Fact Checked

The 5 questions we get asked about the Costs of Prescription Drugs.

For many people seeking prescription drug discounts, one of the most bewildering concerns revolves around the cost of prescription drugs. A few of the most common questions include:

  • “Why is it that some of my medications are mind-bogglingly expensive while others are cheap, or at least reasonably-priced?”
  • “Why isn’t my medication covered?”
  • “When will my medication get a generic version and become cheaper?”
  • “Do I get discounts through USA Rx on generic drugs, too?”
  • “Can I use my USA Rx card for discounts on drugs that are excluded by my insurance company?”

Let’s take these questions one at a time:

1. Why is it that some of my medications are expensive while others are not?

As you probably remember from your High School economics courses, there isn’t a simple, cut-and-dried answer to this question. Even so, here are a few things to keep in mind about the cost of prescription drugs as you search for prescription drug discounts.

Richard G. Frank, Professor of Health Economics at Harvard University, pointed out that “a bewildering range of prices that can exist for the exact same pill. These vary according to one’s insurance coverage, place of purchase (drugstore versus mail order), and the organizational arrangements under which a pharmacy benefit is administered.” And this isn’t even a complete list.

There are a number of additional factors that influence the cost of prescription drugs.  To better understand, it may help you to think of prescription drugs being divided into four different types: Generic Drugs, Preferred Drugs, Other Drugs with Preferred or Generic Equivalents, and Specialty Drugs.

Generic Drugs, as the name suggests, are simply generic versions of an already-existing name brand drug. Generic drugs offer the same clinic benefits as name brand drugs, but they usually cost less because their manufacturers do not have to incur the same development costs as their name brand counterparts do.

Preferred Drugs are name brand drugs that do not have a name brand equivalent.

Other Drugs with Preferred or Generic Equivalents are usually the most expensive drugs because their preferred and generic alternatives are cheaper.

Specialty Drugs are high-cost medications that are used to treat complex medical conditions. Generally speaking, these drugs also have a tendency to be very expensive.

Add all of these factors together and it quickly becomes easy to see why there are widely varying costs for your prescription drugs.

2.   Why isn’t my medication covered?

There are several reasons why a medication may not be covered:

  • It is experimental or new.
  • Your doctor prescribed the medication for a use not recognized by the U.S. Food and Drug Administration or other professional medical organizations.
  • It was dispensed in your doctor's office (example: a measles vaccine). Drugs dispensed in a doctor's office are not covered under your pharmacy benefits; your medical benefits may provide coverage.
  • What you thought was a medication is actually a medical device. Glucose monitors for those with diabetes is an example. These devices show if a drug treatment is having its intended effect; it may be covered by your medical plan instead of your pharmacy plan.
  • There are equivalent over-the-counter medications available.

3.  When will my medication get a generic version and become cheaper?

Essentially, all you need to know to answer this question is when your name brand medication’s patent expires. Most drug patents are protected for 20 years. Once this patent expires, other manufacturers can start making and selling a generic version of the drug.

4. Do I Get Discounts Through USA Rx on Generic Drugs, Too?

Finally, a short answer: YES!

To find out what your specific discount will be, make sure to bring your pharmacy discount card with you the next time you visit your pharmacy. Your pharmacist will be able to tell you the cost of your medication and fill your prescription.

Bonus 5th Question: Can I use my USA Rx card for discounts on drugs that are excluded by my insurance company?

It’s very common for some brands and classes of prescription drugs to be excluded from your insurance company’s drug “formulary”. As a USA Rx Discount Card holder, you can use our card to save on most FDA-approved drugs, which are eligible for the best discounts we could negotiate on your behalf with over 60,000 pharmacies.

It’s important to note that even if a drug IS covered by your insurance company, you should use our card to compare the pricing. It’s not uncommon for a drug to be less expensive with the USA Rx Pharmacy Discount Card than an insurance price or co-pay – especially for generic medications.