Part 1 of the Levothyroxine Deep Dive Webinar focuses on your levothyroxine options. Learn about tablets, capsules, and oral solution, the four key brands, generics, and the different excipient ingredients and dyes. Also find out when you should consider switching from generic to brand name, changing brands, and when capsules or oral solutions are the recommended treatment.
LEVOTHYROXINE COSTS & SAVINGS
If you’re a thyroid patient taking levothyroxine to treat your hypothyroidism, here’s an important question: Are you paying too much?
The answer will surprise you: You may be one of the 50 percent of thyroid patients who are overpaying for this common medication that treats an underactive thyroid!
In this part of the Levothyroxine Deep Dive, we’ll look at the costs of levothyroxine, and how you can stop overpaying, and even enjoy extra savings on the cost of your monthly medication!
How Much Does Levothyroxine Typically Cost?
How much you pay for your levothyroxine depends on your answers to the following questions:
Are you taking a brand name or generic levothyroxine?
What is your prescribed daily dosage?
Do you have health insurance or some sort of health coverage?
If you’re insured, what is your copayment for your levothyroxine?
Are you eligible for a prescription assistance program?
What’s the typical size of your prescription refill? (i.e., one-month, three-months, etc.)
Do you use any copay cards, coupons, or discounts from manufacturers or other discount services?
Where do you fill your prescription–
A regular retail pharmacy?
Your health insurer’s mail order pharmacy program?
A mail order pharmacy?
In this part of the Levothyroxine Deep Dive, we’ll look at all of these factors, and how they affect the amount you pay for your levothyroxine drugs. And most importantly, what YOU can do to save money on your medication!
For an in-depth look at the brand name and generic forms of levothyroxine – including tablets, capsules, and oral solution – and the differences in ingredients and potency, see Part 1 of the Levothyroxine Deep Dive.
How Can You Save On or Afford Your Levothyroxine Prescription?
There are seven ways to save on or be able to afford the cost of your levothyroxine:
Patient Assistance Programs
Pharmacy/Grocery/Retailer Discount Programs
Outside Coupon and Discount Programs
Mail Order Pharmacies
How Are Drugs Distributed and Priced?
Before we jump into the specifics on savings, it may be helpful to review the process of how drugs – including levothyroxine – are distributed and priced, and how that affects how much you pay.
Health Plans and Pharmacy Benefit Managers
If you’re insured, you pay premiums for coverage provided by your health plan. (Frequently, your employer is covering the cost of at least part of those premiums.)
Every health plan has what’s known as a formulary, a list of the generic and brand name prescription drugs that are covered by the plan.
Health plans also contract with a Pharmacy Benefit Manager, known as a PBM. PBMs can be outside companies, and some plans have their own PBM divisions or spinoff companies. The PBM is a “middleman” that performs a number of functions:
PBMs help decide which drugs go on a plan’s formulary
PBMs oversee a plan’s prescription benefits
PBMs negotiate contracts with drug manufacturers and pharmacies to maximize profits.
In exchange, the PBMs get paid by health plans for the cost of drugs dispensed, plus administrative fees.
PBMs also are frequently paid rebates by drug manufacturers, in exchange for being listed as a preferred brand on a formulary and to increase the market share for a drug. (PBMs are supposed to give a portion of the rebate back to the health plan to help lower your costs. Unfortunately, this rarely happens.)
Prescription Drugs: From the Manufacturer to You
A drug manufacturer (pharmaceutical company) makes medications. In the case of levothyroxine, there are four brand name, and numerous generic versions of the drug. The different manufacturers of levothyroxine are covered in depth in Part 1 of the Levothyroxine Deep Dive.
The manufacturer sets a list price for every drug. They typically sell their drugs to wholesalers at what’s called the wholesale acquisition cost, or WAC.
The wholesaler sells to pharmacies at a percentage off the WAC.
Pharmacies typically have two sets of prices for consumers:
The copayment price – called a “copay” for insured patients. This price is determined by your plan and the PBM.
A retail price – also called the “cash price,” which is paid by someone who is uninsured, or who chooses not to use their insurance to pay for the medication.
