How to compare pharmacy cash prices for a generic prescription

In July and August 2014, research assistants telephoned 528 pharmacies in Los Angeles County and asked a simple question on behalf of a hypothetical uninsured patient: what is the cash price for seven 500 mg tablets of generic levofloxacin, and for six 250 mg tablets of generic azithromycin? The answers, published in 2017 in The American Journal of Managed Care¹, were all over the map. In higher-income ZIP codes the levofloxacin quote ran from $5 to $229, with a median of $80. In lower-income ZIP codes the median was $26, with quotes from $4 to $149.

Shopping within a single ZIP code paid off too. The study found¹ that a customer calling a random pharmacy and then the cheapest one in the same ZIP code would have saved an average of $52 on the levofloxacin and $17 on the azithromycin. Pharmacies, meanwhile, were paying about $3.38 for six azithromycin tablets that August, according to GxRadar's monthly figures drawn from CMS's 2014 National Average Drug Acquisition Cost files³.

Nothing about the basic problem has changed since then. Cash prices for generics are set pharmacy by pharmacy, few are posted, and the only way to compare them is to ask. The federal benchmark of what pharmacies themselves pay makes the answers easier to judge. Our pieces on asking for the cash price and on why the same generic costs different amounts cover the background.

Start with what the pharmacy pays

Before calling anyone, it helps to know the floor. CMS surveys retail community pharmacies every month about what they paid to buy drugs and publishes the result as NADAC, which it updates weekly⁴. NADAC covers ingredient cost only. It leaves out the pharmacist's time, rent and the dispensing fee, so no pharmacy should be expected to sell at NADAC. What it gives a shopper is a sense of scale. A $25 quote on a drug that costs the pharmacy 50 cents tells you something different from a $25 quote on a drug that costs the pharmacy $20.

Since December 2024, CMS has calculated generic NADAC rates as a three-month moving average⁴ to damp swings caused by changes in how many pharmacies answer its survey, and the agency says the method will continue until further notice. For a shopper, that makes the generic figure a slightly lagging but steadier reference point.

Our table uses GxRadar's October 2026 monthly figures from the 2026 NADAC files on data.medicaid.gov². Each drug links to its full price history on GxRadar, and the prices page has a live NADAC lookup for other products.

GxRadar did the multiplication. Thirty or 90 units is a convenient yardstick, and the count on a real prescription depends on how the prescriber wrote it.

Making the calls

The Los Angeles researchers made the same request of every pharmacy, and the approach is worth copying. Each call named the same drug, strength, form and quantity, which is what makes the quotes comparable. The details are on the prescription label or the bottle; our guide to reading a prescription label shows where each one sits. The GxRadar pharmacy finder lists pharmacies registered in the federal NPI registry by ZIP code from the federal NPI registry, which makes a call list quick to build.

A short set of questions covers most of what matters:

• "What is your cash price, without insurance, for [drug, strength, form], quantity [number]?"
• "Is that your regular price, or does it include a discount program? If it is a discount, what do I need to sign up or show?"
• "Would the price be different for a 90-day quantity?"
• "Will that price hold for refills, or can it change?"
• "Is there anything added at the register, such as a fee?"

Write each answer down with the date and the name of the pharmacy. The researchers in Los Angeles also asked, once a price was given, whether any discount could lower it, and they recorded both figures. Prices change, and a quote from last month is a weaker guide than one from this week. The pharmacy's regular cash price is often called the usual and customary price, and many insurance contracts refer to it, so it is a reasonable number to ask for by name.

Moving a prescription from one pharmacy to another is routine. If the cheaper option turns out to be a different strength, a different formulation, or a different number of daily doses, that is a question for the pharmacist or prescriber before anything changes.

Where insurance fits

People with drug coverage can comparison shop as well. Two laws signed on Oct. 10, 2018, made it easier. The Patient Right to Know Drug Prices Act⁵ bars group health plans, insurers and the pharmacy benefit managers working for them from restricting a pharmacy from telling an enrollee that the cash price is lower than their out-of-pocket cost under the plan. The Know the Lowest Price Act of 2018⁶ applies the same rule to Medicare drug plans for plan years beginning on or after Jan. 1, 2020. Neither law requires the pharmacist to volunteer the comparison. You have to ask for both numbers.

Most Medicare enrollees already pay little for generics. HHS's planning office found that in 2022⁸, 70.5 percent of 30-day-equivalent generic fills in Part D cost enrollees $2 or less. The same analysis⁸ counted more than 6 million enrollees who filled at least one generic prescription for over $20. That second group is where a phone call is most likely to pay.

Commercial plans also publish more cost data than they used to. Under the federal Transparency in Coverage rules, most group health plans and insurers began posting pricing information for covered items and services on July 1, 2022, and CMS says the final stage took effect on Jan. 1, 2024⁷. It is reasonable to ask the plan for its expected cost for the drug at each pharmacy on your list. Two more questions for the plan are worth asking before paying cash: whether a cash purchase will count toward the deductible, and whether a lower price is available at a different in-network or mail-order pharmacy. Our explainers on cash prices versus copays and discount cards go further into those trade-offs.

Reading the quotes against the benchmark

Once three or four quotes are in hand, set them beside the NADAC figure. A quote that is a few dollars above the ingredient cost reflects the pharmacy's fee and margin on a cheap pill. A quote many times the ingredient cost is where calling around tends to pay. In the 2014 survey, the azithromycin that cost pharmacies about $3.38 at the August NADAC rate drew an average gap of $17 between a random pharmacy and the cheapest in the same ZIP code, the authors reported¹. Our explainer on NADAC covers what the benchmark measures and what it leaves out.

CMS posts a new monthly NADAC file on the first Monday on or after the 15th of each month, with weekly updates in between, according to its pharmacy pricing page⁴, last updated Oct. 28, 2026. The agency has said it plans to ask for stakeholder input on a longer-term fix for the rate volatility that prompted the moving average. Until then, the generic figures in the table above will keep moving in three-month steps.