Navigating the American healthcare system can be overwhelming, and navigating it without insurance can feel like a nightmare.
There are many reasons why a person may find themselves without health insurance, whether due to the rising costs of coverage or unexpected unemployment.
If you’re one of the approximately 8.5% of Americans without insurance, getting the medical care you need can be challenging, but it doesn’t mean you have to go without it.
More than 131 million Americans use prescription drugs to help them live their everyday lives, and many do not have health insurance to help cover the costs.
In this article, I’ll explain how prescription drugs are priced for those without insurance, whether you need insurance to acquire a prescription, why certain drugs can actually cost less for the uninsured, and how K Health can help you get the prescriptions you need, whether you have insurance or not.
How Much Do Prescription Drugs Cost Without Insurance?
The cost of prescription drugs varies widely depending on what they are and how you get them.
Prescriptions tend to cost more for the uninsured, as pharmacies will typically charge them what’s called a “Usual and Customary Price”—a cash price assigned to a drug by the pharmacy—which is often higher than the price negotiated for an insurance holder.
When pricing drugs, manufacturers explain that they take both the cost and time needed to create the drug into consideration.
They also claim that high costs on some drugs will help pay for research and development costs for other, upcoming drugs.
The price they charge the pharmacy for the drug in turn impacts how much you, as the patient, will have to pay for it.
Americans, both insured and uninsured, spend more money on generic drugs and brand-name drugs than any other country in the world, with most citizens paying $1,376 per year, on average.
And this isn’t because Americans are sicker, or take more medications than people in other countries—it’s because drugs are priced higher in the United States.
Unlike other countries, the U.S. government does not regulate drug prices, meaning that pharmaceutical companies have relatively free reign to price their medication however they choose.
New drugs typically have a five- to seven-year period of exclusivity after they’re approved by the Food and Drug Administration (FDA), during which the drug company is the exclusive manufacturer and seller.
This is typically the time when the medication is most expensive, before less-costly generics can be made.
This can have real-life implications: A study published in 2019 found that one in five Americans reported not being able to pay for needed drugs.
But don’t panic. There are plenty of options available for getting your prescription at a lower cost.
Is Insurance Needed To Get A Prescription?
While prescription coverage is included in most insurance plans, you do not need insurance to get a prescription.
And you shouldn’t let your insurance status stop you from seeking medical care when you need it. If you don’t have insurance, the first step is to find the right healthcare provider for you and your budget.
Direct care providers are often the most costly for those without insurance, and some do not serve the uninsured at all.
Look into options like community health clinics, walk-in clinics, or, of course, K Health.
Community health clinics offer medically-necessary care like vaccinations, tests/screenings, and mental health services, for free or at a low cost.
These clinics often use a “pay what you can” or sliding-scale method for payment based on income.
Walk-in or urgent care clinics are less likely to provide these income-based payment options than a non-profit, but they typically allow uninsured patients to pay directly for their services.
Some walk-in and urgent care clinics are more affordable than others, so be sure to ask about costs upfront.
Once you’ve selected a healthcare provider, it’s time to determine where you can get the best price for your meds.
There are websites online that can help you determine which pharmacy in your area sells your prescription for the lowest price, as well as websites that can help determine the best online prices for your medication if it is available to ship by mail from a licensed online pharmacy.
Once you’ve determined your best option, use google to see if there are coupons available for your drug to use at your local pharmacy.
There are also a variety of “Rx discount cards” that can reduce the total cost of your prescription. All K Health members receive a discount card that can help you save up to 80% on your medication.
For even deeper discounts, check to see if your state offers a prescription drug assistance program.
Though not all states have them, some offer subsidized medications and discount programs for those who are not insured or do not qualify for other government programs.
Why Are Some Drugs Cheaper Than Others?
Sometimes drugs can actually be cheaper if you don’t have insurance.
In fact, statistics show that this happens in nearly a quarter of situations.
Here’s why: When it comes to getting prescriptions into the hands of Americans there are three key players that everyone knows—the drug manufacturers, the pharmacies, and the insurance companies.
But there is also another key industry player that flies a little under the radar: the Pharmacy Benefits Manager (PBM).
A PBM’s job is to act as a middleman between drug manufacturers, pharmacies, and insurance companies, helping insurance companies decide which medications they will cover, and how much they will pay the drug manufacturer for them—which then impacts how much someone with insurance will have to pay as their copay.
One would assume that a PBM would work to get the lowest price possible for an insurance company, but that isn’t always the case.
That’s because sometimes a pharmaceutical company will give a PBM a monetary incentive to choose their brand name version, which is pricier, rather than the cheaper generic version.
This kickback—referred to in the pharmaceutical industry as a “clawback”—means the PBM will make more money in the transaction, but it will cost insurance holders a higher copay.
With PBMs streamlining the supply chain, prescription costs are artificially rising—with insurance holders paying the (literal) price.
In these specific cases, those paying the “Usual and Customary Price,” the price those without insurance pay, will get the better deal.
Does K Health See Uninsured Patients?
Yes! No matter your insurance status, we’re here to help.
K Health is a great option for people who are uninsured because it makes great healthcare affordable and accessible at the touch of a smartphone—no strings, or hidden fees, attached.
With the K Health platform, you have the option to book either a one-time visit with a board-certified clinician for $19, or get unlimited visits for $9 a month.
Once connected, your clinician can often diagnose and treat you in minutes.
This includes ordering new or refill prescriptions, and ordering lab tests when appropriate.
Your provider can also help you determine if more affordable over-the-counter medications are most appropriate for your condition, and when you need to be seen in person in an urgent care or ER.
As a K Health member, you will receive an Rx discount card to save you up to 80% on prescriptions.
Some medications, such as treatments for erectile dysfunction, anxiety, or depression, can be sent directly to your home at a significant discount.
Some more perks: K Health is FSA and HSA compatible, there are no deductibles or copays, clinicians are on call 24/7, you’ll save on transportation costs, and you can cancel at any time for free.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
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Millions in U.S. Lost Someone Who Couldn't Afford Treatment. (2019)
Paying for Prescription Drugs Around the World: Why Is the U.S. an Outlier? (2017)
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Why Do People Lack Health Insurance? (n.d.)