How to fill prescription without insurance

Whether you’ve lost your job (and the benefits that came with it), or are saddled with a cut-rate plan that doesn’t cover the medications you need, you may find yourself, at some point, having to fill prescriptions without insurance. While prescription prices alone can be high, the cost of medicine without insurance can actually be cheaper almost 25% of the time. What’s more? There are many ways to find even more savings at the pharmacy. 

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Do you need insurance to get a prescription?

Navigating the healthcare system without health insurance can be daunting, but it shouldn’t stop you from seeking medical care. You can see a doctor and get a prescription without insurance—but you’ll need to choose a healthcare provider wisely in order to keep costs down. Community health clinics are a good option for free or low-cost services, with many offering sliding-scale pricing based on your income. Walk-in clinics and urgent-care centers typically allow patients to pay with cash, but their prices can vary widely. On the other hand, telemedicine—consulting with a physician over the phone or through a web portal—is often cheaper than an office visit. A 2017 study published in Health Affairs found that respiratory patients spent an average of $79 for a telehealth visit versus $146 for an office visit (although it also found that the convenience of telehealth may increase overall spending).

The cost of an office visit with insurance versus without is hard to quantify, as many factors— including location and duration of visit—all play a role. A 15-minute office visit for an established patient in Seattle, for instance, ranges between $128 and $398 while the same type of visit for a patient in New York costs between $138 and $430, according to Healthcare Blue Book. Meanwhile, copays for a standard doctor visit typically range between $15 and $25, according to debt.org. 

The same variance goes for prescription medications too. The brand-name drug Lyrica, for instance, ranges in price from $460 to $720 per month without insurance. Prescription copays differ depending on providers, but average copays range from $11 to $105 depending on drug tier, according to a 2018 survey from Kaiser Family Foundation. 

How much do prescription drugs cost without insurance? 

There’s no denying that prescription drug prices continue to rise. Just this year, the retail price of 460 medications increased by an average of 5.2%, according to the healthcare research firm 3 Axis Advisors. On average, Americans spend about $1,200 each year on pharmaceuticals, according to data from the Organisation for Economic Co-Operation and Development. For many uninsured, those rising costs mean they have to choose between taking the medication they need and paying for necessities like rent and food. In fact, a 2016 survey found that 14% of uninsured Americans had either skipped doses or didn’t fill a prescription because of the cost. In short: Drug prices are costing Americans more than just dollars—they’re costing our health, too.

There are many factors at play when it comes to how much a prescription drug costs. On a larger scale, manufacturers claim that the high cost of one drug often helps offset the research and development costs of another. (However, there are many pharmaceutical expenditures that are not accounted for in this explanation.) 

On a smaller scale, and if you have insurance, the costs will be determined by the plan’s formulary (also known as a drug list), which outlines the brand-name and generic drugs covered by your insurance plan. From there, the formulary is usually divided into tiers (based on things like cost, availability, etc.), with a specific out-of-pocket cost assigned to each tier. So the co-pay for a tier 4 drug, for instance, may vary wildly from the co-pay for a tier 1 drug. 

Also affecting your copay is an industry player few Americans have probably ever heard of—it’s called a Pharmacy Benefits Manager (PBM). Essentially a middleman, a PBM works with pharmacies, insurance companies, and drug manufacturers to streamline the supply chain. (Essentially, a PBM helps an insurance company decide which drugs it will cover (i.e., its formulary) and how much they will pay the manufacturer for them.) 

The prices of medications without insurance may be cheaper 25% of the time. But how can that be? In a perfect world, a PBM would want to secure the lowest price for the insurance company, but oftentimes, a drugmaker will throw in a kickback so that the PBM will choose its name-brand product rather than the generic. These kickbacks, termed “clawbacks” in the pharmaceutical field, are largely where your increased copays end up. This is how it works:

• You’re prescribed a drug that was only $30 last year, but your increased copay now dictates it’s $75.
• The pharmacy receives your $75 copayment and you might think they’re getting a decent profit because it only cost them $15 to buy the drug.
• What you don’t know is that $50 of your $75 goes back to the PBM in the form of a “clawback.” 

Instead of paying a $30 copayment and allowing the pharmacy to net $15 after paying for the drug, bringing PBMs into the mix causes prescription prices to artificially rise so they can get their share, too. The worst part of it all? Pharmacists aren’t allowed to tell you about this system, as doing so could threaten their relationships with insurance carriers and PBMs.

Does SingleCare work without insurance?

Whether you have insurance and are facing a large copay or don’t have insurance and are dreading a high out-of-pocket cost, the SingleCare card could be the answer to reducing the total on your receipt.

SingleCare is not a form of insurance, but rather a prescription discount card that’s free for all pharmacy customers in the United States, including those who are uninsured. SingleCare works without insurance, as the discount is applied to the cash value of the prescription. (Read: You won’t be able to use your SingleCare card and your insurance on a single prescription.) 

So how much can you actually save on the price of prescription medications with SingleCare? Quite a bit, actually. For example, in 2019, the average cash price of the ADHD medicine amphetamine-dextroamphetamine was $131.67. The average SingleCare price? Just $47.57. SingleCare card users saw similar savings on the cholesterol-lowering medicine atorvastatin calcium. Without the card the average price was $105.68. With the card: $29.06. 