The following is the typical retail cash price range for a one-month supply of brand name and generic levothyroxine drugs:
Levoxyl® Tablets: $20 - $35
Synthroid® Tablets: $40 - $55
Tirosint® Capsules: $145 - $175
Tirosint®-SOL Oral Solution: $145 - $175
Unithroid® Tablets: $15 - $20
Generic Tablets: $12 - $20
Insurance Copayments and Tiers
Your copayment is the out-of-pocket cost you are expected to pay for particular drugs. A copay can be a set amount, or a percentage of a drug’s list cost, depending on your plan. Your copays are typically applied to your annual deductible. That means, you’ll need to pay copays for your medications until you have satisfied the annual deductible for your plan.
Your health plan’s approved formulary is divided into a number of categories – 3 or 4 is common – called copayment tiers. Your copay for any particular drug is based on which tier the drug is assigned to by your health plan’s formulary. Tiers typically correlate to the full list price – the “sticker price” of a drug.
Here’s what typical formulary copayment tiers look like, and the typical tiers for generic and brand name levothyroxine:
Tier 1 drugs are usually generics with low list prices. They have the lowest copays and percentages. According to Kaiser Family Foundation research, the average copay for a Tier drug is $11, or 19% of the list price.
Generic levothyroxine and Unithroid® are Tier 1. Some plans also categorize Levoxyl® as Tier 1.
Tier 2 drugs include generics with higher list prices, and some preferred brand medications. The average copay is $33, or 26% of the list price.
Levoxyl® is frequently designated as Tier 2. Some plans categorize Synthroid® as Tier 2.
Tier 3 typically includes preferred and non-preferred brand name drugs with higher list prices. Your health plan may place a drug in tier 3 if there’s a similar drug in a lower tier. The average copay is $59, or 36% of the list cost.
Synthroid® and Tirosint® are frequently designated as Tier 3.
Some health plans also have a Tier 4, which typically includes non-preferred brands, medications with the highest list prices, and specialty drugs, prescribed for rare medical conditions. The out-of-pocket cost is highest in tier 4. The average copay is $105, or 31% of retail cost.
While most plans designate Tirosint® as Tier 3, a small number of plans designate it as Tier 4.
Health plans sometimes choose not to include a brand name prescription drug on its formulary. When they do, they usually cite one of the following reasons:
The drug has a generic version that is considered equivalent
The drug is as equivalent to and as effective as other brands or similar drugs, but costs much more.
The drug is considered less effective than other, similar drugs
If a drug is not on the formulary, many health plans will not help you pay for it. If you fill a prescription for an uncovered drug, you will need to pay the retail/cash price.
It’s not common, but occasionally, I hear from thyroid patients who report that their health plan won’t cover Tirosint®.
The following graphic shows the typical tier levels and average copays for brand name and generic levothyroxine drugs.
How Can Manufacturer Programs Help You Save?
If you are taking a brand name levothyroxine drug – i.e., Synthroid®, Levoxyl®, Tirosint®, Tirosint®-SOL, or Unithroid® – one of the best ways to save on the cost of your medication is to take advantage of a manufacturer savings programs.
Copay Cards and Coupons
Copay cards are special discount cards offered by drug manufacturers that provide a discount off your insurance copay. Using a copay coupon, you may be able to pay a flat rate that is less than your copay amount.
Copay cards frequently have a monthly or annual maximum amount you can save, or some can expire. There are sometimes restrictions on the maximum number of times you can use the card.
Copay cards are not valid for use if your coverage is under Medicare, Medicaid, the Veteran’s Administration, or Department of Defense/ Tricare coverage.
Levoxyl® Copay/Savings Cards
Pfizer offers a copay card for Levoxyl®. The estimated savings for Levoxyl® under the program range from 36% to 75% of the retail cash price, and depend on such factors as the quantity purchased, and the pharmacy where it’s purchased. To learn more about Pfizer’s copay/savings cards to help with your copay costs for Levoxyl®, visit the Pfizer Pathways website at https://www.pfizerrxpathways.com.
Synthroid® “Before Breakfast Club” and Direct Program
Synthroid® manufacturer AbbVie has set up the “Before Breakfast Club” to provide copay cards and a savings coupon.
