How to find the lowest price for your prescriptions

Patients needing lifesaving prescription medications are facing sticker shock right now, as many consumers are struggling to afford them.

Congress is currently reviewing legislation aimed at limiting profits for industry middlemen as one in three Americans struggles to afford prescription medications. The bill seeks to prevent pharmacy benefit managers from driving up costs for patients.

The proposed changes come amid data showing Americans pay four to eight times more for brand-name drugs than patients in other countries. CEO Merith Basey of the nonprofit Patients for Affordable Drugs said the current system is difficult for patients to navigate because pricing remains hidden behind complex negotiations between drug makers and insurance providers.

Martavia Brown has seen the impact of these high costs firsthand. She noted that finding affordable prescriptions has become an increasing challenge for many consumers. “Especially for our older people,” Brown said. “It’s been very hard for them.”

Basey, CEO of Patients for Affordable Drugs, explained that drug manufacturers set initial list prices and often attempt to maintain monopolies as long as possible. Following this, insurance companies and pharmacy benefit managers, often referred to as middlemen, negotiate various deals that can lead to price discrepancies.

“The key piece here is that it’s very opaque, which means that it’s hard for patients to really know exactly what’s going on and how much they’re going to pay,” Basey said. Because of these variations, prices can change depending on a patient’s specific insurance plan or the pharmacy they visit.

Brown found that shopping around and occasionally opting not to use insurance can lead to lower costs. She suggested using coupons and discounted programs to offset the expense.

State governments have developed tools to help residents compare these costs. The “Pennsylvania Prescription Price Finder” website allows users to search by ZIP code for the cash prices of both generic and brand-name drugs. A search on the site for a specific diabetes medication showed prices ranging from $416 to $810, depending on the pharmacy.

Additionally, the Pennsylvania Drug Card is available to all state residents regardless of age or income. The card offers savings of up to 80% on certain medications.

Emmabella Rudd, a patient advocate who has Type 1 diabetes, became an advocate after struggling to secure insulin. She has observed patients skipping bill payments or asking for insulin vials from others just to survive.

“Being a patient, especially in the United States, relying on a prescription drug to survive, is, you know, navigating hurdles day to day, and that can be extremely frustrating,” Rudd said.

Brown described the ongoing struggle for fair costs as a significant burden for families. “They’re fighting for pricing,” Brown said. “It’s just crazy. It’s just crazy.”

Congress is currently evaluating a bill that would limit the profits middlemen can make on prescription medications. The goal of the measure is to make it more difficult for these entities to drive up prices for patients.

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