The Cost of Prescription Drugs

Are you frustrated and confused by the costs of your prescription medications? I am! As a patient, I had my annual doctor’s visit about one month ago.

Two new medications were prescribed for me during this visit. Since I presumed that my least expensive option would be to have my doctor send in these prescriptions to my Pharmacy Benefit Manager (PBM), Express Scripts, I requested that he do so. The prescriptions were for a 90-day supply of generic Celebrex 200 mg (celecoxib) and a 50-day prescription of generic astelazine nasal spray.

Fortunately for me, Express Scripts informed me of the charges for these prescriptions prior to filling them, the first being $99.54 for home delivery and the other being $151.32 for home delivery. When I researched my cost for these same prescriptions on the GoodRx app, one of several free drug discount programs available to all of us, insured or not, I found I could save significant money, each of these prescriptions costing me about $21. For both prescriptions, that was a cost-savings of approximately $209.

As a recently retired family physician, if anybody should understand how this works, I should, right? Wrong!

Only because I was writing this op-ed, I explored my Express Scripts online information. For the first time, I realized that if I had requested that I pick up these prescriptions at a local participating pharmacy, these prescriptions would have cost me much less, like the costs using the GoodRx coupons. In the case of astelazine nasal spray, I could have paid $11.34 at a local pharmacy for a 30-day supply, $34.02 for a 90-day supply. In the case of celecoxib 200 mg, a 90-day supply at the same local pharmacy would have only cost $22.73.

In fact, the Express Scripts webpage gave me four different purchasing options for both medications researched. When I urgently called Express Scripts to cancel both prescriptions due to their high costs for home delivery, their representative did not inform me there was a much less expensive option or any other option. Why not?

This recent experience, as a patient, not a physician, led me to re-explore what PBMs are and why they even exist. “Pharmacy benefit managers are entities that administer prescription drug insurance benefits. Their key functions include negotiating prices with drug manufacturers and pharmacies, establishing drug formularies and pharmacy networks, and processing drug claims.”

The Federal Trade Commission (FTC) released a report in July 2024 entitled “Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies.” The six largest PBMs control 90% of all prescriptions in the United States. The FTC concluded that “PBMs routinely adopt aggressive business practices that increase costs for consumers and financially penalize local pharmacies.”

PBMs were created to reduce prescription costs. However, they have never provided evidence of this. What is true? Their corporate profits have soared! The executive report of the FTC is worth reading and explains their concern that corporate greed is the priority, not consumer costs.

Although I had been recommending the option of GoodRx as a prescription discount plan for years, I also needed to understand how they can offer a significantly lower cost on many prescriptions.

Prescription discount programs are not insurance. They often include cards or apps. I have the most familiarity with GoodRx but others available are SingleCare, FamilyWize, WebMDRx, Blink Health and ScriptSave WellRx. These companies receive a portion of the savings negotiated between a PBM and the pharmaceutical company who manufactures the drug. In other words, these companies are a middleman’s middleman.

Perhaps in a future op-ed, I will elaborate on how PBMs siphon off health care dollars for their own profit.

I will close with advice when you have a prescription written by your doctor. If you do not have health insurance or a prescription plan, then download a drug discount app like GoodRx or request a prescription discount card from your physician or pharmacist.

If you have a prescription plan, it is very wise to compare costs, health insurance coverage options versus prescription discount card costs, before paying the bill. ALWAYS ask your local or PBM pharmacist, “Is this the lowest price I can pay for this prescription?” For those of us who have health insurance pharmacy benefits, I learned from my recent experience that if I want to pay the least amount for my prescriptions, I need to explore my PBM website to determine what I will be charged based on which option I choose.

With all the different health insurance plans being utilized at present, it is nearly impossible to know what your least expensive option is at the moment your doctor writes a new prescription for you.

Dwight Michael, MD, is a long-time member of the Gettysburg Democracy for America Healthcare Taskforce. As co-founder and family physician of Gettysburg Family Practice Inc., he served our community from 1985 until 2019. He remains a concerned citizen. This article was first published in the Gettysburg Times on Thursday, January 9, 2025.