Navigating the Prescription Drug Cost Conundrum: A Patient’s Guide
Prescription drug costs in the U.S. have climbed to levels that could make your wallet consider early retirement. It’s a shared frustration, patients feel the pinch at the pharmacy counter, and doctors feel it when trying to help you stick to treatments without breaking the bank.
We’re here to help. In this guide, we’ll explain why drug costs are so high, share smart strategies to lower them, and spotlight how our Senior Wellness Program can be your secret weapon, especially if you’re over 65.
Why Are Prescription Costs So High?
Prescription prices have risen like rent in a hot housing market. According to a 2023 AARP report, the average annual retail price for a single brand-name drug taken regularly was nearly $7,000, and many patients take more than one. That means total costs can easily exceed $10,000 per year if you’re paying retail and not using discounts or insurance.
And while specialty drugs with six-figure price tags get headlines, everyday medications, like those for diabetes, high blood pressure, cholesterol, and asthma are the ones quietly draining wallets month after month.
A 2024 study from the University of Southern California found that about 40% of what Americans pay for prescriptions doesn’t even go to the drug manufacturers. Instead, it goes to intermediaries like pharmacy benefit managers and insurance companies through a maze of rebates and backdoor deals. Add in frequent changes to formularies, the list of drugs covered by your plan, and you get a system that’s confusing, unpredictable, and expensive.
Strategies to Tame Prescription Drug Costs
You don’t have to tackle this alone. Here are ways we can work together to fight back:
Go Generic, Save Big
Generic drugs are chemically identical to their brand-name counterparts and just as effective, but cost 80 to 90% less. For example, a brand-name statin might cost $200/month, while the generic version costs $10. Always ask if there’s a generic available.
Find Formulary Friends
If your insurer stops covering a drug, or hikes the co-pay out of nowhere, ask about formulary alternatives. These are medications in the same class that are still covered. It might take a little coordination, but the savings can add up quickly.
Self-Pay Pharmacies: The Underdog Option
Sometimes, paying cash beats using insurance. Pharmacies like Cost Plus Drugs and Amazon Pharmacy offer transparent, near-wholesale pricing. A drug that costs $50 with insurance might be just $15 if you pay directly. We’re happy to help you compare prices before you fill a prescription.
Score Deals with Discount Programs
Apps like GoodRx and SingleCare can offer significant savings—even lower than your insurance co-pay. Our prescribing software includes GoodRx pricing, so just let us know cost is a concern. Most pharmacies accept these discounts, but it’s worth confirming in advance.
Pill-Splitting: A Clever Cost-Cutter
Some higher-dose pills cost the same as their lower-dose counterparts. If the medication is safe to split (and scored), your doctor might prescribe the higher dose to split in half—cutting your cost without cutting your treatment.
Manufacturer Assistance Programs
Brand-name drug makers often offer savings programs or financial assistance, especially for high-cost drugs. These programs can make a big difference if you’re uninsured or stuck in a coverage gap.
Shop Around for the Best Price
Prices vary wildly between pharmacies. Use GoodRx or call around, Costco and Walmart are good places to start (and you don’t need a Costco membership to use their pharmacy). You might be surprised by the price differences.
The Senior Wellness Program: Your Prescription Cost Superhero
If you’re over 65, our Senior Wellness Program is designed to improve your health and help you save money, without sacrificing quality.
This summer, we’re launching a new initiative that reviews each participant’s medication list for savings opportunities. We project average annual savings of between $852 and $952. Our care managers will help:
- Identify generic and lower-cost options
- Navigate insurance and formulary hurdles
- Help with manufacturer assistance or discount programs
If you are already enrolled, simply let your Care Coordinator know which medications are hurting your budget. If you’re 65 or older and not enrolled, reach out to our Care Coordinators today. It’s easy to join, there is no out-of-pocket cost, and could save you hundreds of dollars a year (or more).
The System: Not Exactly Your Best Pal
Let’s be honest—the U.S. prescription drug system is about as friendly as a vending machine that eats your dollar. But you’re not powerless. With smart strategies and the right support, you can cut through the complexity and keep your medication costs in check.
Whether it’s finding generics, switching to covered alternatives, or tapping into discount programs, we’re here to help. And if you’re over 65, our Senior Wellness Program adds a powerful ally to your corner.
Let’s work together to make your prescriptions, and your life, a little more affordable.