The cost of a drug to a patient can vary greatly depending on the price being considered, such as the copay price, coinsurance price, or cash discount price. However, consumers currently have no easy way to compare prices for their medications, making informed decisions difficult.
Legislative and regulatory changes, along with advances in AI and technology, may provide consumers with a platform to compare prices, similar to Expedia, according to Miriam Paramore, CEO and founder of RxUtility.
To achieve this, payers must publish their negotiated drug prices, as required by a 2020 CMS rule called Transparency in Coverage. However, only two payers, Blue Cross and Blue Shield of Texas and Baylor Scott & White Health Plan, have done so, despite the rule being in effect.
Current State of Medication Affordability
The latest report from RxUtility finds that there has not been widespread adoption of technology to view real-time drug pricing. Software is available to provide pricing data at the point of prescribing, but there has been limited uptake to connect this with provider healthcare systems.
However, the National Council of Prescription Drug Programs (NCPDP) and the Carin Alliance are working to develop interoperability standards, which could help overcome barriers to information exchange.
Paramore notes that companies are making progress in harvesting data to deliver reports, which will eventually provide transparency on component prices, such as facility fees and admin fees, allowing consumers and payers to make informed decisions.
Benefits of Transparency
One example of where consumers will benefit from transparency is being able to see if a manufacturer coupon is available. Many patients are unaware of these coupons, which could provide them with medication at low or no out-of-pocket costs.
RxUtility found that 79.5% of drug copay coupons are for drugs with no generic equivalent, but lack of consumer awareness and difficulty in accessing these coupons limit their impact.
The report also examined the top six immunology drugs by revenue and found that the ability to find and access a coupon is limited, with a score of 2.5 on a five-point scale, indicating breakdowns in passing this information to consumers.
Availability of Copay Coupons
The number of copay coupons available across therapeutic categories has decreased, especially in the specialty area. In 2025, there were 497 copay coupons available for specialty drugs, compared to 434 in 2026.
However, in some areas, such as cardiovascular drugs, the number of copay coupons has increased, from 28 in 2025 to 60 in 2026. Additionally, 26 states have restricted or banned the use of copay accumulators, where plans don’t apply the assistance to a patient’s deductible.
