How much do prescription drugs cost without insurance?
Individuals without insurance will generally pay the list price set by the pharmaceutical manufacturer. Prescription drug prices in the United States are amongst the highest in the world and continue to rise. Americans spend on average $1228.86 per year on prescription drugs, according to the OECD.
The cost of prescription drugs can vary greatly from one pharmacy to another. There are also a number of ways to save on prescription drugs, such as using coupons, prescription drug discount cards, prescription assistance programs, or ordering medications through mail-order pharmacies. Learn more about how much prescription drugs cost without insurance and how to get the best price on your medication.
How much do prescription drugs cost?
See below the average monthly out-of-pocket costs for the 10 most popular prescription drugs in the United States.
|Condition||Generic drug||Estimated monthly cost||Brand-name drug||Estimated monthly cost|
|Cholesterol||atorvastatin calcium 20mg||$10||Lipitor 20mg||$500|
|Cholesterol||rosuvastatin 10mg||$10||Crestor 10mg||$300|
|GERD||omeprazole 20mg||$10||Prilosec OTC 20mg||$20|
|Seizures||gabapentin 300mg||$5||Neurontin 300mg||$200|
|Depression||escitalopram 10mg||$10||Lexapro 10mg||$400|
|Depression||fluoxetine 20mg||$5||Prozac 20mg||$525|
|Hypertension||amlodipine besylate 10mg||$5||Norvasc 10mg||$320|
|Hypertension||losartan 50mg||$10||Cozaar 50mg||$120|
|Blood clots||clopidogrel 75mg||$10||Plavix 75mg||$200|
|Asthma||montelukast 10mg||$10||Singulair 10mg||$250|
Why are prescription drugs so expensive?
There could be several reasons why a particular prescription drug may be expensive:
The drug is new and there is no generic drug available
If there are no FDA (Food and Drug Administration) approved generic equivalents available for your medication, you will likely have to pay the brand-name price. New drugs, especially those that treat complex conditions like cancer or hepatitis C, can be extremely expensive.
A drug comes off-patent when the exclusivity period expires. This typically happens 20 years after the drug is first patented. After a drug comes off-patent, other drug manufacturers can make and sell generic versions of the drug. However, if there are no generic manufacturers for a particular drug, the price will remain high.
While brand name and generic drugs are equally as effective, there may be differences such as:
- Dosage form (e.g. pill, capsule, patch, etc.)
- Inactive ingredients
There is only one manufacturer
When there is only one manufacturer for a particular drug, that drug company can set the price as high as it wants.
Where the prescription drug is purchased
The prices of prescription drugs vary by pharmacy. For example, drugs purchased through mail-order pharmacies or online pharmacies may be cheaper than those purchased at a brick-and-mortar pharmacy. Local pharmacies may not necessarily have the lowest price for your medication.
A survey by Consumer Report concluded that drug prices could vary by as much as 10 times in the same city, so it is advisable to shop around for the lowest prices.
Why do medications cost so much without insurance?
Uninsured patients will generally need to pay the cash price for their prescription drugs. The cash price is the full price that a pharmaceutical company charges for a drug. If there is no generic drug alternative for your medication, the cash price for the brand-name drug could potentially be very high.
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Are prescription drugs always cheaper with insurance?
Not necessarily. It may make financial sense to purchase the medication for cash, as the drug may not be covered under the health insurance company’s formula, you may not have met your deductible, or the cash price may be cheaper than the insurance copay. You may be better off buying the medication for the cash price without insurance if:
The drug is not covered in the health insurance company’s formulary
The health insurance company’s formulary may not cover the cost of the medication, meaning that the patient would need to pay for the entire cost of the drug.
You have not yet met your deductible
If you have not yet met your deductible, you will be responsible for paying the entire cost of the medication until you reach your deductible.
Your insurance company has high copays for the drug
Even if the medication is covered under the health insurance company’s formulary, you may be responsible for a high copay or coinsurance. In this case, it may make financial sense to pay the cash price for the medication.
