GoodRx, Medicare Part D, and the Truth About Prescription Drug Costs
When it comes to prescription medications, most people are shocked to learn just how inconsistent pricing can be. The truth is, the cost of the same drug can differ dramatically depending on your insurance plan, your pharmacy, and even whether you pay with cash. In fact, I’ve seen cases where paying with a discount coupon through a platform like GoodRx was cheaper than using insurance. That raises an important question: how can you be sure you’re not overpaying?
Understanding the Drug Supply Chain
To answer that, we need to unpack the drug supply chain. Manufacturers create both brand-name and generic medications. Wholesalers buy those drugs in bulk and distribute them to pharmacies and hospitals. Then come pharmacy benefit managers (PBMs) the middlemen who manage insurance claims and decide which drugs are covered under your plan’s formulary. PBMs also negotiate rebates from manufacturers, and those deals can directly affect the price you pay at the counter.
The system is layered, and those layers add costs. That’s why alternative models are gaining traction.
Alternatives to the Traditional System
Platforms like GoodRx partner with PBMs to negotiate lower prices, passing some of those savings to consumers. Even more disruptive is Mark Cuban’s Cost Plus Drug Company, which cuts out PBMs entirely, offering medications directly with a transparent markup and a dispensing fee. For many people, these alternatives can provide meaningful savings—sometimes hundreds of dollars a month.
Medicare and Drug Coverage
If you’re on Medicare, things get even more complicated. Medicare divides coverage into different parts:
- Part A covers inpatient medications.
- Part B covers outpatient medications administered by healthcare professionals.
- Part D is what most people think of when it comes to prescription drug coverage it’s for self-administered medications.
Part D can be included in a Medicare Advantage plan or purchased separately. But here’s the key: if you’re eligible and don’t enroll, you face a lifetime penalty. The penalty is 1% per month based on the national average drug plan premium. That adds up fast.
Why Part D Enrollment Matters
Even if you’re healthy now and don’t take medications, skipping Part D is risky. Some brand-name medications can cost more than $30,000 a month. By 2026, the maximum out-of-pocket cost for Part D will be capped at $2,000, which offers critical protection. Without coverage, a sudden diagnosis could devastate your finances.
Enrollment is only available during the annual period from October 15 to December 7, with coverage starting January 1. If you miss it, you’ll be stuck without drug coverage until the next year.
Recommendations for Choosing a Drug Plan
The smartest approach is to pick a simple Part D plan with low premiums and a decent formulary, even if you don’t take many medications today. Plans can be changed each year during enrollment to adapt to your evolving needs. Think of it as financial insurance coverage you hope not to need, but protection you’ll be grateful for if you do.
Final Thoughts
Prescription drug pricing is complicated by design, but you don’t have to navigate it alone. Whether you’re using GoodRx, exploring Cost Plus Drugs, or choosing a Medicare Part D plan, the goal is the same: protect yourself from surprise costs. The key takeaway? Always have a drug plan in place, compare your options annually, and don’t underestimate how expensive medications can become in retirement.
