THE CURE HEIST

Go to costplusdrugs.com. Type in every prescription you currently take. Compare each price to what you’re paying now (your copay if you have insurance, your cash price if you don’t).

Cost Plus buys drugs at true manufacturer cost, adds 15% markup, adds a $3 pharmacy labor fee, and ships to your door. No PBM. No rebate. No insurer.

For common generics (atorvastatin, metformin, lisinopril, sertraline, omeprazole, and hundreds more), Cost Plus is often 30-90% cheaper than retail.

If something on your list is cheaper, save the screenshot. You’ll act on it tomorrow.

Install the GoodRx app or open the website. Enter the same medications you just looked up on Cost Plus. Enter your zip code.

GoodRx shows the cash price at every pharmacy within 10 miles, sorted from lowest. The same drug at the same dose can vary by 5x or more between two pharmacies on the same block.

You don’t pay GoodRx. You don’t sign up for anything that costs money. You show the digital coupon at the counter and the pharmacist applies the discount.

Privacy note: GoodRx sells anonymized prescription data to the pharma industry. If you’re privacy-sensitive, that’s a tradeoff. For most people, the savings are worth it.

The manufacturer of your insulin or GLP-1 is probably selling direct to consumers right now. They’re cutting out the PBM because their own distribution chain has become too dysfunctional to defend.

Check these specifically:

• LillyDirect for Humalog, Basaglar, Zepbound, Mounjaro, Trulicity
• NovoCare for NovoLog, Levemir, Tresiba, Ozempic, Wegovy
• Pfizer Direct for select Pfizer products

For insulin and GLP-1 specifically, manufacturer direct is often dramatically cheaper than the insured list price. Compare the direct price to your current copay before next refill.

You do NOT need a Costco membership to use the pharmacy. Federal law requires warehouse club pharmacies to serve the public. Walk in. Hand over the prescription. Ask for the cash price before they run your insurance.

Costco runs a high-volume, low-margin pharmacy. Their cash prices often beat GoodRx coupon prices, especially for branded chronic medications.

For non-prescription warehouse purchases, you do need a membership card. The pharmacy counter is open to everyone.

Ask one question. Get one number. Compare.

Log into your insurer’s portal or pull the most recent paper EOB from your mail. The Explanation of Benefits is NOT a bill. It shows what was billed, what the insurer “allowed,” what the insurer paid, and what you owe.

What to look for:

• Any line item marked “denied”
• Any “patient responsibility” amount that looks higher than expected
• Any service flagged for “prior authorization required” that you weren’t told about

If you flag a denial, you have a clock. Internal appeals typically must be filed within 60 to 180 days of the denial date. Calendar that deadline today.

You found one medication that’s significantly cheaper outside insurance. Call your prescriber’s office. They can e-prescribe to almost any pharmacy in the country, including Cost Plus Drugs.

What to say:

“I’ve been paying too much out of pocket for this medication. Can you send the prescription to [Cost Plus Drugs / Costco / LillyDirect] instead? I have the pricing information.”

Most prescribers don’t see your copay. They default to chain pharmacies because that’s the path of least resistance. They will switch when you ask. They just need to know.

Your insurer is required to publish the formulary (the list of covered drugs and which tier each one is on). Find it on your insurer’s website or member portal.

For each medication you take, note:

• What tier is it on? Tier 1 (preferred generic) is cheapest. Tier 4 or Specialty is most expensive.
• Is it excluded entirely? Some plans exclude drugs because cheaper-rebate alternatives exist on the formulary.
• Does it require prior authorization or step therapy?

Knowing this before your next prescriber visit lets you and your doctor pick a covered medication, OR plan to use Cost Plus / manufacturer direct as a workaround.

The formulary changes annually, usually January 1. Check yours during open enrollment every year.

Pick the medication you take most regularly. Run it through all four doors and your current pharmacy. Document the prices.

What to record:

• Cost Plus Drugs price (mail order, cash)
• Costco Pharmacy cash price
• Manufacturer direct (if available)
• GoodRx best local price
• Your insurance copay at your usual pharmacy

The lowest price is your new default for that medication. Switch your prescription accordingly. Repeat the comparison every 6 months because pricing shifts (Cost Plus adds drugs, manufacturer direct programs expand, insurance copays change at plan renewal).

This is the foundational data discipline that drives every other Your Move action.

Open a spreadsheet. Track every prescription you fill. Columns to include:

• Medication name and dose
• Pharmacy or door (Cost Plus, Costco, manufacturer direct, GoodRx, insurance)
• Date filled
• Cash price OR copay paid
• List price if visible (often on EOB)

After six months, you’ll see patterns. Which door wins for which drug. When prices changed. Whether your insurance copay matches your insurer’s stated formulary tier.

Personal data is leverage. When you talk to your employer, your state rep, or your doctor about pharmacy pricing, you bring receipts.

Most employer-sponsored health plans contract with a PBM. The contract is either pass-through (rebates flow back to the plan and members) or spread pricing (the PBM keeps the difference between what they bill the employer and what they pay the pharmacy).

Spread pricing means your employer is being charged more than the pharmacy receives, and you may be paying copays calculated on the higher amount.

The ask:

Email HR or your benefits administrator: “Is our PBM contract pass-through or spread pricing? Can you share the contract terms or summary?”

If they don’t know or won’t say, that’s information too. A growing number of large employers are auditing their PBMs and switching to pass-through contracts. The pressure has to come from somewhere.

PBM regulation is happening at the state level faster than at the federal level. As of 2026, more than 30 states have passed or proposed PBM transparency laws covering rebate disclosure, spread pricing bans, and pharmacy “any willing provider” rules.

The move:

• Identify your state representative and state senator (check your state legislature’s website)
• Send a one-paragraph email referencing your own prescription pricing experience
• Cite specific state-level PBM legislation under consideration in your state
• Ask their position

State legislators receive far less constituent mail than federal officials. A handful of emails on a specific topic can move a vote. The PBM lobby knows this, which is why their state-level lobbying is intense.

Insurers change formularies every January 1. A drug on Tier 1 this year can be on Tier 3 next year, or excluded entirely. The change is usually buried in plan documents that arrive during open enrollment.

What to do every fall:

• Open the Summary of Benefits and Coverage (SBC) the moment it arrives
• Search the formulary for every medication you take
• Note any tier changes, exclusions, or new prior auth requirements
• Compare against other plan options if your employer offers a choice
• Switch plans if your medications are better covered elsewhere

The default is auto-renewal at whatever the new formulary says. The default is designed to favor the insurer’s rebate math, not your prescription costs. Override the default by reading the documents.