Insurance tier placement: a compound might be covered but on a higher tier (higher copay). Moving to a lower tier usually requires prior authorization or documented failure of cheaper alternatives.
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Access · Pricing · continued
List price versus negotiated price versus what you pay posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
s.ferreira, post #42: I read post #40 twice before replying, because I had assumed the opposite. List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays. Go to post
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
Picking up post #60: that is the part I would want checked first.
Compute cost per delivered dose at your dose if you want a number you can act on. That requires knowing your dose, vial volume, and whether you are using a vial or a pen.
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Coming back to post #62, because the follow-up matters more than the original answer.
List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays.
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post #64 is right about the mechanism and I think understates the practical bit.
Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.
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il.dumitru, post #38: Compute cost per delivered dose at your dose if you want a number you can act on. That requires knowing your dose, vial volume, and whether you are using a vial or a pen. Go to post
Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.
Price variation between pharmacies: identical prescriptions can cost different amounts at different pharmacies because pharmacies negotiate individually with insurers and manufacturers.
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I read post #66 twice before replying, because I had assumed the opposite.
International pricing: the same compound costs very different amounts in different countries because healthcare systems and regulatory frameworks differ. Generally, US prices are higher than other developed nations.
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s.kravchenko, post #17: Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive. Go to post
post #68 answers the question as asked. The question underneath it is different.
Biosimilars and future generics: as patents expire, biosimilar and generic versions might become available and prices might fall. That has already happened for some proteins; incretin agonist pricing might follow.
GDashwood, post #33: On post #29 — agreed on the reasoning, with one qualification. Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters. Go to post
On post #66 — agreed on the reasoning, with one qualification.
Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters.
h.nicolaides, post #23: Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live. Go to post
Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.
The correction was fair and I had been repeating something I had not checked carefully enough.
Cost per milligram is the only comparison that survives format differences, but even then it needs care. A pen and a vial are not the same product and cannot be compared on price per milligram alone because dead volume, wastage, and number of doses actually obtainable differ.
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Worth separating two things that post #69 runs together.
Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live.
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Collapsed as off-topic by two members at trust level 3 or above
Biosimilars and future generics: as patents expire, biosimilar and generic versions might become available and prices might fall. That has already happened for some proteins; incretin agonist pricing might follow.
s.kravchenko, post #17: Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive. Go to post
Discount programmes and coupons: manufacturers often offer coupons that reduce out-of-pocket costs if insurance is not covering or is covering at a high copay. These have eligibility restrictions but can save money.
Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live.
3 likes 3mo
On post #73 — agreed on the reasoning, with one qualification.
List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays.
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post #77 answers the question as asked. The question underneath it is different.
For anyone arriving from a search: the marked solution above is the direct answer, and the replies underneath it add the caveats that make it safe to use.
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tracked_parcel, post #9: Picking up post #6: that is the part I would want checked first. Pharmacy acquisition cost: a pharmacy pays less than the patient pays, even at insurance rates. That margin is where the pharmacy's costs and profit live. Go to post
I read post #77 twice before replying, because I had assumed the opposite.
Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters.
IRenaudin, post #71: Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing. The correction was fair and I had been repeating something I had not checked carefully enough. Go to post
This follows post #77 rather than contradicting it.
Insurance tier placement: a compound might be covered but on a higher tier (higher copay). Moving to a lower tier usually requires prior authorization or documented failure of cheaper alternatives.
s.vanhecke, post #46: Coming back to post #44, because the follow-up matters more than the original answer. International pricing: the same compound costs very different amounts in different countries because healthcare systems and regulatory frameworks differ. Generally, US prices are higher than other developed nations. Go to post
Price variation between pharmacies: identical prescriptions can cost different amounts at different pharmacies because pharmacies negotiate individually with insurers and manufacturers.
priorauth_notes, post #65: post #64 is right about the mechanism and I think understates the practical bit. Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up. Go to post
International pricing: the same compound costs very different amounts in different countries because healthcare systems and regulatory frameworks differ. Generally, US prices are higher than other developed nations.
I disagree with the reply above, and I think the disagreement is substantive rather than terminological.
The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.
31 likes 3mo
On post #80 — agreed on the reasoning, with one qualification.
Cost per milligram is the only comparison that survives format differences, but even then it needs care. A pen and a vial are not the same product and cannot be compared on price per milligram alone because dead volume, wastage, and number of doses actually obtainable differ.
0 likes 3mo
Compute cost per delivered dose at your dose if you want a number you can act on. That requires knowing your dose, vial volume, and whether you are using a vial or a pen.
1 like 3mo
a.kwiatkowski, post #77: On post #73 — agreed on the reasoning, with one qualification. List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays. Go to post
List prices versus negotiated prices: the price a pharmaceutical company publishes and the price an insurance company or pharmacy actually pays differ substantially. List price is not what anyone pays.
post #86 is right about the mechanism and I think understates the practical bit.
Insurance tier placement: a compound might be covered but on a higher tier (higher copay). Moving to a lower tier usually requires prior authorization or documented failure of cheaper alternatives.
23 likes 3mo
Worth separating two things that post #84 runs together.
Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.
0 likes 3mo
I disagree with the reply above, and I think the disagreement is substantive rather than terminological.
The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.
10 likes 3mo
j.palacios, post #1: On the subject in the title: List price versus negotiated price versus what you pay Working notes rather than a conclusion. Documenting an access outcome, dated, because everything in this category expires. As of February 2026, in my region, the position is as described below. I have linked the primary source rather than a summary of… Go to post
Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters.