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Access · Pricing · continued

Price changes over 2025 and 2026, tabulated and dated — does this still hold? posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.

AK
an.kirchnerTL2 Moderator6 Dec 2025#31

This follows post #28 rather than contradicting it.

Price variation between pharmacies: identical prescriptions can cost different amounts at different pharmacies because pharmacies negotiate individually with insurers and manufacturers.

14 likes 8mo
R
RidgewayTL3Regular8 Dec 2025#32

I read post #30 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.

29 likes 8mo
HJ
h.jansenTL29 Dec 2025#33
EF
erratum_fileTL3Regular10 Dec 2025#34

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.

2 likes 8mo
VK
v.kjaerTL2 Moderator12 Dec 2025#35
au.pereira, post #28: 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. Go to post

Picking up post #32: 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.

9 likes in reply to #28 8mo
G
GEldridgeTL3Regular13 Dec 2025#36

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.

21 likes 7mo
AN
a.nascimentoTL2 Moderator14 Dec 2025#37

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.

0 likes 7mo
DB
d.bramleyTL3Regular16 Dec 2025 · edited#38

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.

1 like 7mo
CB
c.bakkerTL2 Moderator17 Dec 2025#39
steady_state, post #19: post #18 answers the question as asked. The question underneath it is different. 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

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.

5 likes in reply to #19 7mo
CR
c.ramosTL2 Moderator18 Dec 2025#40

Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters.

15 likes 7mo
CD
cannula_driftTL3Regular20 Dec 2025#41

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.

11 likes 7mo
LD
l.dialloTL2 Moderator21 Dec 2025#42

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.

3 likes 7mo
CI
c.inglethorpeTL3Regular22 Dec 2025 · edited#43
journalclub_wren, post #17: 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. Go to post

On post #39 — 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 in reply to #17 7mo
HB
h.bhattacharyaTL2 Moderator24 Dec 2025#44
s.karlsen_rph, post #7: Coming back to post #5, because the follow-up matters more than the original answer. Two things before anyone answers the substance. First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound. Go to post

post #43 answers the question as asked. The question underneath it is different.

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.

24 likes in reply to #7 7mo
C
CSagredoTL3Regular25 Dec 2025#45

I read post #43 twice before replying, because I had assumed the opposite.

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.

7 likes 7mo
HR
h.ramosTL2 Moderator26 Dec 2025#46

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.

1 like 7mo
OA
o.abrahamsenTL327 Dec 2025#47
MN
m.nwosuTL2 Moderator29 Dec 2025#48
d.fontaine, post #3: I read the opening post 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. Go to post

post #47 is right about the mechanism and I think understates the practical bit.

Price variation between pharmacies: identical prescriptions can cost different amounts at different pharmacies because pharmacies negotiate individually with insurers and manufacturers.

17 likes in reply to #3 7mo
EK
e.kjeldsenTL2Member30 Dec 2025#49

Coming back to post #47, 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.

23 likes 7mo
PL
p.lindqvistTL2 Moderator31 Dec 2025#50
t.karlsen, post #20: 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

Picking up post #47: that is the part I would want checked first.

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.

10 likes in reply to #20 7mo
RM
r.marsdenTL3Regular1 Jan 2026#51

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.

18 likes 7mo
AA
a.amankwahTL2 Moderator3 Jan 2026 · edited#52

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 7mo
LM
lyophil_marginTL3Regular4 Jan 2026#53
dr_okonkwo, post #5: 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

This follows post #50 rather than contradicting it.

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.

1 like in reply to #5 7mo
CB
c.balogunTL2 Moderator5 Jan 2026#54
journalclub_wren, post #17: 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. Go to post

Subscription services and subscriptions: some online clinics bundle compounds into subscription models with different pricing. Understanding the terms before committing matters.

7 likes in reply to #17 7mo
ST
sterile_tableTL3Regular6 Jan 2026#55

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.

25 likes 7mo
YE
y.eriksenTL2 Moderator7 Jan 2026#56

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.

0 likes 7mo
P
PSundbergTL29 Jan 2026#57
JM
j.marchettiTL2 Moderator10 Jan 2026#58

Coming back to post #56, because the follow-up matters more than the original answer.

Two things before anyone answers the substance.

First, the context in the first post is clear and specific. Second, the question is framed so that an answer can actually address it. Both are the norm here and both matter more than they sound.

11 likes 7mo
CC
c.cardosoTL2 Moderator11 Jan 2026 · edited#59

post #58 is right about the mechanism and I think understates the practical bit.

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.

8 likes 7mo
FS
f.sjobergTL2 Moderator12 Jan 2026#60

Worth separating two things that post #56 runs together.

Price variation between pharmacies: identical prescriptions can cost different amounts at different pharmacies because pharmacies negotiate individually with insurers and manufacturers.

19 likes 6mo