Copay Card: According to AbbVie, most patients with insurance pay no more than a $25 copay for a one-month supply of Synthroid®.
Instant Coupon: For those without insurance, the club provides a $3 off coupon for a one-month supply, and $10 off a three-month supply
You can sign up for the Before Breakfast Club at https://www.Synthroid.com/support/before-breakfast-club.
Synthroid® manufacturer AbbVie offers the Synthroid® Direct Enrollment program, through Eagle Pharmacy. In most cases, you can get your Synthroid® prescription filled by mail for $25 a month -- with or without insurance. For information on how to enroll in Synthroid® Direct Enrollment: https://synthroiddirectenrollment.eaglepharmacy.com
Unithroid® distributor Amneal offers a copay card, and a related voucher program, which are outlined at their website at https://www.Unithroid.com/#help-patients-save.
Unithroid® Copay Card: According to Amneal, with the Unithroid® copay card, more than 90% of commercially-insured patients pay as little as $3 for a one-month supply. You can get a Unithroid® Copay Card online at https://www.activatethecard.com/7194
eVoucherRx Program: The eVoucherRx Program does not require a card. You get your Unithroid® prescription filled at a participating pharmacy. According to the manufacturer, most eligible patients with commercial insurance receive an automatic co-pay reduction at participating pharmacies when picking up a Unithroid® prescription. You can find the list of participating pharmacies in your area online at https://evoucherrx.relayhealth.com/storelookup.
Tirosint® Copay Coupons and Tirosint® Direct Program
Tirosint® is a specialty form of levothyroxine that comes in both capsules, and as an oral solution.
Tirosint® forms of levothyroxine have very few excipients, and no dyes, and are often recommended for patients with sensitivities or allergies to ingredients and dyes in levothyroxine tablets. (You can learn more about the effect of excipients and dyes in Part 1 of the Levothyroxine Deep Dive.) When compared to levothyroxine tablets, Tirosint® liquid capsules and Tirosint®-SOL oral solution have also been shown in research to have higher resistance to food, coffee, supplements, and medications that interfere with the absorption of levothyroxine tablets. The Tirosint® forms of levothyroxine are also frequently recommended for people with gastrointestinal and digestive conditions that impair their absorption of levothyroxine.
Tirosint® has the highest list price and retail cash prices of all the levothyroxine drugs. The average retail cash price without any discounts or insurance is around $175 a month, and the retail cash price with discounts/coupons is around $145 per month.
Because it’s typically categorized as Tier 3 or Tier 4, copays for Tirosint® average $59 to $105 a month.
Some health plans and Medicare Part D programs also do not cover Tirosint® on their formularies. The Veteran's Administration, the Department of Defense (Tricare), and Medicaid, however, cover Tirosint® at generally affordable copay prices.
Because of the high copays and retail prices associated with Tirosint®, the manufacturer has not only a copay card, but also a special wholesale program called Tirosint® Direct to make the drug affordable for everyone who could benefit from it.
Tirosint® Copay Cards
For patients with commercial health insurance and high copays, IBSA offers Tirosint® copay savings cards, which can be used at any retail pharmacy on Tirosint® or Tirosint®-SOL prescriptions. According to the manufacturer, 9 out of 10 patients with insurance will pay as little as $25 for a month’s supply when using the card.
For information on the Tirosint® copay savings card: go to https://Tirosint.com/patient-savings-resources/ways-to-save/copay-savings-card.
Download a Tirosint® copay saving card: https://coupon.tirosint.com
Because of the higher price of Tirosint®, IBSA has created the Tirosint® Direct program.
You can use the Tirosint® Direct Program even if you have no health insurance or prescription drug coverage, as long as you have a prescription. Under the program, you can order a one- or three-month supply of Tirosint® capsules or Tirosint®-SOL oral solution from one of IBSA’s network of designated mail order pharmacies.
The designated pharmacies have specifically trained their staff on how to get you the lowest possible price. They evaluate your insurance, determine the copay, apply the Tirosint® copay savings card, and in most cases, if you’re insured, you’ll pay no more than $25 a month for Tirosint® purchased through the program.
