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When you are shopping for prescriptions, it pays to be smart. Here are some insider tips about buying one very common prescription, birth control pills, with hints that can also be applied to buying other medications.

First things first: Are you insured or uninsured?

birth control

If you’re uninsured, you’ve got company — there are about 50 million uninsured people in the U.S. today. Uninsured people are looking for cash or self-pay prices, and those prices can vary widely.

Insured people are supposed to have free birth control pills under the Affordable Care Act, right? Maybe not. I just re-did my insurance, and one of the choices was a high-deductible plan without drugs. So the contract specifically excluded prescriptions. There are other exclusions: If a plan is grandfathered, for example, or if it falls under the exclusion for churches or houses of worship, or nonprofit organizations with a religious objection to supplying birth control. Some insurance plans don’t have to come into compliance with the law until Jan. 1, 2014.

Also, some people may be buying birth control pills without using insurance: for example, someone who doesn’t want to tell her parents that she wants birth control pills.

How Much Do Birth Control Pills Cost?

We did a survey of cash or self-pay birth control prices at New York area pharmacies in late April, in connection with a project about prices of birth control pills and mammograms, and here’s what we found:

  • Aviane, cash prices ranging from $20 to $45 for a monthly pack
  • Gianvi, $45 to $74
  • Loestrin 24FE, $48 to $116
  • Lutera, $19 to $40
  • Ocella, $40 to $80
  • Ortho-Tri-Cyclen Lo 28, $37 to $162
  • Tri-Nessa 28, $16 to $49
  • Tri-Sprintec 28, $12 to $49
  • Yasmin-28, $80 to $105
  • Yaz-28, $65 to $130

Meanwhile, Tri-Sprintec is available for $9 for a monthly pack on Walmart’s generic drug program as well as on Target’s generic drug program. (They weren’t in our survey group.)

OK, so what’s going on here? Well, it’s the free market. For cash prices, pharmacies can charge whatever they want. That’s what our healthcare system is based on: the free market.

Tips for Buying Birth Control Pills (and Other Meds)

If you’re buying birth control pills, here are five things to know.

1. Think about buying generic.

Just don’t make the mistake of thinking that all generics are the same price and are always cheaper. Yes, generics are typically cheaper than brand-name drugs, but they vary widely in price. Remember: Tri-Sprintec in the New York area can be had for $9 or $49 for a monthly pack.

2. Ask about using your insurance coverage.

But don’t assume it’s automatically cheaper because you’re using your insurance. Those $9 prices at Walmart and Target are lower than what you’ll pay with the combination of your insurance premium and the co-pay. We hear a lot from people who buy generic blood-pressure medication for pennies at Shop-Rite and other medications for $4 a month under the big-box stores’ generic plans. One man found he saved $25.90 by not using his insurance. A doctor we know in California, David Belk, has written extensively on this, and always recommends that his patients check Costco, Walmart and the big-box stores first —preferably in a phone call, and not on the website, because websites can be out of date.

3. Use online resources.

But don’t assume that because the site’s search engine tells you it’s the cheapest price they know of, it’s the cheapest price you can find. Here are some of those sites: goodrx.com, werx.org and coupondoc.com (there’s also needymeds.org, for patients needing financial assistance). Be aware that these sites may make money when you redeem their coupon, and so the price to you (and the coupon information) may change depending on their relationship with the manufacturer or pharmacy.

Also, many states have laws mandating that pharmacies must have a printed list of their common medications, with prices, available for shoppers. Some states also have an online search tool, but these tend to vary widely in efficacy; according to the Center for Studying Health System Change, which catalogs several state programs. “Every pharmacy that sells drugs at retail must make Drug Retail Price Lists available” for the top 150 sellers, according to one example, the New York State pharmacy regulation website. The best thing to do, though, is to ask the store directly.

4. Ask for the price every time (whether you’re insured or uninsured).

Prices from manufacturers or distributors to pharmacies can change. Medications go off patent, and pharmacy pricing – both chain and independent store – for retail changes, too. Insurance coverage also changes: Insurance plans have a list of approved or covered medications, called a formulary, which makes preferred drugs less expensive and non-preferred drugs more expensive.

If you could take Generic Drug A and Brand Drug B both, the formulary might impose higher charges on the Brand Drug, encouraging you to switch to generics — or to one generic over another. The formularies can change, meaning that the drug that was covered last month may not be this month. If that happens to you, you might have several choices: ask your doctor for a generic, pay the extra or seek another source. It’s complicated, and annoying. Mail-order services offered by insurance plans may give you a price break (but force you to sign up for a mail-order refill plan), or you might find a club card at your pharmacy that offers a lower price.

5. Look at the big-box prices, but don’t forget the small independents.

We found very low prices at both kinds of store.

Birth control pills can be confusing, so be sure also that you know exactly what medication is being prescribed.

You can take these lessons and expand them to other prescriptions, too. The common cholesterol medication Lipitor, for example, which has gone off patent and is available as a generic called Atorvastatin, as well as other common drugs.

Why do prices vary so much? Well, pharmacies can charge whatever they want, and they’re familiar with consumer buying patterns. So even when a brand drug becomes generic, and therefore cheaper for the pharmacy to buy, the high price often sticks around. Dr. Leslie Ramirez, a Chicago M.D. who runs a price comparison site, has made an in-depth study of drug pricing. She writes on her blog: “Patients are used to paying a high price for branded medications, and pharmacies know this. So when a new generic becomes available, many pharmacies discount the medication, but only by a small fraction as little as 10- 15%. However, the patient buying the prescription sees the new generic medication is somewhat cheaper and appreciates paying a little less for it.”

In late March, Ramirez found the generic version of Lipitor for $17 at a Chicago area Costco, and $153 at Walgreens.

Getting Around the System

Increasingly, we have been hearing people say they buy their birth control prescriptions overseas on vacation – in Ankara, in Bangkok, in Cape Town, in Hong Kong. People in southern Texas tell us they are in the habit of buying in Mexico when they can.

The National Association of Board of Pharmacy gives approval (known as VIPPS, or verified Internet pharmacy practice sites) to online drug sellers that meet its standards. It keeps an online list of approved pharmacies. The online pharmacy world in general is a place full of bad behavior, as this recent news release from the FDA on a crackdown points out, so you should be careful if you’re thinking of going this route.

Bottom line: be a savvy consumer for birth control pills, just as you would be for a flat-screen TV or a tomato – or a procedure like an MRI. You thought the prices were somehow regulated? Nope. You thought the health-care marketplace acts like other marketplaces, as in, for instance, you choose to buy a $2 tomato instead of an identical $20 tomato? Nope. There’s very little pricing transparency, and increasingly, it’s up to the consumer to know what stuff costs in healthcare.

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