Buyer beware: what you need to know about prescription costs
By Nancy Coveleskie, CHMRx
Contrary to the old saying, what you don’t know can hurt you—and that’s certainly true of prescription costs. Here are some ways a lack of knowledge about prescriptions can harm you (and your wallet).
Not all pharmacies are created equal
In recent years, household-name pharmacy chains have captured about 50 percent of market share, with the two largest chains dominating urban markets in most states. Locally- or privately-owned drugstores generally offer lower prescription prices but can’t compete with convenient features offered by larger retailers, such as drive-thrus, 24/7 service, urgent care clinics and the capacity to sell many non-pharmaceutical goods.
Prescription costs vary widely
Savvy shoppers know that generic prescriptions are usually much less expensive than brand-name medicines. After that, though, insight into prescription pricing becomes a murky mire since, for example, the same drug and dosage at different pharmacies can cost $13.77 or $126.95—or any price between the two. Some pharmacies have low pricing on certain prescriptions but charge much more than their competitors for other drugs.
It may help to think of prescription pricing like airline seats—the same seat can be a bargain for one customer but cost a small fortune for another. It depends on when, where and how the seat is purchased.
There are deals to be had, but few of us know what is a good deal
Similar to the lack of pricing transparency among most hospitals and doctor’s offices, many patients don’t have a frame of reference for how much their prescription should cost and whether they’re overpaying for their medicine. Even doctors sometimes don’t have a good “estimate” to give their patients.
Unless a patient gets a paper prescription, they usually arrive at the pharmacy to find that the doctor’s office has already contacted the pharmacy to fill the prescription.
Insured patients and those without prescription coverage are both at a disadvantage: neither knows the actual price ahead of time and the insured patient may never know if all they must pay is their co-pay amount.
Using a mail-order service helps eliminate this problem and can significantly reduce costs, but typically mail order is only used for routine, long-term prescriptions.
As with any industry, unethical behavior exists
Lack of pricing transparency can compound problems for patients. There have been reports of some pharmacists and technicians “backing out” discounts. The scenario plays out like this: The patient presents a prescription discount card to a pharmacy staff member. The staff member runs the card and sees the discount amount, but doesn’t share the information with the patient. Instead, the patient is told that the pharmacy’s own discount program will give them a greater reduction on their cost when, in fact, the opposite is true.
Certainly, most pharmacists and their staff members genuinely care about their customers’ welfare and operate with integrity. However, the opportunity for abuse increases when patients are uneducated about prescription prices and their purchasing options.
CHM’s prescription for preventing pocketbook pain
CHM doesn’t share maintenance prescription costs (please see Guideline T). However, each new member receives a prescription savings card, the CHMRx card. On the card’s website, chmrx.com, members can use the online drug pricing tool to search pharmacies and prices in your area.
The card is effective; members used the CHMRx card in 2018 for nearly $29 million in prescription costs and saw more than $21 million reduced—saving almost 74 percent!
The CHMRx staff* has worked with CHM to make improvements to the card that address many of the problems listed above. For more information and assistance getting the best pricing on your prescription costs, visit the card's website.
*Editor’s note: The CHMRx card is administered by a third party, not CHM. Please call the Rx Member Help Desk number on your CHMRx card or visit the card’s website for assistance. You can also request a new card at chmrx.com. There is no guarantee or set discount amount.