Why Are My Prescriptions Cheaper With A Coupon Verses Insurance?

For many folks on Medicare, prescription coverage is certainly a point of contention. For individuals with brand name medications, high costs in the donut hole can stretch a lot of budgets. However, there are many issues with the other end of the spectrum as well - generics.

Since generics are made by numerous manufacturers, there can be significant fluctuations in price. Given supply shortages, we’ve seen some large swings in generic drug prices. Drugs that used to cost less than a dollar, can increase to $30 with very little notice.

This has led to higher costs for those who may have only a few generics.

Typically, we’d recommend individuals ask their pharmacist to see whether a coupon without insurance may be less expensive than using their Part D prescription plan (unfortunately Medicare prevents someone from using both their insurance and a coupon).

Each pharmacy has different negotiated rates with each insurance plan as well as each manufacturer. The same drug can be $10 for let’s say CVS versus $20 for Walgreens (or vice versa). There are essentially no differences between the drugs, it’s just the way the prices are negotiated.

Unfortunately, there is very little transparency on a global level, meaning as a consumer, you’ll have to do a lot more leg work to make sure you’re getting the best deals.

Here are the 3 steps we take to help find deals on prescriptions:

1. Optimizing your Part D coverage

Each year between Oct 15-Dec 7 during the Medicare Annual Enrollment period, we plug in your medications to our system (based on Medicare.gov) to find which prescription plan has low prices on your prescriptions next year.

2. Compare drug prices (insurance vs. coupon)

We identify high priced generics and cross reference them against coupon databases for lower costs. To do this search we use websites such as goodrx.com and look at average coupon prices.

3. Shop across different pharmacies

For drugs that are cheaper via a coupon versus insurance, we then take a look at price differences across the pharmacies near you.

What we often find is that although most individuals will benefit by sticking with one pharmacy and using their Part D plan, there are commonly exceptions where someone can save a few hundred dollars a year by going to another pharmacy for 1-2 medications.

Until we have some standardization and transparency on drug prices, we’ll have to wash, rinse and repeat every year.