Synopsis: Pharmacists aren’t the bad guys, but the pharmacies they work for can take advantage of you when you have to pay the “cash” price (the full retail cost) for your prescriptions. When your prescriptions are lost, stolen, or accidentally damaged, your insurance company often won’t cover the replacement costs, which leaves you covering the whole tab. This article addresses how to protect yourself when paying for your prescription medications without insurance.

BY LEN LANTZ, MD / 5.25.23; No. 67 / 7 min read

Disclaimer: Yes, I am a physician, but I’m not your doctor, and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post might also contain affiliate links. Please click this LINK for the full disclaimer.

Finding yourself in a tight situation at the pharmacy

Imagine going to the pharmacy to pick up a prescription and being told that the cost is $200 when you know it should cost much less. Maybe you picked up the same medication previously for $10 or $20, or you have a sense that the medication should be cheaper because it is available as a generic. Even if you ask the pharmacist for more information, they might tell you that they are giving you the lowest price that they can for that particular medication. What would you do at that moment, especially if you really needed to start a prescription or did not want to run out of a medication you were already on? Would you call your doctor, buy just a few pills, or simply leave without the medication?

Paying for medication without insurance can be confusing, especially with the terminology that pharmacies use. For example, you would normally expect a discounted price when you pay for something with cash, but when patients pay the “cash” price for a prescription medication at a large chain pharmacy, they are often being charged the maximum retail price listed at that pharmacy.

In this article when I’m referring to paying the “cash” price for a prescription medication, I’m referring to a situation when your health insurance company is not there to help you out. When this happens and you find yourself paying the cash price for your medication, you should become extremely suspicious if you are asked to pay more than $50 for any generically available medication. Unfortunately, this happens all the time. Here are some actual examples of what some of my patients have run into:

• A large pharmacy chain charged $385 for a 30-day supply of generic Seroquel that the patient could have gotten for $17 at a different pharmacy in town with a free prescription discount card.

• A mid-sized pharmacy chain charged $222 for a 30-day supply of generic Abilify that the patient could have gotten for $3 at the same pharmacy with a free prescription discount card.

• A large pharmacy chain charged $312 for a 30-day supply of generic Risperdal that the patient could have gotten for $4 at a different pharmacy in town with a free prescription discount card.

Having to pay the cash price happens more often than you would expect

My heart sinks when I talk to patients who have paid hundreds of dollars for a generically available medication, and I have to explain to them how they were taken advantage of by that pharmacy when they could have gotten the same medication for $6 or $12. My purpose in writing this article is to give you the knowledge to protect yourself and your finances if you are ever asked to pay more than you think you should for a generically available medication at the pharmacy.

There are numerous problems that you can run into at the pharmacy, but the cost of medications is one of the top concerns for my patients. You can find yourself getting overcharged for your prescriptions for any number of reasons. Here are some situations when you might need to pay the cash price for a prescription at the pharmacy:

• You need to replace prescriptions that have been lost or stolen.

• You travel to another town only to realize that you forgot to pack your meds.

• You need to replace damaged medication, such as meds that were accidentally dropped into a water-filled sink.

• You are between jobs and temporarily do not have health insurance.

• Your doctor prescribed you a new medication that you want to start today, but your health insurance company is requiring prior authorization, which could take days to weeks to process.

How can pharmacies legally jack up the price of a generically available medication?

All pharmacies have a list of maximum retail prices that they set for generic medications and their brand name version. So, even though you can normally get a 30-day prescription of fluoxetine (generic for Prozac) for under $10, the listed retail price of the generic at a given pharmacy might be as much as $100. The listed retail price for 30 pills of brand-name Prozac is typically over $1,000.

If you have health insurance, you can get the generic version of Prozac from the pharmacy for under $10 for three reasons:

• Your insurance plan protects you financially by requiring the pharmacy to provide you generic fluoxetine instead of brand name Prozac.

• Your insurance plan negotiates with the pharmacy to discount the price of generic fluoxetine from $100 to about $20.

• Your insurance plan pays the pharmacy $10 toward the prescription, and then you pay $10 (often referred to as a co-pay).

