Cost & Number of Prescriptions

Drug stores in half the states are not allowed to volunteer to you that the cash price is less than your co-pay, but the other half of states have laws letting them tell you. You can always ask about the cash price and ask if they have coupons or discount cards for the drugs you're buying.

Dr. David Belk has clear data on wholesale (NADAC) and retail costs of generic and branded drugs (from GoodRx) and what drives the costs.

CMS has National Average Drug Acquisition Cost (NADAC) database at data.medicaid.gov/nadac. An explanation from West Virginia dhhr.wv.gov/bms/BMS%20Pharmacy/Documents/NADAC%20Survey.pdf

Commercial services (cost) wolterskluwer.com/en/solutions/medi-span/price-rx and www.fdbhealth.com/

IQVIA reports on wholesale and retail costs and number of prescriptions.

Express Scripts has numerous articles on drug pricing and 11 billion prescription records (paid access).

Drugs are distributed to retail pharmacies primarily by three companies: AmerisourceBergen, Cardinal, and McKesson, which have paid small fines, relative to their revenue, for not reporting excessive deliveries of opioids.

Hospitals which serve many poor people get discounted drugs for some patients from the 340B program.

You can find the number of drug prescriptions from each doctor and costs for Medicare patients in at least 2 places, described below. For non-Medicare prices see above.

ProPublica has Medicare Part D cost for each drug: number of prescriptions and total spending. You can get separate totals for US and each state, so you can get average cost per prescription, and for each doctor who prescribed a drug 50 or more times in 2013.

Medicare itself has more complete Part D data. The US and state summary files (bottom of the link) show for each drug: the number of beneficiaries as well as prescriptions and spending, so you can get average per beneficiary (total during a year), as well as per prescription for each drug.

Medicare's detailed files show number of days prescribed, so you can get average cost of a daily dose, as well as each doctor who prescribed a drug 11 or more times in 2013. This info is in 23 million records, without state or US summaries. However you can get good state and national estimates by opening any of their 36 spreadsheets (divided by last name of prescriber) and getting averages there. The average costs do not vary much by last name of prescriber. (Tips for working with large spreadsheets)

Some doctors and drugs typically have 30-day or 90-day prescriptions, which may be renewed all year. Their averages include the cost for each  whole long prescription (30 or 90 days). Docs & drugs with shorter prescriptions only include that lower cost. Medicare's focus seems to be on cutting total costs, not cost per dose.

ProPublica's methodology says it has "retail cost" for these prescriptions.

Medicare's fact sheet gives more detail, saying it includes,

• total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees. It's based on the amounts paid by the Part D plan, Medicare beneficiary, other government subsidies, and any other third-party payers (such as employers and liability insurers). Total drug costs do not reflect any manufacturer rebates paid to Part D plan sponsors through direct and indirect remuneration or point-of sale rebates

It does not directly include patients' monthly premiums, though on average those premiums may cover all drugs, administration, and profits.

After seeing which drugs a doctor prescribes, you can find drug safety and effectiveness from the main drugs page here.