Paying Cash For Medication
Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- paying cash for medication. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.
In this blog post, we want to educate our patients and any prospective patients about paying cash for medication.
Increases in Prescription Drug Prices
Prices for more than 1,200 prescription drugs rose faster than inflation between July 2021 to July 2022, according to a recent report from the department of Health and Human Services. Prescription drugs prices increased 31.6%, exceeding the inflation rate of 8.5%. Another report for the department of Health and Human Services states that in 2018 US prescription drug prices were 2.5 times those in 32 comparable countries, and 1.9 times as high when rebates and other discounts are taken into account.
The retail price of a drug at the counter is determined by negotiations between pharmacies and insurers (more likely their pharmacy benefit managers, or PBMs- read more what these are here), and reflects various markups. What you pay depends on whether you have insurance and if met your plan’s annual deductible. If you have no insurance you are paying the ‘usual and customary price (U&C),’ namely the prescription price a pharmacy charges a cash-paying customer.
How high and widely variable are medication costs you ask? One study in the American Journal of Managed Care found a common antibiotic (levofloxacin) ranged in price from as low as $4 to as high as $229. So, yes- there is a cost transparency problem with generic medications. In other words, big pharma and chain pharmacies are really sticking it to the American consumer.
GoodRx
GoodRx, established in 2011, was among the first well known companies to offer people a chance for lower prescription medication. The GoodRx business model depends on pharmacies charging the U&C price as described above.
Though, in order to lower prescription costs and offer transparency, GoodRx partners with the bad guys: PBMs. Essentially, GoodRx is a tech version of a PBM that provides patients a convenient and user-friendly interface for finding these prescription PBM rates.
Why wouldn’t your neighborhood pharmacy tell you about GoodRx every time you went to pick up a prescription? That is because the PBMs collect per-prescription fees from the pharmacy whenever the patient uses the discount program. GoodRx then gets a cut of that fee because they directed the patient to that pharmacy. You can see that pharmacies actually lose money from cash paying patients who would have paid more than what they would have received from the PBM.
Still, if your insurance doesn’t cover a medication near 100% or your doctor does not do medication dispensing, GoodRx is a better option than nothing. For people looking for a tutorial on GoodRx, please see this video I uploaded to YouTube.
Paying Cash for Medication
Direct Primary Care (DPC) clinics are another great avenue for prescription drug savings. In contrast to GoodRx, DPC clinics utilize modern medicine but with an old school approach to healthcare, a direct relationship between our patients and the physicians. That said, the vast majority of DPC clinics are independently owned / non corporate facilities.
The beauty in this continuity is that DPC patients can be seen AND treated with a transparent, no-hassle price all within the same visit, eliminating higher cost middlemen out there.
DPC clinics purchase their medications from wholesalers like any other chain pharmacy, but instead of marking up the medications like those chain pharmacies, DPC clinics sell the medication to their patients at a fraction of those costs. Compare the costs at “Relief for Prescription Drug Prices.”
Advantages of patients at DPC clinics paying cash for their medications allows them to save time by eliminating unnecessary trips to a pharmacy, getting the lowest cash price- every time, and ability to get extended amounts of medication at a time, covering you sometimes six months to one year. Additionally, the physicians at DPC clinics are great resources towards obtaining other affordable services such as cash-pay colonoscopies, heart stress tests, or even non-emergent surgeries.
Beyond Primary Care is DPC clinic located in Ann Arbor, Michigan and cares for patients all throughout Washtenaw County, Wayne County, and Livingston County. Click here to join us in saving money on your healthcare.
Thank you for reading
To make an appointment with Dr. Jeff O’Boyle please see our scheduling link.
Dr. Jeff O’Boyle with Beyond Primary Care
