In December 2017 Consumer Reports published secret-shopper research on cash prices for the same drugs at different U.S. pharmacies. A one-month supply of the "basket" of 5 generic prescription drugs ranged in price from $95 to $1093 - more than ten times as much for the same prescriptions! These are representative prices, not extreme examples. You can reads the article here (there's no paywall) and compare the prices they found. The lowest prices were online at HealthWarehouse.com (though special in-store discounts can occasionally be lower).
These are straight cash prices. Therefore you don't need to have insurance, meet income guidelines, be a citizen, or hassle with other paperwork. You do need a prescription for a prescription drug, and your doctor can email, fax, or call it in. (HealthWarehouse.com also sells non-prescription health items, including specialty products like diabetes supplies.)
But when checking drug prices be sure to search for the generic name if a generic is available - not the brand name. For example, a search today on HealthWarehouse.com for the brand name Lipitor shows a price of $295.80 (for 30 10-mg tablets) - vs. only $7.35 for the same prescription if you search for the generic name of the drug, atorvastatin. That's 40 times higher just for a different name - a huge profit for a pharmaceutical company from customers who don't know.
Of the 10 pharmacies checked by Consumer Reports, HealthWarehouse.com and Costco's pharmacy(https://www.costco.com/Pharmacy/home-delivery) were the least expensive. (You do not need to be a member of Costco, since Federal law does not allow pharmacies to restrict services to store members.) The most expensive of the 10 were Kmart and CVS/Target. Others were in between (often meaning that you will pay several times more than necessary for your generic prescription drug if you buy it from them).
* First check the prices of your drugs at HealthWarehouse.com, to get a ballpark minimum price of the drug in the U.S. You will pay more if you need the medicine immediately instead of ordering it online. But is it 20% more - or 20 times (2000%) more? Yes, you can easily pay 20 times too much to fill your prescription. And online ordering can be important in rural areas, where transportation to a pharmacy can be difficult. Modern online pharmacies should ship fairly quickly - although there could be a few days delay at the sender, in addition to any delay at the doctor's office in emailing, faxing, or calling in the prescription, plus the shipping time of course. See below for more information on generic drug pricing.
* Coupons: They can help a lot if you need to pick up the prescription immediately. For years U.S. pharmacies have had huge and confusing coupon systems. Their purpose is to sell exactly the same pills at wildly different prices, to those who don't pay attention or would rather not bother, vs. those who will do some extra work for a much better price. Someone who has plenty of money and doesn't want to bother with coupons may pay 10 or 20 times too much for their prescription; that's not a problem. Unfortunately others suffer serious hardship because they assume that pharmacy prices at different drugstores, grocery stores, big-box stores, or online are much the same, when they are not. (Online prices are usually lowest, because customers can so easily type a different Web address and buy from a competitor.)
With a coupon system, prescription drugs can sell at cash-cow prices 10 or 20 times more than you would pay online, while also selling at more normal prices with coupons, to customers who would have gone elsewhere if the coupons were not available.
Various sites have coupons that you can print and take to the pharmacy. We suggest checking www.GoodRx.com, a tech startup that knows the lowest prices and provides useful coupons. You can print multiple coupons for a prescription, and decide at the pharmacy whether to use it there, or go to another pharmacy instead.
Blink Health (www.blinkhealth.com) is similar to GoodRx.com, but it uses a paperless system that bypasses printing out physical coupons. While we like this approach philosophically, the paper coupons seem to work better in this case, because they are more awkward for pharmacies and chains to reject (while they continue to accept other coupons). BlinkHealth is no longer accepted at CVS/Target or Walgreens, but according to the company is accepted at 40,000 other pharmacies. Both GoodRx.com and BlinkHealth.com are noted in the Consumer Reports article.
* Patented Brand-Name Drugs: While the patent (or various "evergreening" extensions of the patent) still applies, there are no generic options in the U.S. and most other countries. So you are likely to be charged prices that are 20 times or more what it would cost to sell the drug at a profit. A previous U.S. Congress didn't accept the harshness of this, and insisted that in return for the monopoly, pharmaceutical companies offer "patient assistance programs" that allow poor patients to get critical drugs when they would otherwise have no access and not get the treatment they need.
* Patient Assistance Programs for Patented Drugs. These programs differ greatly by company - in who qualifies, what paperwork is required, etc. But they do work for some people. If you need to apply, try to get help from a nonprofit or an individual you trust, and who knows about the programs.
* Super-Cost Generics. In recent years in the U.S., some companies have cornered the legal supply of generic drugs that were available for pennies for decades, and raised the prices to sometimes a hundred times or more what they used to be - same drug, vastly higher price. The sites we linked to above usually don't tell you when this has happened - they just quote the price, maybe thousands of dollars for a bottle of pills, as if it were a patented brand-name drug - and don't tell you if the same drug sold for decades in the U.S. for tens or hundreds of times less. Sometimes the companies responsible run clinical trials, mostly as an excuse for the extreme prices; sometimes they don't. A quick way to find out if this is why prices are so high is to check Canadian prices for the same drug, for example at PharmacyChecker.com. If the U.S. prices on HealthWarehouse.com are tens of times higher than what Canadians pay, sometimes more than a hundred times higher, this new generation of super-cost generics is probably responsible.
For example, pyrimethamine (a bottle of 60 tablets costs more than $45,000 anywhere in the U.S. - but less than $45 Canadian in Canada) - a U.S. price more than a thousand times higher than in other countries. Or nitazoxanide, more than $500. for 6 tablets in the U.S., less than $50 for 60 tablets in Canada, over 100 times too expensive in the U.S. The companies do have patient-assistance programs, which probably work if you qualify under their arbitrary rules and conditions.
Unfortunately Congress made it illegal for Americans to order Canadian or other foreign drugs, even if they are approved by the FDA here. While the law has typically not been enforced against patients who buy small supplies for personal use, no one knows what will happen.
No government that cared about the welfare, health, or even the lives of its citizens would allow the current abuses of the U.S. prescription-drug business to continue - let alone use the government's powers to enforce it. Unfortunately most politicians of both parties say what they need to say to look good in public, while they do what they need to do to get big political donations, future jobs, and other favors from the pharmaceutical and other industries, and from the big-donor class of individuals - the richest one in 10,000, who never have a problem paying for the medical care they need.
This situation will continue until the American people demand better, and organize movements that can make their government listen and care about their health, their healthcare, and their lives.
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