onto your pharmacy card.
Finding drug information through your insurance company
If you have health insurance, your insurance company maintains a list called a formulary that shows which drugs are covered and how much you pay for each one. You can usually find this list on your insurance company's website, or you can call the customer service number on the back of your insurance card.
When you call or search online, have the drug name and dose ready. The formulary will tell you whether the drug is covered, what tier it is on (which affects your cost), and whether your doctor needs to get special permission before you can fill it. Some drugs require prior authorization, which means your insurance company must approve it first — your doctor's office usually handles this step.
Using discount programs to compare prices
Websites like GoodRx, SingleCare, and RxSaver let you enter a drug name and see prices at different pharmacies in your area. These are free to use and do not require you to sign up or provide insurance information. You can often get a discount code or coupon to show at the pharmacy.
These programs work whether or not you have insurance. If you have insurance, compare the price your insurance covers with the discount program price — sometimes the discount is better, sometimes your insurance is. You can use whichever is lower. Be aware that using a discount program instead of your insurance may not count toward your deductible or out-of-pocket maximum.
Medicare drug coverage information
If you are 65 or older and have Medicare, the Medicare Plan Finder tool on Medicare.gov lets you search for specific drugs and see which Medicare plans cover them and at what cost. You enter the drug name, dose, and quantity, and the tool shows you plans ranked by total cost.
Medicare drug coverage changes every year, and the costs and covered drugs vary by plan. The Plan Finder is updated annually and shows you the current year's information. You can also call 1-800-MEDICARE to speak with someone who can walk you through the tool or answer questions about your specific situation.
Manufacturer information programs for medication costs
Drug manufacturers often run programs that provide free or reduced-cost medications to people who cannot afford them. These programs have different names — some call them patient information programs, others call them co-pay information or hardship programs. To learn about a program exists for your medication, search the drug name plus "patient information program" online, or ask your doctor or pharmacist.
Most programs require you to show proof of income and citizenship or legal residency. The process process usually takes a few weeks. Some programs send the medication directly to your home, while others send it to your doctor's office. Your doctor's office or pharmacy can often help you with the process.
Understanding generic versus brand-name drug costs
Generic drugs contain the same active ingredient as brand-name drugs and work the same way, but they cost significantly less. If your doctor prescribes a brand-name drug, ask whether a generic version is available. Most insurance plans cover generics at a lower cost than brand-name versions.
Sometimes a generic is not available yet, or your doctor believes the brand-name version is medically necessary for you. In those cases, your insurance may require prior authorization, or you may need to pay more out of pocket. Your pharmacist can tell you whether a generic exists for your medication and what the price difference is.
Frequently Asked Questions
Where do I find information about what my insurance will pay for a drug?
Call the customer service number on the back of your insurance card with the drug name and dose. They can tell you whether it is covered, what you will pay, and whether your doctor needs to get permission first. You can also log into your insurance company's website and search their formulary.
Can I use a discount program if I have insurance?
Yes. Compare the price your insurance covers with the discount program price and use whichever is lower. Keep in mind that using a discount program instead of insurance may not count toward your deductible or annual out-of-pocket maximum, so check both before you decide.
How do I learn about a drug manufacturer offers a free medication program?
Search the drug name plus "patient information program" online, or ask your pharmacist or doctor. Most programs require proof of income and take a few weeks to process. Your doctor's office can often help you with the process.
What is the difference between a generic drug and a brand-name drug in terms of cost?
Generic drugs contain the same active ingredient and work the same way as brand-name drugs, but cost much less. Most insurance plans cover generics at a lower price. Ask your pharmacist if a generic version exists for your medication and what the price difference is.
Where can I find drug prices if I do not have insurance?
Call your pharmacy directly and ask about their discount programs, or use free websites like GoodRx, SingleCare, or RxSaver to compare prices at different pharmacies. You can also ask your doctor or pharmacist about manufacturer information programs that provide free or reduced-cost medications based on income.