In some cases, a pharmaceutical company will give a PBM a monetary incentive to choose their brand name version, which is more expensive, instead of the cheaper generic version which is cheaper for the patient. This kickback is known as a “clawback” when the PBM makes more money while the insured patient is required to pay a higher copay. Check with your healthcare provider if there is a generic alternative for the best price on your medication.
Which prescription drugs are the most expensive?
The most expensive prescription drugs are most commonly known as biological drugs which are breakthrough treatments for life-threatening or serious conditions. Biological drugs been genetically engineered or derived from living cells to treat diseases. They are often very effective, but also very costly.
Some examples of the most expensive prescriptions drugs are:
Zolgensma – Annual cost: $2,125,000
Zolgensma, manufactured by Novartis Gene Therapies EU Limited, is a gene therapy medication used to treat spinal muscular atrophy a rare disease that can cause respiratory issues, paralysis and progressive loss of movement. An annual supply of Zogensma costs around $2,125,000, or $177,000 a month.
Zokivny – Annual cost: $1,032,480
Zokivny is used to treat a rare and fatal genetic condition, Hutchinson-Gilford progeria syndrome, a condition that causes rapid aging in children. Zokivny, manufactured by Eiger BioPharmaceuticals, combats the buildup of harmful proteins and can extend the lives of those with progeria by up to two and a half years. An annual supply of this prescription medication is $1,032,480, or $86,040 a month.
Danyelza – Annual cost: $977,664
Danyelza, manufactured by Y-mAbs Therapeutics, Inc., is used to treat pediatric and adult patients with neuroblastoma in the bone or bone marrow, a rare form of cancer. Danyelza has an annual cost of $977,664, or $81,472 per month.
Who decides on the cost of prescription drugs?
Prescription drug prices are negotiated by pharmaceutical companies, pharmacy benefit managers and health insurance companies.
Pharmaceutical companies incur the research and development costs (R&D) associated with introducing a new drug to the market. They will manufacture and sell the drugs to patients.
Pharmacy benefit managers (PBMs) work in collaboration with health insurance companies and employers to administer their drug benefits. They negotiate discounts on the cost of the prescription drugs with the pharmaceutical companies, as well as rebates which provide favorable coverage for the pharmaceutical company’s drug, resulting in increased sales and utilization by patients who are covered by the health plan. These arrangements are not disclosed to patients. PBMs are known as the “middleman” between the pharmaceutical manufacturers, pharmacies, and insurance companies, influencing the insurance companies on which drugs to cover and how much patients will pay as part of their copay.
Health insurance companies will reimburse patients and/or their employers for a portion of the prescription drug costs. They are responsible for approving requests for treatment, setting the copays, and determining the prices with the PBMs which dictates how much covered patients will pay for the drugs.
Save money when buying prescription drugs without insurance
Fortunately, there are multiple options you can consider which may help you save money when purchasing your prescription drugs. While Americans are faced with the highest prescription drug prices in the world, there are still several ways to save on medications.
Generic drug alternatives
Always check if there is a generic alternative available for your medication as generic drug prices are generally much lower than brand-name drugs. Most brand-name drugs can be interchanged with generic drugs, with some exceptions such as drugs with a narrow therapeutic index. Speak with your healthcare provider to find out if there is a generic drug available for your treatment.
Another way to save on prescription drugs is to use mail-order pharmacies. Many insurance companies have their own mail-order pharmacies and offer discounts for using them. The convenience of having medications delivered to your doorstep can be especially helpful for seniors or those with mobility issues.
Prescription drug discount cards
If you don’t have insurance, you can still get discounts on your prescription drugs by using a prescription drug discount card. These discount cards work by providing discounts on the cash price of medications at participating pharmacies.
Some pharmaceutical manufacturers may offer coupons or savings cards that can be used with or without insurance. These coupons can be found on the manufacturer’s website.
Prescription assistance programs
If you’re struggling to afford your medications, there are a number of prescription assistance programs that can help. These programs are usually run by pharmaceutical companies or non-profit organizations and can help cover the cost of medications for those who qualify.
Ask for a 90-day supply of medication
If you are taking a long-term maintenance medication, you may be able to save money by purchasing a 90-day supply of your medication instead of a 30-day supply.
A medical professional has reviewed this article.