By Patricia Prewitt
My Personal Rx Adviser
No question, understanding prescription costs can be very confusing. Often, people may be confused about their actual out-of-pocket costs. Most of us simply want to be reassured that we are not drastically over-paying. Much like the Explanation of Benefits (EOBs) for medical care
covered amounts, what a consumer pays varies dramatically based on the type of prescription plan.
As a consumer education advocate, I recommend everyone start with a basic list of their prescriptions. Review exactly what is being paid at the retail or mail order pharmacy.
Bring the Rx list to your appointments to make sure all medications are still needed to address current health needs.
Here are my suggestions to find and review out-of-pocket Rx costs:
- Ask the pharmacy to run a report of the current medications list for 2024. This may be called a medical expenses summary to verify the medications dispensed and the price paid.
- The “retail cost” on a prescription receipt is not typically what a consumer pays. Carefully review the dollar amount that was paid. The patient cost calculated after the prescription plan has covered its contracted amount. Often, I need to remind a loved one that their monthly out-of-pocket cost is $15, not the $752 retail cost that also appears on the receipt.
- The “days supply” number is an important measure of an out-of-pocket costs review.
Typically, a prescription is written for one month (30 days) or three months (90 days). Basic math is required to find the monthly cost of a 90-day prescription. If a medication is $10 for 90 days, this calculates to about $3.34 a month. Realistically, it is hard to think of anything in a personal monthly budget that provides better value. - Often, multiple medications are being picked up at one time. This makes the bill for prescriptions easy to complain about. “My bill at the pharmacy was over $100.” Check the receipt. Was the bill for six medications, all of which were for a 90-day supply? Estimating a monthly cost for each prescription, the average is about $5.50 a month: $5.50 x 6 medications = $33 a month x 3 months (90-day supply) = $99.
Did you also pay for vitamins, supplements, ibuprofen, or other items on this receipt? Those costs would not be a part of your out-of-pocket prescription costs. - Have some perspective. A gallon of gas or a gallon of milk runs about $3.50. Do these items last one month?
Clearly, this is a simplistic view of a complicated topic. Yet FDA.gov reports that nine out of 10 medications in the U.S. are filled with generically available medications, providing great value to many people in managing prescription costs.
Content provided is for educational purposes only, and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.
About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James
