Prescription medication prices

Prescription medication prices are the dollar amounts charged for drugs prescribed by licensed healthcare providers, such as antibiotics (amoxicillin), insulin, or blood pressure medications (lisinopril). Insurance plans, including PPOs and HMOs, negotiate lower drug prices with pharmacies, resulting in reduced costs for members.

Copays for generic medications average $12, while brand-name copays range from $30–$60 per prescription under employer health plans (KFF 2022). High-deductible health plans require members to pay full retail prices–such as $350 for a month’s supply of Eliquis–until deductibles are met.

Pharmacy benefit managers (PBMs) like CVS Caremark and Express Scripts often set the final price after rebates. Formularies group drugs into tiers: generics (lowest cost), preferred brands (mid-cost), non-preferred brands (highest cost); for example, Lipitor may cost more if it is listed as non-preferred.

Medicare Part D enrollees pay an average annual out-of-pocket medication expense of $452 (CMS 2023). Manufacturer coupons may reduce patient costs by up to 80% on select branded medications such as Humira.

State laws in Massachusetts and California limit copay accumulators that prevent coupon values from counting toward deductibles, YourInsurance.info states. Out-of-network pharmacy purchases–like filling prescriptions at Walgreens without plan participation–result in paying full retail price, which averages $228 for branded drugs according to GoodRx.

Drug prices vary widely by pharmacy: a one-month supply of atorvastatin ranges from $9 at Costco to $25 at CVS Pharmacy.