Whether you’ve lost your job (and the benefits that came with it), or are saddled with a cut-rate plan that doesn’t cover the medications you need, you may find yourself, at some point, having to fill prescriptions without insurance. While prescription prices alone can be high, the cost of medicine without insurance can actually be cheaper almost 25% of the time. What’s more? There are many ways to find even more savings at the pharmacy.
Do you need insurance to get a prescription?
Navigating the healthcare system without health insurance can be daunting, but it shouldn’t stop you from seeking medical care. You can see a doctor and get a prescription without insurance—but you’ll need to choose a healthcare provider wisely in order to keep costs down. Community health clinics are a good option for free or low-cost services, with many offering sliding-scale pricing based on your income. Walk-in clinics and urgent-care centers typically allow patients to pay with cash, but their prices can vary widely. On the other hand, telemedicine—consulting with a physician 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 may increase overall spending).
The cost of an office visit with insurance versus without is hard to quantify, as many factors— including location and duration of visit—all play a role. A 15-minute office visit for an established patient in Seattle, for instance, ranges between $128 and $398 while the same type of visit for a patient in New York costs between $138 and $430, according to Healthcare Blue Book. Meanwhile, copays for a standard doctor visit typically range between $15 and $25, according to debt.org.
The same variance goes for prescription medications too. The brand-name drug Lyrica, for instance, ranges in price from $460 to $720 per month without insurance. Prescription copays differ depending on providers, but average copays range from $11 to $105 depending on drug tier, according to a 2018 survey from Kaiser Family Foundation.
How much do prescription drugs cost without insurance?
There’s no denying that prescription drug prices continue to rise. Just this year, the retail price of 460 medications increased by an average of 5.2%, according to the healthcare research firm 3 Axis Advisors. On average, Americans spend about $1,200 each year on pharmaceuticals, according to data from the Organisation for Economic Co-Operation and Development. For many uninsured, those rising costs mean they have to choose between taking the medication they need and paying for necessities like rent and food. In fact, a 2016 survey found that 14% of uninsured Americans had either skipped doses or didn’t fill a prescription because of the cost. In short: Drug prices are costing Americans more than just dollars—they’re costing our health, too.
There are many factors at play when it comes to how much a prescription drug costs. On a larger scale, manufacturers claim that the high cost of one drug often helps offset the research and development costs of another. (However, there are many pharmaceutical expenditures that are not accounted for in this explanation.)
On a smaller scale, and if you have insurance, the costs will be determined by the plan’s formulary (also known as a drug list), which outlines the brand-name and generic drugs covered by your insurance plan. From there, the formulary is usually divided into tiers (based on things like cost, availability, etc.), with a specific out-of-pocket cost assigned to each tier. So the co-pay for a tier 4 drug, for instance, may vary wildly from the co-pay for a tier 1 drug.
Also affecting your copay is an industry player few Americans have probably ever heard of—it’s called a Pharmacy Benefits 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 they will pay the manufacturer for them.)
Why are some prescriptions cheaper without insurance?
The prices of medications without insurance may 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 oftentimes, a drugmaker will throw in a kickback so that the PBM will choose its name-brand product rather than the generic. These kickbacks, termed “clawbacks” in the pharmaceutical field, are largely where your increased copays end up. This is how it works:
- You’re prescribed a drug that was only $30 last year, but your increased copay now dictates it’s $75.
- The pharmacy receives your $75 copayment and you might think they’re getting 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 a “clawback.”
Instead of paying a $30 copayment and allowing the pharmacy to net $15 after paying for the drug, bringing PBMs into the mix causes prescription prices to artificially rise so they can get their share, too. The worst part of it all? Pharmacists aren’t allowed to tell you about this system, as doing so could threaten their relationships with insurance carriers and PBMs.
Does SingleCare work without insurance?
Whether you have insurance and are facing a large copay or don’t have insurance and are dreading a high out-of-pocket cost, the SingleCare card could be the answer to reducing the total on your receipt.
SingleCare is not a form of insurance, but rather a prescription discount card that’s free for all pharmacy customers in the United States, including those who are uninsured. 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 actually save on the price of prescription medications with SingleCare? Quite a bit, actually. For example, in 2019, the average cash price of the ADHD medicine amphetamine-dextroamphetamine was $131.67. The average SingleCare price? Just $47.57. SingleCare card users saw similar savings on the cholesterol-lowering medicine 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:
- Ask your doctor for the generic version: Name-brand drugs are almost always more expensive than generic medications. Going back to the Lyrica example, while the brand-name drug costs $460 to $720 per month, the generic version ranges between $140 and $370 per month.
- Ask your doctor for a different medicine: Is the cash price of another blood pressure medicine significantly lower than the one you’re currently on? Ask your physician if you can make the switch.
Research patient assistance programs: Many drug manufacturers and non-profit organizations offer discount programs for people who can’t afford their prescriptions, which could mean low-cost or even free medications. Eligibility requirements vary, so you’ll need to check with the drug company to see if you qualify.