{"id":2250,"date":"2017-11-02T17:12:43","date_gmt":"2017-11-02T21:12:43","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=2250"},"modified":"2021-04-16T14:54:01","modified_gmt":"2021-04-16T18:54:01","slug":"prescriptions-cheaper-without-insurance","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/prescriptions-cheaper-without-insurance\/","title":{"rendered":"How to pay for prescriptions without insurance"},"content":{"rendered":"

Whether you\u2019ve lost your job (and the benefits that came with it), or are saddled with a cut-rate plan that doesn\u2019t 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 <\/span>25%<\/span><\/a> of the time. What\u2019s more? There are many ways to find even more savings at the pharmacy.\u00a0<\/span><\/p>\n

RELATED: <\/b>No health insurance? Try these 2020 resources<\/b><\/a><\/p>\n

Do you need insurance to get a prescription?<\/span><\/h2>\n

Navigating the healthcare system without health insurance can be daunting, but it shouldn\u2019t stop you from seeking medical care. You can <\/span>see a doctor and get a prescription without insurance<\/span><\/a>\u2014but you\u2019ll 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, <\/span>telemedicine<\/span><\/a>\u2014consulting with a physician over the phone or through a web portal\u2014is often cheaper than an office visit. A 2017 study published in <\/span>Health Affairs<\/span><\/i><\/a> 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).<\/span><\/p>\n

The cost of an office visit with insurance versus without is hard to quantify, as many factors\u2014 including location and duration of visit\u2014all 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 <\/span>Healthcare Blue Book<\/span><\/a>. Meanwhile, copays for a standard doctor visit typically range between $15 and $25, according to <\/span>debt.org<\/span><\/a>.\u00a0<\/span><\/p>\n

The same variance goes for prescription medications too. The brand-name drug <\/span>Lyrica<\/span><\/a>, 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, <\/span>according to a 2018 survey from Kaiser Family Foundation<\/span><\/a>.\u00a0<\/span><\/p>\n

How much do prescription drugs cost without insurance?\u00a0<\/span><\/h2>\n

There\u2019s no denying that prescription drug prices continue to rise. Just this year, <\/span>the retail price of 460 medications increased by an average of 5.2%,<\/span><\/a> 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 <\/span>Organisation for Economic Co-Operation and Development<\/span><\/a>. 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 <\/span>2016 survey<\/span><\/a> found that 14% of uninsured Americans had either skipped doses or didn\u2019t fill a prescription because of the cost. In short: Drug prices are costing Americans more than just dollars\u2014they\u2019re costing our health, too.<\/span><\/p>\n

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 <\/span>pharmaceutical expenditures that are not accounted for in this explanation<\/span><\/a>.)\u00a0<\/span><\/p>\n

On a smaller scale, and if you have insurance, the costs will be determined by the plan\u2019s formulary (also known as a drug list), which outlines the brand-name and generic drugs covered by your insurance plan. From there, <\/span>the formulary is usually divided into tiers<\/span><\/a> (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.\u00a0<\/span><\/p>\n

Also affecting your copay is an industry player few Americans have probably ever heard of\u2014it\u2019s 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.)\u00a0<\/span><\/p>\n

Why are some prescriptions cheaper without insurance?<\/span><\/h2>\n

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 \u201cclawbacks\u201d in the pharmaceutical field, are largely where your increased copays end up. This is how it works:<\/span><\/p>\n