Difference can be hundreds of dollars

The formularies of Prescription Drug Plans show if, and how, the plan covers medications. A report by the Kaiser Family Foundation shows how the costs of on-formulary drugs differ between plans.

Of those listed, most generics’ highest cost will be $10, with the median cost hovering around $3-$5 dollars. Atorvastatin spans $0 to $20. Hydrocodone can cost up to $78- double the median cost of $36. Half of these drugs treat hypertension and high cholesterol.


This image is from the Kaiser Family Foundation.

The fluctuation in pricing is more severe with brand drugs. This list includes drugs that treat diabetes, asthma and other conditions. The highest cost of 60% of the top 10 brands is over $100. In the case of Spiriva, the highest cost is over ten times the lowest cost.

How is there such a difference?
The most important questions when looking at drug costs are:
  • Which tier is the drug in? 
  • What’s the cost to the customer per tier? 
  • Is the cost in copays (a flat cost for all drugs in a tier) or coinsurance (a percentage of the drug cost)?
These can make a big difference in the cost to the beneficiary.
This image is from the Kaiser Family Foundation.
What if it’s not on the formulary?
Then costs are even higher. If your drugs aren’t covered, there are alternatives: using websites that compare drug prices and looking into Canadian pharmacies.
This image is from the Kaiser Family Foundation.
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