Cost Plus Drugs Beats Commercial Insurance Co-Pays 80% of the Time

Generic prescriptions with cost-sharing above $15 under employer-sponsored insurance could be purchased for less at the Mark Cuban Cost Plus Drug Company (MCCPDC) nearly 80% of the time, according to a brief report published in Annals of Internal Medicine.¹ For drugs with cost-sharing above $100, patients could save a median of $119 per prescription.

The findings provide a data-driven framework for when commercially insured patients may actually be better off bypassing their insurance altogether and paying cash through a direct-to-consumer (DTC) pharmacy.

The study arrives at a moment of heightened political attention on DTC pharmacy models. The Trump administration has made drug pricing a central economic message with its TrumpRx initiative, which routes consumers to cash-price alternatives, including the MCCPDC and Amazon Pharmacy, for generics.²

Experts have found that some brand-name drugs available through TrumpRx are actually cheaper to purchase through GoodRx or Cost Plus Drugs, underscoring the confusion patients can face when trying to identify the lowest cash price across competing platforms.³

Insurance Co-Pays vs Cost Plus Drugs

The analysis reviewed more than 62 million generic prescription claims from Merative MarketScan commercial claims data covering January 2024 through December 2024 and matched them against 2025 direct-purchase prices at the MCCPDC, a DTC pharmacy that applies a fixed markup and ships medications directly to patients without requiring a paid membership.

Nearly 97% of the drug-form-strength combinations in the dataset were available through the MCCPDC, making it broadly applicable across the commercially insured population studied. The analysis was stratified by out-of-pocket (OOP) cost tiers ($0-$15, $15-$25, $25-$50, $50-$100, and > $100) to identify where savings opportunities are most concentrated.

Overall, purchasing through the MCCPDC offered savings on only 15% of prescriptions, with a modest median savings of $6. However, the savings were larger at higher-tier levels. Among generics with cost-sharing above $100 under insurance, median OOP costs were $140 through a plan vs just $25 through the MCCPDC—an 85% relative savings and $119 in absolute savings per prescription.

Disease areas with the highest frequency of high-cost generic prescriptions included oncology (median savings of $468), urology ($139), psychiatry ($136), neurology ($133), and cardiology ($110). Specific drugs in those categories included abiraterone, imatinib, sildenafil, tadalafil, venlafaxine, and rivaroxaban.

Why the Commercially Insured Are Still Vulnerable

The assumption that employer-sponsored coverage insulates patients from high drug costs has increasingly come under scrutiny. Benefit designs have shifted in ways that expose plan members to more direct cost exposure, particularly during deductible phases.

The overall shift in employer plan drug costs has been moving more responsibility onto patients in the form of higher deductibles, cost-sharing for specialty drugs, and a move away from flat co-pays for specialty medications, Patty Taddei-Allen, PharmD, MBA, a clinical assistant professor at the University of Florida, explained.⁴

“And as a result of that, plans and PBMs [pharmacy benefit managers] are really looking to see how they can best manage and protect, from their perspective, the integrity of the plan's benefit design,” she said.

The new Annals study underscores how that dynamic plays out at the pharmacy counter. Even patients with active pharmacy benefits who are covered under plans that include generic drug tiers can face triple-digit cost-sharing when deductibles are unmet or when specific drugs are placed on higher-cost formulary tiers.

The DTC Tradeoff: Access vs Accumulation

One complication the study raises is that DTC purchases do not count toward a patient's deductible or OOP maximum under their insurance plan. The patients who are most likely to benefit from DTC models are those who are engaged and where the friction cost of using the DTC channel is lower than that of traditional coverage. But they need to remember they may pay more OOP.

"The cost that they're paying as a consumer doesn't come out of their total out-of-pocket network or deductible costs, and so it's almost inflating the costs above and beyond what they might be seeing through employer-sponsored coverage," said Jennifer Graff, PharmD, of Innov8 Health Policy.⁵

The Case for RTPB Integration

The study also calls attention to the underperformance of real-time prescription benefit (RTPB) tools, which are systems embedded in electronic health records that flag cost information to prescribers at the point of care. Prior research has shown that RTPBs identified savings opportunities in only 11% of prescriptions with cost-sharing between $50 and $100 and 39% of prescriptions with cost-sharing above $100, which is far below the 82% to 85% savings frequency the MCCPDC offered in those same tiers.¹

Michael Burger, senior consultant at Point-of-Care Partners, previously told The American Journal of Managed Care^® that a real-time benefit check is meant to make prescription costs visible to the physician at the exact point of prescribing, "so they can decide on the most cost-effective drug, one that they know that the patient can afford, so that way they're sure that the patient gets on therapy."⁶ However, the new data suggest that current RTPB infrastructure still lacks the reach to incorporate DTC pharmacy pricing routinely.

Study Boundaries: Which Drugs and Patients Are Excluded?

The researchers noted several important boundaries to the findings. The study focused exclusively on generic drugs and the MCCPDC, excluding controlled substances, drugs with zero cost-sharing requirements under the Affordable Care Act, and drugs subject to Risk Evaluation and Mitigation Strategy requirements. The results are also not generalizable to patients on Medicare, Medicaid, or other types of commercial coverage.

Additionally, the study treated MCCPDC's $5.25 shipping fee as applying to each individual drug, which is a conservative assumption, since the fee is charged once per shipment regardless of the number of prescriptions included. As a result, the true savings may be modestly larger than reported.

The authors suggest the findings can help both patients and clinicians navigate generic prescription affordability more efficiently, particularly for disease areas like oncology and psychiatry where high cost-sharing on generics is common.

“Patients with employer-sponsored insurance facing drug-affordability challenges may consider DTC pharmacies whenever their generic prescription’s co-payment or coinsurance exceeds $15, where savings are frequent (nearly 80%),” the authors concluded. “They should particularly consider DTC pharmacies for higher out-of-pocket cost drugs, where savings are often considerable.”

References

1. Lin JK, Xiang JJ, Lei X, et al. Identifying meaningful patient savings on generics: direct-to-consumer prices versus commercial insurance cost sharing. Ann Intern Med. 2026. doi:10.7326/ANNALS-25-05049
2. Steinzor P. TrumpRx expands generic drug offerings with Mark Cuban partnership, Amazon Pharmacy support. AJMC^®. May 19, 2026. Accessed May 22, 2026. https://www.ajmc.com/view/trumprx-expands-generic-drug-offerings-with-mark-cuban-partnership-amazon-pharmacy-support
3. Bonavitacola J. Two months later, success of TrumpRx is mixed: are lower prices really available? AJMC. March 31, 2026. Accessed May 22, 2026. https://www.ajmc.com/view/two-months-later-success-of-trumprx-is-mixed-are-lower-prices-really-available-
4. McCrear S. Taddei-Allen P. Rising specialty drug costs and co-pay models raise access concerns. AJMC. April 15, 2026. Accessed May 22, 2026. https://www.ajmc.com/view/rising-specialty-drug-costs-and-co-pay-models-raise-access-concerns-patty-taddei-allen-pharmd-mba
5. McCormick B. Patients face new care complexities as DTC options expand. AJMC. November 25, 2025. Accessed May 22, 2026. https://www.ajmc.com/view/patients-face-new-care-complexities-as-dtc-options-expand
6. Klein HE. How real-time benefit check can improve prescriber decision-making and treatment uptake. AJMC. March 25, 2023. Accessed May 22, 2026. https://www.ajmc.com/view/how-real-time-benefit-check-can-improve-prescriber-decision-making-and-treatment-uptake