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In the United States, with a given US-based health insurance and for a given prescription drug, is the co-pay the same regardless of where the drug is purchased?

In other words, I have insurance X and want to buy a prescription drug (for which I have a prescription): is the price I'll have to pay guaranteed to be the same in shop A (e.g., CVS) and shop B (e.g., Walgreens)?

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If the pharmacy is in-network, then you will pay what the insurance policy states is the price.

If the pharmacy is not-in-network then you will pay what the pharmacy charges you, and then you will get a partial refund from the insurance company.

For some medicines that have existed for decades the cost is so low that it is cheaper to get it without insurance. For example a few years ago penicillin was only $3 at the pharmacy, even before mentioning that I had insurance, but the cost of a generic prescription was $10.

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The copay will be the same if certain conditions are true.

(1) we are taking about a fixed price copay and not a percentage copay. If it is the latter, then the price you pay will be a function of the retail price of the drug. This less favorable copay is sometimes used when your doctor requests that the prescription be filled with a name brand instead of a generic.

(2) both pharmacies are in network and in the same tier. I believe ExpressScripts has in network and in network preferred with better price at the latter. Also some insurance companies own pharmacies and your plan description will indicate a different co-pay for them.

(3) we are comparing the same prescription. There was a comment on another answer about the mail order pharmacy option that is often offered for 90 day scripts. A 90 day script is different than a 30 day script. There are often bulk discounts associated since you are sent an entire bottle (no need to count out pills).

So in summary if you are considering a 30 day fill at two pharmacies that are both in network at the same tier and three drug is covered with a flat copay, then the copay will be the same at both.

  • Thanks, interesting, I wasn't aware that in-network pharmacies could be in different tier. Good to know about 90-day script vs. 30-day script. – Franck Dernoncourt Jan 28 '17 at 23:25
  • @FranckDernoncourt I believe that is not common. But if there are different copays based on tiers that will be stated in your plan documents and what the difference is, so there should be no surprises – Eric Johnson Jan 29 '17 at 0:55

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