Why do Rx prices change?

It can be a shock when the medications you take each month suddenly get more expensive.

And we’re not talking about a couple of extra bucks here and there. Branded medication list prices (suggested retail prices) increased by nearly 160% from 2007 to 2018. That’s according to a 2020 study published in JAMA.

So why do prescription medication prices change so much? We’ll walk you through what goes into pricing and help you find the best deal for your medications.

Why medication prices change

Several factors affect how medication prices are calculated, according to Amber Turrentine, PharmD. She’s the associate director of business performance for the Optum Store. Some of these reasons include:

• What it costs the pharmacy to buy the medication from manufacturers or distributors
• How much of the medication cost is covered by health insurance
• The cost of packaging the medication
• The cost to ship the medication

Typically, pharmacies evaluate these expenses once a quarter.

Sometimes the costs go up. For example, drug manufacturers might encounter a shortage of supplies or workers they need to create a medication. Any shortage will limit how much medication they’re able to make. When fewer medications become available, the cost increases.

Other factors that affect the cost of a medication include:

• Whether a medication is branded or generic (branded medications cost more)
• How long the medication has been on the market (new medications cost more)
• The number of similar medications available from other manufacturers
• What a manufacturer spends to market its product

All of these factors affect how much it costs the pharmacy to keep a medication on the shelves.

Some pharmacies charge consumers more or less for medications every quarter to account for these fluctuating costs.

Other pharmacies limit how often they change their prices. With pharmacy services through the Optum Store, for example, prices change only once a year, says Turrentine.

The Optum Store can help you get the best prices on your medication — and we’ll deliver it right to your door. Find out more.

How to get the best price for your medications

You’ll have to do some research to find the best deal for your medications. Here are a few tips to get you started:

• Price shop. Many health plans offer tools to compare medication costs at various pharmacies, including retail and online pharmacies, Turrentine says. Call your insurance provider or check online to see if your health insurance company provides these price estimates.
   
• Buy in bulk. Another way to save is to buy more of a medication at once — if your health insurance allows it. “Some insurance plans allow members to fill a 90-day supply of medication at a lower price than filling a 30-day supply 3 times,” Turrentine says.
   
• Find coupons for specific medications. Some websites offer discounts and coupons for many prescription medications. Optum Perks is a free service you can use to save money. Simply search for your medication and Optum Perks will gather current prices and discounts to help you find the lowest-cost pharmacy.
   
• Print out a pharmacy discount card. Optum Perks also offers a free pharmacy discount card you can present to your pharmacist for automatic discounts on most medications.
   
• Get your medications delivered. Sometimes it’s cheaper to have your prescription medications mailed to you. You can get discounted medication shipped straight to your door through the Optum Store.

What does it mean to buy medications “off benefit”?

You may come across the term “off benefit” when shopping for medications. If you buy a medication off benefit, it means you pay the price determined by the pharmacy without any contribution from your insurance company.

Buying a medication “on benefit,” on the other hand, involves a pharmacy submitting a claim to your prescription medication insurance plan. “The insurance pays a portion of the cost of the prescription, and the consumer is typically responsible for a copay,” Turrentine explains.

You might assume that you’ll get a better price if you buy your medication using your insurance benefits. But that’s not always the case. Sometimes it can be cheaper to pay for a prescription medication without using insurance.

Why? Pharmacies are sometimes able to negotiate with drug manufacturers to secure a better price for consumers. Thankfully, most pharmacies let you compare the cost of buying with or without insurance. This way you can choose the option that’s cheapest.

You buy everything else online. Why not your medicine?

Compare our prices. You might be surprised by how much you can save by transferring to the Optum Store.

Learn more

Additional source
Study on fluctuating medication prices: JAMA (2020). “Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018”