More Patients Turning to Non-Insurance Prices and Discount Cards

Rx Savings Solutions | April 28, 2023

Rx Savings Solutions | April 28, 2023

Last year, NBC News told the story of a Florida man with a $650 monthly prescription who found the same medication at an Ohio pharmacy for $85. Why the big price difference? The pharmacy in Ohio didn’t take the man’s insurance.

How and why a prescription price can be lower without insurance is an explanation for another time. But it’s often true with generic medications, which happen to be nine out of 10 prescriptions filled today. For years, prescriptions bought using GoodRx and other discount card programs haven’t used insurance either.

More and more people are discovering this pleasant and puzzling surprise:

  • In 2019, only 5% of prescriptions were purchased at a pharmacy’s “cash” (non-insurance) price.
  • In 2022, a study reported that 61% of consumers surveyed had paid cash prices for prescriptions even though the drugs were covered by their health insurance.
  • In the same 2022 study, 50% of those surveyed living in urban markets said it’s less expensive to pay out of pocket than to use insurance.

What is a “Cash” Pharmacy?

Should everyone start carrying cash again? No, “cash” in this context refers to pharmacies that don’t take patients’ insurance. Instead, they sell medications for a cash price that’s based on what the pharmacy paid to get the drug, plus a dispensing fee and their markup.

A cash or discount card price may be lower or higher than an insurance plan’s negotiated price with an in-network pharmacy—or a patient’s copay or out-of-pocket cost for it. It’s not hard to see why people would gravitate to whichever is lower.

Price isn’t the only factor driving people to use cash instead of insurance. Other reasons cited by consumers in a recent study:

  • 18% knew they wouldn’t hit their deductible anyway.
  • 22% did so because their prescribed drug wasn’t on their plan’s formulary.
  • 29% went the cash route because their preferred pharmacy was not in-network.

For anyone lacking prescription coverage, cash pharmacies provide critical access to affordable medication. For many patients, distance from, and transportation to, the closest brick-and-mortar pharmacy is an equal or bigger barrier to access. Cash pharmacies with direct-to-door shipping can be a lifeline.

Cash or Insurance?

For the Florida man, $85 vs. $650 each month is an easy choice. Depending on the size of his annual deductible, however, it may not be the best call every fill. Paying down the deductible will take longer. Maybe his health plan will apply cash purchases to the deductible, maybe it won’t. (Medicare does not.)

When it comes to cash pharmacies and discount cards, there are some tradeoffs for patients:

  • Lower out-of-pocket cost up front but slower deductible paydown.
  • Consistent pricing and no pharmacy network to deal with, but the patient has to do the searching and shopping.

Knowing All Your Options

Right now, most people either search for or stumble onto a cash-pay option for their prescription—and they often have more than one. At the same time, there may be effective clinical alternatives that cost less through insurance and can work toward their deductibles.

People need one simple source that shows all available insurance, cash and discount card prices. They need accurate pricing and deductible status in real time. They might also need help changing or transferring a prescription to take advantage of a lower-cost option.

For many people, that simple source comes from a service called Rx Savings Solutions (RxSS). If your employer or health insurance company uses RxSS, you can access your RxSS account and easily see all the options you have for prescriptions—from cash pricing, to insurance coverage to convenient delivery options. And RxSS has a team of pharmacy experts ready to answer your phone call and walk you through everything.

No matter what option works best for you, it’s nice to know you can see them all in one place.

more about rxSS

If your employer or health insurance company works with Rx Savings Solutions, we’re here to help you save money on prescription drugs. Watch the video to learn more.
blog icon

Here are a few ways you can use RxSS to lower out-of-pocket prescription drug expenses.

1 – See options for lower-cost medications

2 – Receive personalized notifications of savings opportunities

3 – Access personalized assistance from certified pharmacy technicians when you need it