Woman’s prescription comes out to $45. Then she asks the pharmacy worker for a discount

Great news, America! Your life-saving prescription costs only $20… As long as you have the right coupon, secret handshake, and possibly a four-leaf clover. A viral TikTok clip is putting the country’s bizarre, borderline game-show healthcare system on full display.

In a clip that’s been viewed more than 247,000 times, online creator Lana (@lananaanaa) shared that her recent trip to the pharmacy was going to come with a $45 payment for the prescription she needed to get filled. Lana showed a bit of consumer savvy by asking if there was a way to lower the cost, and found out the pharmacy had a coupon that dropped prescription costs by more than half, to $20.

“I don't know why America is like this,” she said. Pretty much everyone who heard it probably agreed with her sentiment.

Why are prescription costs so high?

In the United States, prescription costs are notoriously inconsistent due to a tangled system of middlemen, manufacturer discounts, and insurance loopholes.

• Pharmacy Benefit Managers (PBMs): These companies negotiate drug prices between manufacturers, insurers, and pharmacies, often inflating costs by prioritizing expensive drugs that offer higher rebates.
• Manufacturer Coupons: Drug companies use coupons to keep patients on expensive brand-name medications, undercutting insurance rules and ultimately driving up overall healthcare spending.
• Insurance Pricing Gaps: Drug formularies (the lists of covered medications) vary wildly, meaning the same prescription might cost $10 at one pharmacy and $100 at another, depending on the insurer.

Pharmaceutical companies offer coupons to encourage brand loyalty, counteract high copays, and compete with generics. While they save patients money short-term, they also contribute to higher insurance premiums and overall prescription costs.

The American way

The U.S. government has historically been limited in its ability to negotiate drug prices directly with pharmaceutical manufacturers, especially concerning Medicare, the federal health insurance program for seniors. This restriction has often resulted in higher prices for consumers.

Recent legislative changes, such as the Inflation Reduction Act, have begun to address this issue by granting Medicare the authority to negotiate prices for certain high-cost drugs, aiming to reduce expenses for both the program and its beneficiaries. 

The U.S. also employs a market-driven pricing model for pharmaceuticals, allowing drug manufacturers to set prices based on market dynamics without direct government intervention. In contrast, many other countries have regulatory bodies that negotiate or set price ceilings for medications, ensuring more standardized and often lower costs for consumers. ​

Additionally, the U.S. is one of the few countries that permits direct-to-consumer advertising of prescription drugs. This practice can drive demand for specific, often more expensive, medications, influencing both prescribing patterns and consumer behavior. 

Collectively, these factors—limited government negotiation, market-driven pricing, and direct-to-consumer advertising—contribute to the uniquely high prescription drug prices observed in the U.S. compared to other countries.

How to get lower prescription costs

Navigating the labyrinthine world of prescription drug pricing in the U.S. can be daunting. However, several strategies can help you secure more affordable medications:

Shop Around for the Best Prices: Prescription drug prices can vary significantly between pharmacies, even within the same area. For instance, a 2023 analysis revealed that Medicare paid vastly different prices for the same drug across various locations. Discrepancies reached up to $2,500.

Utilize Prescription Discount Programs: Platforms like GoodRx provide coupons and discounts that can substantially lower the cost of medications. These services compare drug prices across pharmacies and offer coupons that can be presented at the pharmacy to receive discounts.

Inquire About Cash Prices: Sometimes, paying out-of-pocket without involving insurance can be cheaper. Pharmacies may offer lower cash prices, especially for generic medications. Always ask the pharmacist if there's a more affordable cash price available.​vox.com

Consider Pill Splitting: Some medications are priced similarly regardless of dosage. For example, a 20 mg pill might cost the same as a 10 mg pill. If your doctor approves, you could request a higher dosage and split the pills, effectively reducing your medication costs.

Explore Patient Assistance Programs: Organizations like SIRUM (Supporting Initiatives to Redistribute Unused Medicine) connect surplus unused medications to patients in need, providing access to affordable or free prescriptions.

No one is a fan of this system

Of course, we’re all pretty long on outrage at the U.S. health care system, and the cost of prescriptions in particular. Two recent Daily Dot articles highlight strategies consumers are employing to reduce prescription medication costs.​

One neat trick involves requesting that prescriptions be processed under a "universal Rx code," which a pharmacy customer found reduced her medication cost from $252 to $51, suggesting that this method can yield greater savings than using GoodRx codes.

We also liked when a creator pointed out that Costco's Kirkland brand, Allerclear, offers 365 tablets for $12, compared to $42 for 115 tablets of Claritin. Ah, the joys of store-brand generics.

Viewers react

Commenters on the clip were quick with disdain for pretty much every component of the U.S. health care system.

“We shouldn’t have to play the coupon game with our health care,” one of the wrote succinctly.

This testimony from a pharmacy worker was revealing. They wrote, “Pharmacy tech here, we're told not to apply discount coupons like GoodRx unless the patient asks for it. They said it's because when you use a coupon you are agreeing to let that company collect and sell your data.”

And how about this one from a dollar-pinched customer. “I once was being charged $70+ for a prescription, used GoodRx, the pharmacist rolled her eyes and huffed about having to put in the codes. And then my prescription was $6," they wrote. "Like what the [expletive].”

The Daily Dot reached out to Lana via direct message.

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