What pharmacies pay for a month of common generics

In January 2014, retail pharmacies paid an average of $11.79 for 30 tablets of extended-release metoprolol succinate 50 mg, according to the federal government's weekly drug cost survey. In October 2026 the same 30 tablets cost them $1.51.

That drop was the largest among the 10 most widely used generics GxRadar tracks, but it was not unusual. Thirty tablets or capsules of each of the 10 together cost pharmacies $35.70 at January 2014 prices and $8.80 at October 2026 prices, a 75 percent decline, according to our analysis of CMS's National Average Drug Acquisition Cost (NADAC) files¹.

Those figures are the pharmacy's cost for the medicine itself, before anyone is paid for filling the prescription. They are not what a patient pays at the counter, and for most of these drugs they are now the smallest part of the bill.

Picking the 10

To rank the drugs we used CMS's Medicare Part D Spending by Drug⁴ data for 2024, the latest year published, and summed claims for each molecule across all strengths and versions. Atorvastatin led with 73.4 million Part D claims. Rosuvastatin ranked ninth but was left out because our generic price series for it starts in July 2016, so it has no 2014 figure; pantoprazole, 11th, took its place.

For each molecule we priced the single strength and form on its GxRadar drug page. Thirty units is a common one-a-day month. Many of these drugs are often prescribed in other strengths or more than once a day, which changes the totals.

The 30-day cost, 2014 and 2026

Sources: CMS Medicare Part D Spending by Drug (2024 claims, all strengths and versions of each molecule); GxRadar analysis of CMS NADAC weekly files, generic rates only. Each 30-unit cost is 30 times the month's median weekly NADAC per unit. Rounded to the cent.

The drugs that fell most were the ones that were still relatively expensive in 2014. Metoprolol succinate, atorvastatin and levothyroxine each lost more than four-fifths of their acquisition cost. Levothyroxine went up before it came down, with 30 tablets costing $11.51 at the February 2015 peak, according to the same files.

Lisinopril and metformin barely moved because there was little left to lose. Both cost about two cents a tablet in the January 2014 file² and a little less than that now.

Losartan took a detour. Its NADAC rose from 3.3 cents a tablet in December 2018 to 12.3 cents in September 2020, about $3.70 for 30, after a run of recalls of losartan lots containing nitrosamine impurities⁸ that FDA logged from November 2018 through 2019. It has since fallen back to about three cents. The story of its chemical cousin is in our piece on the valsartan recall and prices.

Competition explains most of the long decline. In a December 2019 analysis⁷, FDA economists found that with six or more generic makers, prices were more than 95 percent below the brand's price before generics arrived. CMS's 2024 Part D data list 30 manufacturers for generic atorvastatin and 40 for gabapentin.

What sits on top of the ingredient cost

Pharmacies are not reimbursed at NADAC alone. Most state Medicaid programs pay an ingredient cost tied to NADAC plus a professional dispensing fee, according to CMS's state-by-state reimbursement table for the quarter ending September 2026⁶. In that table the fee was $10.64 in Alabama, $10.24 in Florida, $10.92 in New Jersey, $10.18 in New York and $10.00 in Pennsylvania.

Set against October 2026 costs, New Jersey's fee is about 13 times the $0.85 a pharmacy paid for 30 atorvastatin tablets. For a month of any drug in the table, the fee is several times the ingredient cost.

Medicare spending shows the same pattern. The table below lists 2024 average gross spending per Part D claim for the generic version of each molecule. CMS says in its methodology for the dataset⁵ that gross drug cost includes ingredient cost, dispensing fees and sales tax, counts both plan and beneficiary payments, and does not reflect manufacturer rebates.

Source: CMS Medicare Part D Spending by Drug⁴, 2024 data, generic-name rows. A Part D claim can cover a 30-day or 90-day supply, so these figures are not directly comparable with the 30-unit costs above.

What any one patient pays depends on insurance design, deductibles and the pharmacy's own price list, none of which NADAC captures. Our explainers on how pharmacies get paid, on when the cash price beats the copay and on why the same generic costs different amounts cover that ground, and our script for talking to your pharmacist lists questions people commonly ask about price.

How the numbers were built, and their limits

NADAC is a national average of invoice prices reported by chain and independent retail community pharmacies in a voluntary monthly survey, as described in CMS's December 2024 methodology³. CMS says discounts and rebates that do not appear on the invoice line are left out, so a pharmacy's true net cost can be lower. Individual pharmacies may also pay more or less than the average.

For each drug we took the generic-classified rows in each weekly file, averaged them by week and used the month's median weekly value. Generic NADACs swung sharply from month to month during 2024; CMS's methodology says it began smoothing generic rates with a three-month moving average in December 2024. The October 2026 figures above are on that smoothed basis. How the swings show up across our whole basket is covered in the GxRadar generic price index.

Brand versions of these molecules carry far higher NADACs, which we compare in the brand-generic NADAC gap. Current per-unit figures for all 47 tracked generics are on the prices page, updated as CMS posts each weekly file to data.medicaid.gov¹.