Healthcare providers will prescribe what the guidelines recommend. The big surprise is when the patient arrives at the pharmacy to pick up their prescription. The price of the prescription, based on their insurance prescription coverage or having no insurance, can prevent the patient from receiving the benefits of the medication. In other words, that patient will not take the medication prescribed because it is unaffordable.
One of my assignments for my students is to take one medication from the current “top 10 most commonly prescribed medications” and present to me how the medication works, side effects, and indications. I will also ask for the cost of a 30-day supply to the patient without insurance. I utilize two lists of medication categories, which include the most prescribed medications and top medications in spending for the latest year of data.
The “top 10 most commonly prescribed medications” refers to the drugs dispensed most frequently to patients. In comparison, the “top 10 medications in spending” refers to the drugs that cost the most overall, even if they are not necessarily prescribed as often. A common medication prescribed could be relatively inexpensive. In contrast, a high-cost medication might not be prescribed as frequently, but it still ranks high in overall spending due to its price per dose.
Drug spending is heavily driven by a relatively small number of high-cost medications. The majority (80%) of prescriptions that patients fill is for generic drugs, while brand name drugs accounted for 80% of prescription drug spending in retail and non-retail settings. The top 10% of drugs by price make up fewer than 1% of all prescriptions but account for higher retail spending and 20%-25% of non-retail spending (ASPE Office of Science & Data Issue Brief, September 2022).
Due to our inflationary times and the high cost of insurance even with good prescription coverage, I would like to share with you how to navigate healthcare insurance and decrease costs when possible. This information was not a part of my pharmacy education. I had to learn where to look for drug list coverage information for the commonly used health insurance companies, including Medicaid and Medicare. Welcome to my medication cost-cutting 101 Master Class.
You, as the patient, must be your advocate. Any time a medication is prescribed for you, ask for a generic version. If the provider does not know if the medication is generic, ask Google, “Is there a generic form of this medication?” If not, I recommend visiting your insurance coverage website and finding the Drug List coverage for 2025. The drug list will tell you if your insurance covers the brand name medication and/or generic form, other medications in the same class that are covered, and what tier level the medication is in.
Tier 1 medications are the least expensive and usually generic drugs with the lowest copay. Tier 2 medications are higher-priced generic drugs, lower-priced brand-name drugs, or preferred brand-name drugs with no generic equivalent. Tier 3 drugs are higher-priced brand-name drugs and non-preferred brand-name drugs. Non-preferred brand-name drugs are medications with a cheaper alternative brand name that the insurance company has deemed the best choice in that medication’s category. An example would be choosing an anticoagulant medication to prevent strokes in atrial fibrillation. The medication choices are Pradaxa, Xarelto, and Eliquis. Based on contract pricing and studies, the insurance company may prefer Eliquis as their Tier 2 medication and designate Pradaxa and Xarelto as Tier 3. The prescription price may be as low as $35 monthly for Eliquis versus $330 for Pradaxa and Xarelto.
The second most likely scenario for your mouth to drop is upon picking up your prescription. You may have been prescribed a medication not covered by your insurance. You are asked to pay $1,400 a month for the new medication. You politely ask, “What would be the price if you apply a Good Rx coupon?” I have seen the price of a medication go from $417 to $50. Another best recommendation to decrease prescription costs is Mark Cuban Cost Plus Drugs. I have checked the Cost Plus Drugs on numerous occasions. GoodRx or Cost Plus Drugs can produce significant savings for the patient, with Cost Plus Drugs offering significantly higher savings rates if the prescribed medication is available.
Levothyroxine is a thyroid hormone prescribed for hypothyroid patients. The hypothyroid patient is very low in two thyroid hormones, T3 and T4. The symptoms of hypothyroidism are cold intolerance, fatigue, weight gain, and hair loss. Many patients were told by their physicians that the brand name levothyroxine (Synthroid) was better than generic levothyroxine due to better blood levels of levothyroxine with the Synthroid brand. Synthroid cost would be $29.50 for a 30-day supply to approximately $75 for a 90-day supply. Generic levothyroxine is $12 for a 30-day supply. With a GoodRx coupon, the cost is $7.19. The price also depends on which pharmacy fills your prescription.
Albuterol HFA inhaler is a medication used in asthmatic patients. Inhaled albuterol opens up the inflamed airways during an asthma attack, allowing the patient to breathe better. Albuterol can also be used before exercise to prevent bronchoconstriction in patients with exercise-induced asthma. The generic form of Albuterol HFA inhaler is about $98. With a GoodRx coupon at a Walmart pharmacy, the cost would be $28. On Cost Plus Drugs albuterol HFA is $46.
The following are two examples of medications in the top 25 by spending in 2023: semaglutide (Ozempic, Wegovy, Rybelsus) and empagliflozin (Jardiance).
Semaglutide is a GLP-1 medication whose original indication is lowering blood glucose in diabetes type II patients. Weight loss was seen in the patients taking semaglutide. Semaglutide is also indicated for weight loss in obese patients. This medication is injected or given orally. Semaglutide is a glucagon-like peptide-1 receptor agonist that works in the pancreas and hypothalamus. This binding activates the pancreas to increase insulin secretion, reduce glucagon (glucose polymer) release, and slow gastric emptying in diabetic patients. Ozempic cost without insurance, at a Walgreens pharmacy, is $1,172 per month, Wegovy is $1,619 monthly, and Rybelsus is $1,174 monthly. With a GoodRx coupon at the Walgreens pharmacy, Ozempic costs $1,028, Wegovy is $1,388, and Rybelsus is $1,028.
Dapagliflozin (Farxiga) is a medication that is indicated for diabetes type II patients. Dapagliflozin increases the elimination of water and glucose. Dapagliflozin also decreases blood pressure, increases weight loss, decreases the risk of cardiovascular events, and decreases the progression of chronic kidney disease. If a patient is prescribed dapagliflozin, please ask for the generic form. The average out-of-pocket cost of the brand name Farxiga is $649. The cost of generic dapagliflozin with a GoodRx coupon at the CVS pharmacy is $33, the Farxiga website discount can be as low as $25 with some private insurance, and Cost Plus Drugs is $390 for a month’s supply. It’s important to note that these are list prices, and actual costs may vary depending on the pharmacy and other factors. Some pharmacies offer discounts or coupons that can help to reduce the cost.
I hope I have added to your medication knowledge toolbox. Drug knowledge can help many patients live long and happy lives with excellent outcomes. These tips can save hundreds to thousands of dollars annually for some patients. Be aware that the U.S. gets many generic and brand-name medications from other countries. The proposed tariffs on other countries that manufacture generic medications and compounds used by pharmaceutical countries in the U.S. may cause increases in drug costs to the consumer. Be well and fly safe.
