GoodRx, Insurance, or Cash Price: Which One Should You Actually Use?

Understanding the Three Pricing Options

Option 1, Your Insurance When you present your insurance card at a pharmacy, the pharmacy submits a claim to your PBM and charges you the copay determined by your plan’s formulary for that medication at that tier.

When insurance is likely the best option: when your medication is on a preferred generic tier with a low copay, when you have already met your annual deductible, when the medication is a specialty drug where your out of pocket maximum applies, or when the medication is expensive enough that your coinsurance calculation under insurance is lower than any cash or discount option.

When insurance is not the best option: when you have a high deductible plan and have not met your deductible, when the medication is a generic with a low market price, when your copay exceeds the cash price of the medication, or when you are on a medication that has not yet been filled enough times to count toward your deductible in a meaningful way.

Option 2, GoodRx and Discount Cards GoodRx, RxSaver, NeedyMeds, and similar discount card programs negotiate prices with individual pharmacies and provide a coupon code that the pharmacy uses instead of your insurance. The price you pay is the discount card price, which varies by pharmacy, by drug, and by the specific program being used.

When GoodRx is likely the best option: for generic medications where the market price is low, when you are uninsured or underinsured, when your insurance copay exceeds the GoodRx price, or when you are on a medication that your insurance does not cover.

When GoodRx is not the best option: when using a discount card instead of insurance means the fill does not count toward your deductible or out of pocket maximum, when the medication is expensive enough that your insurance coinsurance is lower than the GoodRx price, when you have a low copay under your insurance plan that beats the GoodRx price, or when your pharmacy offers a better cash price than GoodRx shows.

Option 3, The Pharmacy’s Cash Price The cash price is the price a pharmacy charges if you present no insurance and no discount card. It is set by the pharmacy independently and varies significantly between pharmacy types.

At chain pharmacies the cash price for generic medications is often higher than the GoodRx discount card price. At independent pharmacies the cash price for generic medications is sometimes competitive with or better than GoodRx, particularly for common generics where an independent pharmacy has efficient sourcing.

When the cash price is the best option: at independent pharmacies for common generic medications, when a pharmacy offers a generic drug program with flat pricing, or when the pharmacy’s relationship pricing for established patients offers a competitive rate.

The Deductible Complication

Here is the most important nuance that most patients, and many online articles about prescription pricing, miss entirely.

When you use GoodRx or pay cash for a prescription instead of running it through your insurance, that fill typically does not count toward your annual deductible or out of pocket maximum.

For a patient with a $3,000 deductible who takes one inexpensive generic medication, this is irrelevant. The deductible is met through other medical expenses and the $8 GoodRx price is clearly better than the $20 insurance price.

For a patient with a $3,000 deductible who takes multiple medications and whose total prescription spend approaches or exceeds the deductible, using GoodRx instead of insurance may save money month by month but cost more over the full year, because the fills that were paid through GoodRx did not count toward meeting the deductible that would eventually reduce the cost of more expensive medications.

This calculation requires knowing your deductible, your annual prescription spend, and which medications are expensive enough to benefit from deductible credit. Your pharmacist can help you think through this calculation if you are not sure how it applies to your situation.

The Manufacturer Coupon Option

There is a fourth pricing option that is relevant for brand name medications specifically.

Many pharmaceutical manufacturers offer copay assistance programs, sometimes called copay cards, co pay assistance, or patient assistance programs, that reduce the out of pocket cost of brand name medications for commercially insured patients.

These programs can be remarkably generous. Some reduce the patient’s copay for a brand name medication to $0 for the first year or longer. They exist because the manufacturer would rather give you the drug essentially free through a coupon than lose your prescription to a generic competitor.

The important caveat: manufacturer copay assistance programs are typically not available for patients on Medicare, Medicaid, or other government funded insurance programs. They are designed for commercially insured patients. And they do not reduce the total cost of the drug to the healthcare system, they shift the patient’s portion of the cost to the manufacturer while the insurance plan continues to pay full price.

For eligible patients they are nonetheless genuinely valuable. Your pharmacist can identify whether a manufacturer program exists for your specific brand name medication and help you enroll.

The Simple Decision Framework

Use this framework every time you fill a prescription:

Step 1: Ask your pharmacist for all three prices. The cash price, the GoodRx or comparable discount card price, and your insurance copay. A good pharmacist will have all three available within about sixty seconds.

Step 2: Consider your deductible situation. If you have a high deductible plan and significant prescription spending, factor in whether

Step 2: Consider your deductible situation. If you have a high deductible plan and significant prescription spending, factor in whether using a discount card instead of insurance will cost you more over the full year by not counting toward your deductible.

Step 3: Check for a manufacturer coupon if the medication is a brand name. Ask your pharmacist whether one exists. If you are commercially insured and a coupon is available, it may reduce your cost to zero.

Step 4: Choose the lowest price that accounts for all of the above. For most generic medications in most situations the answer is GoodRx or the pharmacy cash price. For brand medications the answer is often the manufacturer coupon. For expensive specialty medications with high coinsurance the answer is usually insurance after the deductible is met.

The Most Important Thing to Know

No single pricing option is always right. The correct answer changes by medication, by plan, by time of year, and by your individual health and financial situation. The only way to consistently pay the lowest available price is to ask the question every time, and to fill your prescriptions at a pharmacy where the pharmacist is willing to answer it honestly.

At a chain pharmacy with seventeen people in line, that conversation rarely happens. At Fairview, it is part of every prescription interaction we have.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.