What your pharmacy actually paid for your prescription
The short answer
- The US government publishes what pharmacies pay to buy a drug. It is called NADAC, CMS surveys it weekly, and it is public.
- For most common generics it is a few dollars a month, or less. Atorvastatin — the cholesterol drug 40 million Americans take — costs a pharmacy about $0.92 for thirty tablets.
- That is not what you pay.Your price is set after that, by your insurer’s formulary, your deductible, the pharmacy’s markup and the middlemen in between. The gap is the business.
- Which is why nobody shows you this number. A company that earns its living routing you to a discount has no reason to open with the fact that the drug cost three dollars. We don’t sell drugs and we don’t sell coupons — we rate them on their FDA recall record — so here it is.
What the pharmacy pays — 40 common drugs
The CMS NADAC acquisition cost for a 30-day supply of tablets or capsules. Every figure is the government’s, not ours.
| Drug | Class | Pharmacy pays, for 30 |
|---|---|---|
| amlodipine besylate | Calcium Channel Blocker | $0.33 |
| meloxicam | Nonsteroidal Anti-inflammatory Drug | $0.56 |
| metoprolol tartrate | beta-Adrenergic Blocker | $0.58 |
| folic acid | — | $0.58 |
| cyclobenzaprine hydrochloride | Muscle Relaxant | $0.63 |
| tramadol hydrochloride | Opioid Agonist | $0.72 |
| metformin hydrochloride | Biguanide | $0.74 |
| alprazolam | Benzodiazepine | $0.75 |
| atenolol | beta-Adrenergic Blocker | $0.76 |
| lisinopril | Angiotensin Converting Enzyme Inhibitor | $0.77 |
| diazepam | Benzodiazepine | $0.87 |
| hydrochlorothiazide | Thiazide Diuretic | $0.89 |
| simvastatin | HMG-CoA Reductase Inhibitor | $0.93 |
| zolpidem tartrate | gamma-Aminobutyric Acid A Receptor Positive Modulator | $1 |
| clonidine hydrochloride | Central alpha-2 Adrenergic Agonist | $1 |
| sertraline hydrochloride | Serotonin Reuptake Inhibitor | $1 |
| lorazepam | Benzodiazepine | $1 |
| buspirone hydrochloride | — | $1 |
| lovastatin | HMG-CoA Reductase Inhibitor | $1 |
| metoclopramide hydrochloride | Dopamine-2 Receptor Antagonist | $1 |
| rosuvastatin calcium | HMG-CoA Reductase Inhibitor | $1 |
| glipizide | Sulfonylurea | $1 |
| meclizine hydrochloride | Antiemetic | $1 |
| famotidine | Histamine-2 Receptor Antagonist | $2 |
| baclofen | gamma-Aminobutyric Acid-ergic Agonist | $2 |
| loratadine | — | $2 |
| prednisone | Corticosteroid | $2 |
| levothyroxine sodium | l-Thyroxine | $2 |
| glyburide | Sulfonylurea | $2 |
| risperidone | Atypical Antipsychotic | $2 |
| finasteride | 5-alpha Reductase Inhibitor | $2 |
| benzonatate | Non-narcotic Antitussive | $2 |
| dicyclomine hydrochloride | Anticholinergic | $2 |
| olmesartan medoxomil | Angiotensin 2 Receptor Blocker | $2 |
| levetiracetam | — | $2 |
| ropinirole hydrochloride | Nonergot Dopamine Agonist | $2 |
| celecoxib | Nonsteroidal Anti-inflammatory Drug | $2 |
| memantine hydrochloride | N-methyl-D-aspartate Receptor Antagonist | $2 |
| propranolol hydrochloride | beta-Adrenergic Blocker | $2 |
| doxazosin mesylate | alpha-Adrenergic Blocker | $3 |
Why your price is a different number
NADAC is the pharmacy’s cost of goods — what it paid the wholesaler. Between that number and the one on your receipt sit your insurer’s formulary tier, your deductible (before it is met, you may pay the full negotiated rate), the pharmacy’s dispensing fee and markup, and a pharmacy benefit manager whose contract determines what the pharmacy is reimbursed and what you are billed. None of those layers are published, which is why the same drug can cost you two different amounts at two pharmacies on the same street, and why a discount card can beat your insurance.
Knowing the acquisition cost does not get you that price. What it does is tell you when the number you are being quoted is far from the cost of the thing — which is the moment to ask the pharmacist whether there is a cheaper way to buy it, and to ask your prescriber whether a generic of the same molecule would do.
Frequently asked questions
What is NADAC?
The National Average Drug Acquisition Cost — a survey CMS (the US agency that runs Medicare and Medicaid) publishes, of what retail pharmacies actually pay their wholesaler for a drug. It is a real, national, government-published number, updated weekly. It is the closest thing there is to the true cost of a pill.
Is NADAC what I will pay at the counter?
No, and that is the point of this page. NADAC is the pharmacy's cost of goods. What you are charged is set after that by your insurer's formulary, your deductible, the pharmacy's markup, and — if you use one — a discount card. Those layers are why a drug that cost the pharmacy $4 can be billed at $40, and why the same drug can cost you a different amount at two pharmacies on the same street.
Why does nobody else show this number?
Because the gap between the acquisition cost and your price is where the money in the system is. A company whose revenue comes from routing you to a discount has no reason to lead with the fact that the drug cost $3. We don't sell drugs and we don't sell coupons — we rate drugs on their FDA recall record — so we can just show you the number.
Does a cheap acquisition cost mean it's a good drug?
No. Price is not quality and it is not safety. Most of the cheapest drugs on this page are old generics, which is exactly why they are cheap: the patent expired and many manufacturers make them. Whether a given manufacturer's product has a clean FDA recall record is a separate question — that is what our rating measures, and it is on each drug's page.
Source: the CMS National Average Drug Acquisition Cost survey, a weekly national survey of what retail pharmacies pay to acquire drugs. NADAC is published per unit; a 30-count figure is that unit price × 30, and it applies to the molecule rather than to one brand — CMS surveys the drug, not the label on the bottle. It is an acquisition benchmark, not a retail quote, and not a prediction of what you will be charged.