Whether you’ve lost your job (and the benefits that came with it) or are stuck with a reduced-rate plan that doesn’t cover the drugs you need, you may find yourself filling prescriptions without insurance at some point . while prescription drug prices alone can be high, drug costs without insurance can be cheaper nearly 25% of the time. And what is more? there are many ways to find even more savings at the pharmacy.
related: don’t have health insurance? try these 2020 resources
do you need insurance to get a prescription?
Navigating the health care system without health insurance can be daunting, but it shouldn’t stop you from seeking care. You can see a doctor and get a prescription without insurance, but you’ll need to choose a health care provider wisely to keep costs down. Community health clinics are a good option for free or low-cost services, and many offer sliding-scale prices based on your income. Walk-in clinics and urgent care centers generally allow patients to pay in cash, but their prices can vary widely. On the other hand, telemedicine (seeing a doctor over the phone or through a web portal) is often cheaper than an office visit. a 2017 study published in health affairs found that respiratory patients spent an average of $79 for a telehealth visit versus $146 for an office visit (although it also found that the convenience of telehealth can increase the general expense).
The cost of an insured versus uninsured office visit is difficult to quantify, as many factors, including location and length of visit, play a role. A 15-minute office visit for an established patient in Seattle, for example, runs between $128 and $398, while the same type of visit for a patient in New York costs between $138 and $430, according to the Blue Book. of medical care. meanwhile, copays for a standard doctor’s visit typically range from $15 to $25, according to debit.org.
The same variation applies to prescription drugs as well. the brand-name drug lyrica, for example, ranges in price from $460 to $720 per month without insurance. Prescription copays differ among providers, but average copays range from $11 to $105 depending on drug tier, according to a 2018 survey by the Kaiser Family Foundation.
how much do prescription drugs cost without insurance?
See also: Is prepaid insurance an asset?
There’s no denying that prescription drug prices continue to rise. This year alone, the retail price of 460 drugs increased by an average of 5.2%, according to the health care research firm 3 Axis Advisors. On average, Americans spend about $1,200 each year on pharmaceuticals, according to data from the Organization for Economic Co-operation and Development. For many without insurance, those rising costs mean they have to choose between taking the medications they need and paying for necessities like rent and food. in fact, a 2016 survey found that 14% of uninsured Americans had missed doses or missed a prescription due to cost. Bottom line: Drug prices are costing Americans more than dollars, they’re also costing our health.
There are many factors at play when it comes to how much a prescription drug costs. On a larger scale, manufacturers say the high cost of one drug often helps offset the research and development costs of another. (However, there are many pharmaceutical expenses that are not included in this explanation.)
On a smaller scale, and if you have insurance, your costs will be determined by the plan’s formulary (also known as a drug list), which describes the brand-name and generic drugs covered by your insurance plan. From there, the formulary is typically divided into tiers (based on things like cost, availability, etc.), with a specific out-of-pocket cost assigned to each tier. therefore, the copay for a tier 4 drug, for example, can vary greatly from the copay for a tier 1 drug.
Also affecting your copay is an industry player that few Americans have probably heard of: it’s called a pharmacy benefit manager (pbm). Essentially a middleman, a PBM works with pharmacies, insurance companies, and drug manufacturers to streamline the supply chain. (Essentially, a PBM helps an insurance company decide which drugs it will cover (i.e., its formulary) and how much it will pay the manufacturer for them.)
why are some prescription drugs cheaper without insurance?
Uninsured drug prices can be cheaper 25% of the time. but how can that be? In a perfect world, a PBM would want to secure the lowest price for the insurance company, but often a drug manufacturer offers a bribe for the PBM to choose their brand-name product over the generic. These kickbacks, called “clawbacks” in the pharmaceutical field, are largely where your increased copays end up. this is how it works:
- You were prescribed a drug that cost only $30 last year, but your increased copay now reads $75.
- The pharmacy gets your $75 copay, and you might think they’re making a decent profit because it only cost them $15 to buy the drug.
- What you don’t know is that $50 of your $75 goes back to the pbm in the form of clawback.
- Ask your doctor about the generic version: Brand-name drugs are almost always more expensive than generic drugs. Going back to the lyrica example, while the brand name drug costs between $460 and $720 per month, the generic version ranges from $140 to $370 per month.
- Ask your doctor about a different medication: Is the cash price of another blood pressure medication significantly lower than what you are currently taking? ask your doctor if you can make the switch.
Instead of paying a $30 copay and allowing the pharmacy to get a net $15 after paying for the drug, bringing pbms on board artificially raises prescription drug prices so they can get their share, too. the worst part of all? pharmacists cannot tell you about this system, as doing so could threaten their relationships with insurance companies and pbms.
does singlecare work without insurance?
Whether you have insurance and face a large copay or are uninsured and fear high out-of-pocket costs, the singlecare card could be the answer to lowering your bill total.
SingleCare is not a form of insurance, but rather a prescription discount card that is free to all pharmacy customers in the United States, including those without insurance. singlecare works without insurance, as the discount is applied to the cash value of the prescription. (read: you won’t be able to use your singlecare card and your insurance on a single prescription.)
So how much can you really save on prescription drug prices with singlecare? quite a lot, actually. For example, in 2019, the average cash price of the ADHD medication amphetamine-dextroamphetamine was $131.67. the average singlecare price? only $47.57. SingleCare card users saw similar savings on the cholesterol-lowering drug atorvastatin calcium. without the card the average price was $105.68. with the card: $29.06.
In addition to the singlecare card, there are several ways to potentially reduce the price of your prescription:
Research patient assistance programs: Many drug manufacturers and nonprofit organizations offer discount programs for people who can’t afford their prescriptions, which could mean low-cost medications or even free. eligibility requirements vary, so you’ll need to check with the drug company to see if you qualify.