If you don't have insurance, or the copay is till high even with discounts – or, less commonly, your insurance doesn’t cover Tirosint® -- you will have the option to pay the program’s cash price of $50 per month, or $120 for a three-month supply ($40 per month.)
After ordering, you'll typically receive your filled prescription by mail within three days. You’ll also get a receipt that can be submitted to flexible spending account (FSA) or health savings account (HSA) administrators or health plans.For information on how to participate in Tirosint® Direct, go to: https://Tirosint.com/patient-savings-resources/Tirosint-direct-program
How Can Patient Assistance Programs Help You Afford Your Levothyroxine?
Patient Assistance Programs – known as PAPs – provide free or low-cost medication for people who qualify. Your eligibility for a PAP is based on your income and health insurance status. After you apply for a PAP and provide information about your income and insurance, you’ll be notified whether you are eligible.
Most major drug manufacturers have their own PAPs, and your starting place to apply is at their websites, where they provide information about their specific eligibility requirements.
Levoxyl®/Pfizer Patient Assistance Program
This program provides eligible patients with their Pfizer medicines for free. This program is based on income and insurance coverage. You can learn more about – and apply for – the program online at https://www.pfizerrxpathways.com/start-enrollment.
Synthroid®/AbbVie Patient Assistance Program
AbbVie’s Patient Assistance Program is based on your income eligibility, insurance coverage, and out-of-pocket medical expenses. You can review the income guidelines, and apply for the program online at https://www.abbvie.com/patients/patient-assistance/program-qualification/Synthroid-program-selection.html.
Tirosint®/IBSA Patient Assistance Program
IBSA has a patient assistance program for Tirosint®, with eligibility based on your annual household income and prescription insurance status.
After you complete and return an enrollment form, if you qualify, you will automatically be mailed your first one- or three-month supply. You will then be eligible to receive free medicine for up to one year by calling to refill your prescription every month. You need to re-enroll each year to remain in the program.
You can review the income eligibility requirements and apply for the program online at http://www.ibsapap.com.
Other PAP Programs
Beyond manufacturer programs, there are other PAPs run by non-profit organizations that may be able to help you offset the cost of medications if you are eligible. Here are several of the best places to search for patient assistance programs:
NeedyMeds – https://www.needymeds.org
RxAssist – https://www.rxassist.org/patients
Medication Assistance Tool – https://medicineassistancetool.org
Retailer Discount Programs
Grocery stories and pharmacies like CVS, Walgreens, Rite-Aid, Kroger, Publix, Meijer, Safeway, and others have retailer discount programs you can join that provide discounts on medications. For example, when you’re a member of these free or low-cost programs, you get discounts off the retail cash price of thousands of brand-name and generic medications.
You can search for these discount programs at NeedyMeds at https://www.needymeds.org/discount-drugs.
Also be sure to check with organizations you belong to, as some also offer pharmacy discount programs. For example, the American Association of Retired People (AARP) offers a discount program that saves members an average of 61% on prescriptions not covered by current insurance.
The Walmart $4 Prescription Program
You may be aware of Walmart’s nationwide $4 Prescription Program. Some pharmacists describe the Walmart program as a “loss leader,” meaning that Walmart takes a loss on some of their $4 medications so that customers use their pharmacy for other, more profitable medications.
You’ll find a list of all the drugs on their program – which includes levothyroxine – online at https://www.goodrx.com/blog/the-walmart-4-generic-prescriptions-list.
Walmart makes dosage sizes of generic levothyroxine from 25 mcg to 200 mcg available for $4 for a one-month supply, and $10 for a three-month supply.
The important takeaway: If your copay is more than $4 for generic levothyroxine, you’re overpaying.
Keep in mind that with Walmart, you won’t be able to specify which generic manufacturer’s product is being used to fill your prescription. You can learn why this is a problem for some thyroid patients in Part 1 of the Levothyroxine Deep Dive program.
Costco’s Member Prescription Program, available for Costco members, has Levoxyl® and Synthroid® on their preferred drug list. (You can view their full preferred drug list here.) According to Costco, as of Spring 2020, you can get a three-month supply of 88 mcg Levoxyl® for an estimated retail cash price of $69.00, and a three-month supply of 100 mcg Synthroid® for $125.99.
