At the pharmacy counter
Cash prices, copays, insurance rules and help paying. 25 articles: 19 explainers, 6 how-to guides.
Cash price & comparison
How to compare pharmacy cash prices for a generic prescription
A 2014 phone survey found one generic antibiotic priced from $5 to $229 in a single county. How to compare cash quotes by phone, and how to read them against NADAC.
How to transfer a prescription to another pharmacy
How pharmacists move a prescription between stores, what the new pharmacy needs, the federal limits on controlled drugs including a 2023 DEA change, and when a transfer will not work.
Specialty pharmacies, limited distribution and how they differ from the drugstore
Specialty pharmacy has no federal definition. What CMS and FDA documents do say, how limited distribution works, what specialty generics cost Medicare, and the 2029 network rule change.
State drug price transparency laws, and what they show
At least 30 states require drug price reporting. What the laws demand, what California's public reports show for generics, and the few rules that put prices in front of shoppers.
A script for talking to your pharmacist about price
Twelve specific questions to ask about the cost of a prescription, why each one helps, which ones belong with your prescriber, and the 2018 federal laws that let pharmacists tell you when cash is cheaper.
How prescription discount cards work
Free discount cards run on negotiated pharmacy rates and per-fill fees. When they can lower a cash price, why the purchase usually sits outside insurance and Medicare's cap, and which federal privacy rules apply.
How to ask for the cash price at the pharmacy
Two 2018 federal laws let pharmacists tell you when paying without insurance costs less. What the laws say, what pharmacies pay for common generics, and the questions that get you both prices.
Mail-order pharmacy basics
How mail-order pharmacies fill and ship prescriptions, the Part D rule that keeps 90-day fills available at retail, what two studies found about temperatures inside shipped packages, and the 2023 transfer rule.
When the cash price beats the copay
For many cheap generics the copay can be more than the drug costs. What a 2018 JAMA study found, what October 2026 NADAC benchmarks show, the two 2018 laws that ended gag clauses, and what to ask.
Why a 90-day fill often costs less than three 30-day fills
For cheap generics the dispensing fee can be most of the bill, and a 90-day fill pays it once. The arithmetic with October 2026 NADAC and Medicaid fee benchmarks, plus plan rules and when a long supply may not fit.
Insurance & plans
Copay accumulators and maximizers, and the rules that govern them
How plans can stop drug coupons from counting toward a deductible, what a 2023 court ruling changed, why generic equivalents matter, and where federal and state rules stand in 2026.
Early refills, vacation overrides and emergency supplies
Drug plans reject refills that come too soon, often until 75 percent of the last fill is used. How those edits work, the vacation and lost-supply overrides, disaster rules and state emergency-supply laws.
How to appeal a drug coverage denial
The steps and deadlines for challenging a denied prescription in Medicare Part D and in private plans, from the first coverage request to independent review, with 2026 and 2027 dollar thresholds.
Medicaid prescription copays and the federal limits on them
Federal rules cap Medicaid drug copays at $4 for preferred drugs and $8 for others, indexed since 2015, with broad exemptions and a 5 percent household cap. A 2025 law adds required copays in 2028.
Preventive drugs that plans must cover with no cost sharing
The ACA requires most private plans to cover task force A and B items, including statins for some adults and HIV PrEP, at $0. The Supreme Court upheld the system in 2025; the panel has since been remade.
What a pharmacy benefit manager does
Three PBMs processed nearly 80 percent of US prescriptions in 2023, FTC staff found. How PBMs run drug benefits, how they are paid, and what a February 2026 law changes from 2028.
High-deductible health plans and generic drugs
The 2026 IRS limits for high-deductible plans, the 2019 notice that lets plans cover some chronic-condition drugs before the deductible, and how cash prices fit in while the deductible is unmet.
Prior authorization and step therapy
What prior authorization and step therapy are, the 2024 CMS rule that set 2026 decision deadlines but excluded drugs, and the Part D and marketplace rules that do cover prescriptions.
Tiered formularies explained
How plans sort drugs into cost tiers, why most generics land on the cheapest one, the federal rules for Medicare Part D tiers in 2026, and how a tiering exception request works.
Medicare Part D changes in 2025, 2026 and 2027
The Part D out-of-pocket cap went from $2,000 in 2025 to $2,100 in 2026 and is set at $2,400 for 2027. How it is indexed, who pays in each phase, where generics fit, and the Extra Help amounts.
Help paying
How the 340B drug pricing program works
The federal program behind $100 billion a year in discounted drug purchases: how the ceiling price is set, who qualifies, the contract pharmacy and rebate fights, and what it means at the counter.
Medicare Extra Help: who qualifies in 2026 and what it costs
The 2026 income and resource limits for Medicare's Low-Income Subsidy, the copays enrollees pay for generics and brands in 2026 and 2027, and how to apply.
The Medicare Prescription Payment Plan, and what its first year of data shows
How Medicare's option to pay Part D drug costs in monthly installments works, worked examples of the billing formula, and GxRadar's tally of CMS's first-year 2025 data.
Patient assistance programs, Extra Help and 340B, compared
Manufacturer programs, state pharmaceutical assistance, Medicare's Extra Help and health centers in the 340B program each help a different group. Current eligibility figures and how the pieces interact.
Using an HSA or FSA for prescriptions
The 2026 HSA and FSA limits, why over-the-counter medicines have qualified without a prescription since 2020, and the account rules that differ from the medical deduction on a tax return.