Health
Questions worth asking about a prescription's cost
The price of the same medication varies by pharmacy, by payment route and by whether anybody asked. Four questions cover most of it.
The first is whether a generic or a therapeutically similar alternative exists. That question belongs with the prescriber, who can say whether a substitution is clinically appropriate — which is not something a pharmacy or a website can decide.
The second is what the plan's formulary says. Plans sort medications into tiers with different costs, and the same drug can sit in different tiers in different plans. Formularies are published, and a prescriber can often request an exception where there is a clinical reason.
The third is whether the cash price is lower than the insured price. It sometimes is, particularly for inexpensive generics, and pharmacies are now permitted to tell you so. Prices also differ between pharmacies in the same town by more than most people assume.
The fourth is whether a patient assistance programme exists. Many manufacturers run them, and non-profit foundations run others. They have application processes and conditions, and nothing here can say what any particular person will receive.
What to do next. Ask the prescriber about alternatives, and ask the pharmacy whether the cash price is lower than the insured price.
studentaid.gov outranks this page. Rules, figures and dates change
between academic years. This is written to help you read the official sources, not to
stand in front of them. Start there.
Nothing here is a determination. We cannot tell you what you qualify
for, and no website can. The programme and the office that runs it decide that, after
you apply.
Still have a question?
Describe what you are trying to work out and a member of the team will answer, or direct you to the office that makes the decision.