One question to ask: What would this cost if I did not use my insurance? For a surprising share of prescriptions, the answer is less.
Researchers at the University of Southern California's Schaeffer Center, working from 2013 prescription data, found that in roughly 23 percent of filled prescriptions the patient's copay ran more than $2 above what the insurer actually paid the pharmacy. The overpayments added up to more than $135 million.
Until 2018, the pharmacist frequently could not mention it. Contracts with the companies that administer drug benefits carried what the industry called gag clauses, barring a pharmacist from volunteering that the cash price was lower. Two federal laws ended the practice that October, one covering private plans and one covering Medicare Part D and Advantage. A pharmacist can answer the question now. Most still wait to be asked.
Cash prices are also easier to look up than they were. TrumpRx.gov, which opened in February, lists discounted cash prices from participating manufacturers. According to KFF, the site is a lookup tool rather than a store: It points visitors to drugmakers' own pages and coupons, and the prices it shows apply only to people paying out of pocket. GoodRx and Cost Plus Drugs work along similar lines.
What you pay in cash usually does not count toward the deductible. The out-of-pocket maximum does not move closer. For someone on Medicare Part D, drugs bought outside the plan do not count toward the annual cap on out-of-pocket spending, which is $2,100 this year and rises to $2,400 in 2027.
Anyone whose drug spending will never come near a deductible or a cap loses nothing by paying cash. Anyone who expects to reach either one should run every prescription through the plan, because each one moves the finish line closer.
Rick Good spent ten years in the newspaper business, including with The News & Observer (Raleigh, NC) and The Greenville News (Greenville, SC). He co-wrote, with Melinda Coleman, Rutledge to Riley: Governors of South Carolina, 1776–Present (Published by The Greenville News), and is the author of Mind Games Trivia #1 (Amazon). He has recently spent 15 years creating original trivia content through Sounds Good Mobile Entertainment and continues that with his new company, SGME Software. He edits The Smart Reader’s money, real estate, and business coverage.
