Can Paying out of Pocket for Prescriptions be Cheaper than Copays?

Prescription pad, pen and stethoscrope

PBS recently ran a story about a retired physicist, Z. Ming Ma, who ordered a prescription blood pressure medication called telmisartan for his wife through his Anthem Medicare plan. The copay for a 90-day supply of the medication was $285.

A month later, needing another prescription for a long trip with his wife, Ma went to Costco. Insurance would not cover the cost of the prescription within 90 days. Ma asked how much the medication would cost out of pocket. The pharmacist informed him that the out of pocket price was only $40, a staggering difference.

More Common than You’d Think

Ma’s story is not singular. This happens more often than you’d expect.

In fact, a recent study by the University of Southern California’s Schaeffer Center for Health Policy and Economics finds that about 25% of the time, out of pocket prices can be less expensive than insurance copays.

A lead author of the study dealt with this herself when she found out she could get her heart medication for $35 instead of paying a $120 copay with her insurance.

When you go to the pharmacy to pick up a prescription that is covered in-part by your insurance plan, you assume that you’ll be paying the lowest possible price. Obviously, that isn’t always the case. Although, some discrepancies in price can be explained by certain pharmacies working with manufacturers to provide a discount on drugs, the massive difference in price in Ma’s case seems to point to that being unlikely. So, how can you be sure you’re getting the best price for your prescriptions, whether they’re for your blood pressure like telmisartan or an inflammation fighting corticosteroid like Prednisone?

What to Do

The first thing to do is make sure you don’t just make assumptions that your insurance copay is the lowest price you’ll pay for important medications.

One great way to save on your prescriptions with or without insurance is to try to find discounts on your medications. An easy way to do this is to use our website. All you have to do is search for your medication and find the discount associated with your pharmacy. Prescription savings offers, like the ones we help you find, are totally free. You only pay at the counter when picking up your prescription from the pharmacist.

With our site, you can see the best offers and choose what works for you.