In addition to the SingleCare card, there are several ways to potentially reduce the price of your prescription:

• Ask your doctor for the generic version: Name-brand drugs are almost always more expensive than generic medications. Going back to the Lyrica example, while the brand-name drug costs $460 to $720 per month, the generic version ranges between $140 and $370 per month.
• Ask your doctor for a different medicine: Is the cash price of another blood pressure medicine significantly lower than the one you’re currently on? Ask your physician if you can make the switch.

Research patient assistance programs: Many drug manufacturers and non-profit organizations offer discount programs for people who can’t afford their prescriptions, which could mean low-cost or even free medications. Eligibility requirements vary, so you’ll need to check with the drug company to see if you qualify.  

Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Has your doctor included refills on your prescription? Check the label. If the label shows a number next to the "refills" section, that's how many times you can get more of your medicine without going back to see your doctor.

There are several ways to refill your prescription:

• In person. Go to the pharmacy where you originally filled your prescription, request a refill, and either wait for it or come back to pick it later.
• By phone. Use the pharmacy's phone number listed on your medicine label to call in your refill. Most large pharmacies or chain stores have automated menus that you can use anytime, day or night (though of course you'll have to wait for store hours to pick up your refill). The voice prompts will lead you through the process. At smaller pharmacies, you might speak to the pharmacist or pharmacy technician directly. You also can download smartphone apps that let you refill your prescription without making a phone call.
• Online. If your pharmacy lets you reorder a prescription online, you may still have to go to the store to pick it up.
• By mail. People who take medicine regularly (such as every day to manage a health condition) can sometimes refill prescriptions by mail. This option is convenient because you can often get your medicine in batches (say, a 3-month supply of allergy pills) if your doctor gives you a prescription for that amount. Ask your doctor about this option. If you want to use the mail-order option, plan ahead because it may take up to 2 weeks to get your medicine.

If your prescriptions are covered by health insurance, be sure to tell the pharmacy if your insurance has changed since you last filled your prescription. If you're not sure about the cost of your medicine or the co-pay, ask so you don't get an unexpected surprise. Some health insurance programs have specific instructions on how and where you can fill your prescriptions.

Use the Label

No matter how you choose to refill a prescription, it will be easier if you have all your prescription information handy. Most of what you need is printed on the label.

The prescription label is usually wrapped around the medicine bottle. In some cases — especially with medicines like eye drops and skin creams — it may be stuck on the outer box instead. Check the box when you first get your prescription so you don't throw it out by mistake.

What if you know your prescription is refillable but you threw the bottle or carton away? You can call or go in person to the pharmacy where you got the prescription filled and ask them to look it up in their database. They may ask for ID or want to see your prescription card before giving you a refill, so make sure you bring your cards with you, just in case.

Here's what to look for on the label:

• Pharmacy phone number. This is the number you'll call to place the refill.
• Prescription number. This number is often shown as "Rx#" on the label. Although a pharmacist can look up your prescription in the computer, the refill process will go a lot faster if you have this number handy as it is the short code for your prescription.
• Refills remaining. The prescription label will tell you how many refills you have left. Most labels show a number of refills with a cutoff date. If you refill your prescription before that date, you should be able to place your order with no problem. However, if the label says something like "Refills require authorization" or if your refills have expired, you'll need to get in touch with the doctor who prescribed the medicine. Sometimes the pharmacy can do that for you, but other times the doctor will want to see you or talk to you before authorizing the pharmacy to refill the prescription.

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Make Sure You Don't Run Out

Probably the trickiest part about refilling a prescription is remembering to check when you're running low. If you wait until you've taken your last pill to place your refill, and for some reason end up having to wait for it, it could be a mere annoyance — or a major ordeal. Missing even one daily dose of some medicines can be dangerous.

On the flip side, if you try to get a jump on things and place a refill weeks in advance, your insurance might not cover it. So keep your eye on the bottle and try to time your refill so the pharmacy has a few days to get things ready for you — especially if they're going to need to contact your doctor.

Talk to the Pharmacist

When you pick up your refill, you'll probably be asked if you have any questions for the pharmacist. This is a good time to go over how you should be taking the medicine — such as whether you should take it with or without food. If you're at all unsure about your medicine, ask to see the pharmacist. Most pharmacies ask you to sign a "waiver" if you don't have questions.

Since you've already been taking the medicine for a while, you might have noticed side effects. For example, does your acne cream leave your face red and irritated? Do you notice headaches after using your prescription eye drops? These are all good things to mention to your pharmacist — especially as people can sometimes notice new side effects even after they've been taking a medicine for many years.

When you pick up your prescription, let your pharmacist know if you've started using any new medicines. Even over-the-counter medicines (like cold medicines) or herbal supplements can sometimes affect how well prescriptions work or interact with prescription medicines to cause health problems.

If the pharmacy seems busy or you don't want to ask about something personal (like birth control) in front of other people, call and ask to speak to the pharmacist after you leave. Mention that you just refilled your prescription and have questions. No matter how busy they are, pharmacists are eager to help — it's their job to make sure people take their medicines safely and effectively.