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Understanding Prescription Prices: How Insurance Isn’t Always the Best Price

“Why do my prescriptions cost so much?”, “Why do my copays change so frequently?”, and “How are the prices of my medication determined?” are all commonly asked questions by patients at the pharmacy. When you go into your pharmacy and ask these questions, most of the time pharmacy staff will respond with an answer involving your insurance or telling you to give them a call to inquire about these questions you continue to have.

In the United States, the prices of medications are not directly regulated or negotiated, pharmacies can set their own prices. When it comes to these corporations deciding how much their medications will cost, there is a series of steps they must take and people they need to communicate with to ensure that they make a sizable profit. When it comes to creating copays they work hand in hand with Pharmacy Benefit Managers, also known as PBMs.

How are the prices of medications determined? The average wholesale price (AWP) is decided individually by retail pharmacies which is why you may see different prices for the same prescription drug at different corporations. AWP is the retail listed price for the drugs sold by pharmacies. It typically has a 20 percent mark-up from the wholesale acquisition (WAC) price given by the manufacturers of the drugs. AWPs can vary based on a multitude of factors including, but not limited to, manufacturer, active ingredients, dosage form, strength, and package size. Throughout the years, there has been an average inflation rate on drug prices at an 8.5 percent increase. Between July 2021 and July 2022 for over one thousand different medications, the average inflation within big retail pharmacy chains was 31.6 percent! Luckily, the Inflation Reduction Act implemented a new requirement for manufacturers to pay rebates to Medicare for Part D drugs whose price increases exceeded inflation to reduce the frequency and size of increased prices. Tragically, this still doesn’t provide affordable health care services or products for the public.

Unfortunately, with insurance and big retail pharmacy chains, the discussion of your out-of-pocket cost does not end there. PBMs are third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. Pharmacy Benefit Managers help control drug costs, public access to medications, and how much payment pharmacies can receive. They also process and pay prescription drug claims and hold the responsibility of creating and updating your health insurance plan’s drug formulary, which is the list of medications that a particular health insurance plan will cover.

At Sonoran Drugs, we strive to provide excellent pricing for all our customers. Although we do not bill coupon cards or insurance companies, we offer competitive cash prices on prescriptions. We work hard to keep costs low, and do not let middlemen such as Pharmacy Benefit Managers (PBMs) mark up our prices by avoiding the use of insurance. Our patients can be confident that they are receiving the best price possible when they fill prescriptions with us, along with the reassurance that our prices do not and will not fluctuate with such drastic measures. At Sonoran Drugs, we believe that it should not be expensive to maintain your health and take care of yourself. We still have better prices in comparison to big retail chain pharmacy’s standard coupons on the GoodRx website. These prices for these commonly prescribed medications on GoodRx were gathered on 08/24/23 (their prices also fluctuate by the day and never stay stagnant). See charts below for comparison (and this is just showing a few examples, if only we could list every medication in comparison):

Insurance is a wonderful resource to utilize and can be of use in various situations. This regrettably does not eliminate the chance of higher copays that patients must endure from time to time. At Sonoran Drugs, we have no intention in tricking people, we just want to ensure that patients are receiving high quality products at an affordable rate. Not only do we have amazing cash prices on maintenance medications, but we have nominal costs for compounded medications as well. Sonoran Drugs can compound for various specialties including, but not limited to, podiatry, dermatology, weight loss, oncology, dentistry, and sexual health. For your convenience, we offer a free mail-order service to all patients.

If you would like to speak directly with a member of our staff, we would be happy to help answer any questions or concerns you may have. Sonoran Drugs will always be transparent about if we are the most cost-efficient route for your healthcare needs. Our operating hours are Monday through Friday from 9am to 5pm. We can be reached by phone call at (623)583-2045, through our social media platforms, and even through email at

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