Please note that pharmacists and pharmacy staff are not the bad guys. Pharmacists are typically employees, not owners, of pharmacies. They must follow their company’s rules or risk losing their jobs. So, try not to get mad at pharmacists if you get taken advantage of at a large chain pharmacy, just use the strategies in this article to save money in the future. I would not be surprised if a pharmacist could be fired by their employer if they told patients that the same medication was available across the street for a tenth of their price or that a customer could get an immediate 99% discount with a pharmacy discount card.

So, how do pharmacies legally jack up the price of a generically available medication by hundreds of dollars? Typically, they reverse the protections offered by health insurance plans without telling the patient. While this is unethical, it’s not yet illegal in the US. When you are paying the cash price for a prescription, the pharmacy can:

• Charge you their listed retail price either for a generic or a brand-name medication.

• Give you the more expensive brand-name medication even if your doctor prescribed an inexpensive generic version on the original prescription.

• Charge you the whole amount for the prescription.

Protect yourself by always having a backup prescription discount card

While there are dozens of prescription discount cards, I’m only going to be writing about the GoodRx card, which is the most commonly used free prescription discount card in the US. I have a stack of these cards at the reception desk at my office, and you can quickly sign up and download a GoodRx app on your smartphone. In full disclosure, I have no affiliations (financial or otherwise) with the GoodRx company or any of its employees.

When you use the GoodRx card or app, you have the pharmacist scan or enter your code into their system and use that instead of your insurance plan to generate a discount on your medication. On the GoodRx app or website, you can look up the cost of specific medications at specific doses and determine which pharmacies in your city or zip code will offer you the best discount. Even when using the GoodRx card or app, there can be substantial differences in medication pricing between pharmacies. The following chart shows some of the variable pricing between pharmacies when using GoodRx.

There is a nonmonetary cost to the “free” prescription discount cards, which is allowing them access to your health data. You give up a degree of privacy when you allow any additional party access to your health information – this includes technology companies, from the makers of health apps to smartwatches. You should know how these companies will share your information and how much privacy you can expect from them. For example, the GoodRx company was fined $1.5 million in 2023 for “failing to report its unauthorized disclosure of consumer health data to Facebook, Google, and other companies” (source: Federal Trade Commission). Here is GoodRx’s response to the FTC action.

Prescription discount cards can save you more money than your insurance plan

I’ve had more than a few patients tell me that, even with their insurance plan, they are having to pay higher and higher amounts for common generic prescriptions. When this happens, I always encourage them to check how much they would pay with a prescription discount card at various pharmacies in town instead of their insurance plan. Many people are astonished to learn that they would save hundreds of dollars per month by using the prescription discount card.

This is probably because their insurance companies are paying less toward certain generic prescriptions (shifting more of the cost to patients) and using pharmacy benefit managers (PBMs), which act as middlemen between pharmacies and insurance plans. PBMs have been alleged to have obscured and inflated drug pricing through a lack of transparency and legalized kickbacks, such as tactics called “rebates” and “spread pricing” (source: The Commonwealth Fund).

While you can use a prescription discount card to pay the cash price for medication instead of involving your insurance plan, you will not receive credit toward your out-of-pocket contribution or deductible on your insurance plan when you don’t involve your insurance plan.

Just getting access to your prescriptions can be a challenge

Just knowing the above information will not immediately get you authorization to purchase your prescriptions for the cash price. At times, you might need your doctor’s authorization to fill a prescription early or you might need your doctor’s help in transferring a prescription from one pharmacy chain to another to get the best price for your prescription medications. It’s also helpful to keep in mind that pharmacists can call your health insurance plan and sometimes get a one-time replacement refill for prescription medications that were lost, stolen, or damaged. I wrote about other strategies for getting your prescription medications when you need a refill quickly in my article, “Dealing with Serotonin Withdrawal from Antidepressants.”

You can take proactive steps today to protect yourself when paying the cash price for prescriptions

It’s worth your time to prepare now for the future event of having to pay the cash price for your prescription medications. Prescription costs can vary tremendously between pharmacies and you’ll pay the most if you are not using your insurance plan or a prescription discount card. You can find a free prescription discount card that you like and have it ready on short notice. It’s also worth it to compare how much you are currently paying for your medications to the cost after using a prescription discount card and paying the cash price. Imagine saving hundreds of dollars per month on your current prescription medications. There’s no need to pay huge amounts for generic medications. Use this information today to protect yourself and share it with the people you care about!

For further reading, check out:

• Len’s Article, “Dealing with Serotonin Withdrawal from Antidepressants”

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