Why consumers still can’t comparison shop for medication

How much a drug costs a patient often depends on which price is being considered: the copay price, the coinsurance price, the price with a manufacturer coupon, the cash discount price from companies such as GoodRx, the direct-to-consumer cash price set by manufacturers or the most-favored price.

Consumers, however, have no way of easily comparing prices for their medications. There is no mechanism for seeing these prices to make informed decisions. But that could change in the near future.

Legislative and regulatory changes, along with AI and technology advances, could provide consumers with an “Expedia-like” environment to do just that, said Miriam Paramore, CEO and founder of RxUtility, which has developed a platform for comparing prices.

To make that happen, however, payers have to publish their negotiated drug prices. Payers, except for grandfathered plans that have been in existence since March 23, 2010, are required to publish their negotiated drug prices as part of a 2020 CMS rule called Transparency in Coverage. Plans have until January 2027 to make available their drug pricing in a machine-readable file.

“Hospitals have published their prices, and the payers have published what they pay the hospitals,” Paramore said. “Within that data, you can find information about infused drugs. Now payers have to publish their negotiated drug prices.”

So far, she said, only two payers have done so: Blue Cross and Blue Shield of Texas and Baylor Scott & White Health Plan. “They've resisted. There were some lawsuits filed. The rule is still in effect, but it has been unenforced.”

The latest The State of Medication Affordability report from RxUtility finds that there has not been widespread uptake of the technology needed to view real-time drug pricing. There is software available now to allow for pricing data at the point of prescribing; there has not been a lot of uptake to connect this with provider healthcare systems.

There is, however, work being done by the National Council of Prescription Drug Programs (NCPDP) and the Carin Alliance to develop interoperability standards. NCPCP is a not-for-profit organization that develops technology standards. The Carin Alliance was created to overcome barriers to information exchange.

“There is lots of progress being made, and companies are working to harvest data to deliver reports,” Paramore said. “We will have transparency so we can put together the component prices, meaning the facility fee, the admin fee, and then the cost of the drug, for the final prices. We will be able to tell consumers and payers from value-based care or managed care about the different choices they have.”

She said it’s likely we will see large differences in pricing based on the site of care, whether biosimilars save patients money and whether their medication is available. “We’ll be able to see if there is something else driving these disparities,” she said.

Where transparency can help patients

One example of where consumers will benefit is being able to see whether there is a manufacturer coupon available. Patients may not know about manufacturer copay coupons that could provide them with medication with low or no out-of-pocket costs, the RxUtility report said.

In fact, many patients don’t know what a medication will cost until they reach the pharmacy counter. Patients have no way to compare prices like they do with airline tickets. “The healthcare system is designed to keep consumers guessing,” Paramore said.

RxUtility found that 79.5% of drug copay coupons are for drugs that have no generic equivalent. But lack of consumer awareness and the difficulty in digitally accessing copay coupons limit their impact. “I had no idea of the sheer volume of money available to consumers because no one really counts it," said Paramore. “There’s no aggregated way to see that.”

This year, RxUtility examined the top six immunology drugs by revenue and asked how easily a patient could learn that a coupon exists and then use it. The drugs studied include Humira, Stelara, Dupixent, Rinvoq, Entyvio and Skyrizi. The analysis found that the ability to find and access a coupon is 2.5 on a five-point scale. This score, RxUtility said, indicates that there are breakdowns in passing this information to consumers.

The number of copay coupons available across therapeutic categories has decreased, especially in the specialty area. In 2025, RxUtility found there were 497 copay coupons available for specialty drugs; this year, there are 434 coupons for specialty drugs. In some areas, the number of copay coupons has increased. For example, in the cardiovascular areas, RxUtility found 28 copay coupons in 2025; in 2026, there were 60 coupons for cardiovascular drugs.

The report noted that there are 26 states that have restricted or banned the use of copay accumulators, where plans don’t apply the assistance to a patient’s deductible. However, the RxUtility report noted that these bans generally apply to fully insured plans.