What Your Medications Actually Cost Without Insurance in New Jersey

Most people have no idea what their medications actually cost. They know their copay. They know what the pharmacy charged them last month. But the number on the receipt often has very little to do with what the medication is genuinely worth — and the gap between those two numbers is frequently hundreds of dollars a year.

Fun story - one of the most useful aspects of my last EMR (electronic medical record) was being able to send a prescription to multiple pharmacies and compare prices that way for patients. I have a better system now that I am independent. Nevertheless, I had a patient tell me that the range of difference at one pharmacy for 30 days of her medication was over $250.00! So yea, shopping around is important!

The real prices

Here is what a month of some of the most commonly prescribed medications in America actually costs, paying cash, at the right pharmacy:

• Metformin, for type 2 diabetesaround $4 to $8.
• Lisinopril, for blood pressurearound $4.
• Atorvastatin, for cholesterolaround $5 to $9.
• Sertraline, for depression and anxietyaround $7 to $12.
• Levothyroxine, for thyroidaround $6 to $10.
• Amlodipine, for blood pressurearound $4.

Now compare that to what people commonly report paying: thirty, forty, sixty dollars a month for the same medication at a retail pharmacy without a discount applied. Over a year, on three or four medications, that difference adds up to real money — often more than a thousand dollars.

Why the gap exists

Drug pricing in the United States is not a market in any normal sense. The price you pay depends on your insurance plan, the pharmacy benefit manager negotiating on its behalf, the specific pharmacy, and whether anyone applied a discount card. None of these are visible to you at the counter.

A generic medication that costs the pharmacy two dollars might be billed at forty. Your insurance might cover thirty of it, leaving you a ten-dollar copay — and you would reasonably conclude that insurance saved you thirty dollars. In fact you could have paid four dollars cash and skipped the whole arrangement.

This happens constantly. It is not fraud, exactly. It is a system nobody designed and nobody is responsible for explaining to you.

Where to actually look

• Cost Plus Drugs — Mark Cuban's pharmacy publishes what it pays for each medication, adds a flat fifteen percent, a three dollar dispensing fee, and shipping. That is the entire price. You can look up any medication on their site right now without an account. Not every drug is available, but most common generics are.

• GoodRx — free discount codes accepted at most pharmacies. You are not using insurance when you use GoodRx; you are using a separate discount network. Sometimes it beats your copay by a wide margin. Always check.

• Costco pharmacy — you do not need a membership to use the pharmacy. Federal law requires pharmacies inside membership clubs to be open to the public. Their cash prices are frequently among the lowest available. Keep in mind, however, that they do have the “Costco Membership Subscription Program” for Costco members. The prices for members are actually pretty hard to beat!

• Your pharmacist — genuinely. Ask directly: "What is the cash price if I don't use my insurance?" Pharmacists know, and most will tell you. Many are frustrated by the same system. Some of my favorite phone calls are with my local pharmacists.

A caution worth stating

If you have insurance and a deductible you are trying to meet, paying cash may not count toward it. For an expensive specialty medication that matters. For a four dollar generic it usually does not.

And do not stop or change a medication because of price without talking to your physician. There is often a cheaper drug in the same class that works just as well — but that is a clinical decision, not a financial one.

What this has to do with how I practice

It takes about two minutes. In a system paying physicians for volume, two minutes is a luxury nobody has — which is why almost nobody does it, and why so many patients are quietly overpaying for medications they need to take every day for the rest of their lives.

At Rawq Medicine in Hillsborough, that two minutes is part of the visit. So is the twenty minutes it might take to explain why you are on the medication in the first place, whether you still need it, and what it is actually doing.

That is the whole idea. A flat monthly fee, no insurance in between, and a doctor with enough time to do the parts of medicine that get cut when time is the scarcest thing in the room. Visit my page www.rawqmedicine.com, or follow my practice on IG or Facebook: @rawqmedicine.

Nada Farooqui, M.D.