Medicaid tracks nationwide wholesale drug prices, and you can find per-unit prices if you take the time. Finding the best price for your own prescription is easier -- if you know where to look. Medicaid tracks average retail drug prices to help the states price their Medicaid drugs. In July 2013, Medicaid stopped tracking the price tags for patients, but it still tracks how much community pharmacies pay for medicines. This National Average Drug Acquisition Cost survey, or NADAC, is published once a week.
In May 2015, for example, a pharmacy's wholesale cost for simvastatin, a cholesterol-lowering drug, averaged 2.955 cents per 10 mg. pill, or just under 89 cents for a 30-day prescription. Add an average of $11.34 per prescription for overhead -- the latest available figure, from 2012 -- and the pharmacy's cost is $12.23. Overhead is 93 percent of the cost.
With such tight operating margins, pharmacies typically charge uninsured patients a "usual and customary" price. That usually means they will pay more than insured patients. How much more depends on where you live, how the pharmacy calibrates its drug prices, and a host of other factors.
A new medicine is at its priciest in the five to seven years after it's approved by the federal Food and Drug Administration. During this period, the company that developed the drug is its exclusive manufacturer and seller. It holds the patent on the drug, which can run for 20 years. The drug is sold under its brand name, and the retail price can start wherever the drug company wants it and then rise. Some prices rose by 1,000 percent, according to a 2009 report by the U. S. General Accounting Office.
Drug companies can reformulate the original medicine and rename it, creating for legal purposes a new drug that usually has three years of exclusivity. The original medicine, however, can be manufactured and sold by other drug companies as a generic drug under its pharmaceutical name.
If you are uninsured and buying drugs out of pocket, you'll probably want to use generic drugs. But once a generic is available, pharmacy prices still vary -- a lot.
The lowest price is comparatively easy to find: Several websites scope out prices for drugs that are available by mail. One such website is pharmacychecker.com.
At least one web application will track prices in your immediate neighborhood. Goodrx.com scopes out prices by zip code and then offers coupons for your drug at local pharmacies. In a single California zip code, the price of 30 tablets of simvastatin (20 mg.) ranged from $5.10 (online) to $5.73 with a coupon at several local pharmacies and $9.99 for a retail pharmacy with a membership program. A prescription for 30 generic pramipexole pills (.25 mg.), for Parkinson's disease, cost $9 to $47.61.
Finally, you can sign up for a state-sponsored "RX buying club" or "discount drug club," as they're called. More states have them than not. You can read more about them on the National Conference of State Legislatures web site.
- Medicaid.gov: Survey of Retail Prices
- U.S. Pharmacist: Understanding Drug Pricing; Joey Mattingly
- U.S. Food and Drug Administration: Frequently Asked Questions on Patents and Exclusivity
- General Accounting Office: Report to Congressional Requesters -- Brand-Name Prescription Drug Pricing
- WebMD.com: The Letter (and Spirit) of Drug Import Laws; Neil Osterweil
- National Conference of State Lesiglatures: State Pharmaceutical Assistance Programs