For more information, see https://www.costco.com/member-prescription-program.html.
BlinkHealth is a website that lets you preorder a prescription online at a negotiated discounted price, and then pick it up locally at one of 40,000 network pharmacies. You do not need medical insurance to use this free service. BlinkHealth is online at https://www.blinkhealth.com.
Outside Coupon and Discount Programs
Several services offer websites where you can compare drug prices at pharmacies in your area, and find manufacturer and retailer copay cards, coupons, and discounts. The two best places to start your research include:
Here’s an example: I used GoodRx and SingleCare to compare prices on a medication – not levothyroxine – that was not covered by my insurance. The retail cash price was around $198 a month at most pharmacies, but SingleCare had a discount coupon for retail/cash customers that brought the cost down to $98 at a local grocery store pharmacy. I saved $100 with every refill!
Here are several other recommended sites that you can use to compare prices, and research discounts include:
WeRx – https://werx.org
Drugs.com – https://www.drugs.com
HealthWarehouse – https://www.healthwarehouse.com
I recommend that, at minimum, you search both GoodRx and SingleCare every time you fill a prescription for any drug (not just levothyroxine). Discounts can change, and some of the best coupons and savings may be available at just one of these sites.
How Can You Save With Mail Order Pharmacies?
Your health plan may offer refills of prescriptions – including levothyroxine – from their mail order pharmacy. Usually these refills are available at lower cost than at local pharmacies. It’s worth contacting your health plan to find out what price difference for mail mail-order pharmacy refills.
If you are taking Unithroid® or generic levothyroxine you can get low prices from several wholesale mail order pharmacies. Note, however, that these pharmacies do not accept medical insurance, so you’ll pay their retail cash price.
Mail My Prescriptions
Mail My Prescriptions is a mail order pharmacy licensed in 49 states. They offer free shipping. They offer two features that are unique among the mail order pharmacies: first, they guarantee the lowest cash-pay generic drug prices, and second, they price match any competitor. They also let you specify your preferred levothyroxine, letting you choose Amneal’s Unithroid® or the generic levothyroxine from Alvogen. As of Spring 2020, their price is listed as $11 to $22 for a one-month supply. Mail My Prescriptions is online at: https://www.mailmyprescriptions.com.
Honeybee Health is a discount wholesale mail order pharmacy, licensed in 41 states. They offer free shipping. You won’t be able to specify a generic from a particular manufacturer with Honeybee. Honeybee charges $8 for a one-month supply, $22 for a three-month supply, and $44 for a six-month supply of generic levothyroxine. You can find Honeybee online at https://honeybeehealth.com.
Rx Outreach is unique, as it’s a nonprofit charitable mail order pharmacy that provides eligible patients with access to more than 800 medications at an affordable cost. If you’re eligible, you can get generic levothyroxine for $10 for a month’s supply, $13 for three months, and $20 for six months. If you’re eligible, you can get a full year of generic levothyroxine treatment for $40. Rx Outreach is on the web at https://rxoutreach.org.
How Can You Save By Paying Retail/Cash Prices?
As noted, in many cases, your copay amount is higher than the retail cash price of levothyroxine. According to a study released by the University of Southern California's Schaeffer Center for Health Policy & Economics:
42% of patients overpay for generic levothyroxine, an average of $6 per prescription, or $72 a year
The overpayments for brand names are even higher!
Around 44% of patients purchasing Synthroid® overpay around $10.50 per month, or $126 per year
Almost 50% of all patients purchasing Levoxyl® overpaid by around $12 per month, or $144 per year
And we also know that many patients using Tirosint® overpay by as much as $50 to $100 per month, or $600 - $1200 per year!
Let’s take a look at what’s happening when you overpay.
As mentioned, for every medication, there’s your copay amount, and there’s a retail cash price. Here’s a question: When your copay is more than the cost of the drug, where do those savings go?
The answer: Frequently, those savings go back to the PBM. This is known as a clawback. The PBM is “clawing back” the savings between the drug's cost and your higher copay.
Here are two important things you need to know about clawbacks:
Some states prohibit clawbacks and in those states, pharmacists are required to tell you if a cash price is less than your copay.
Some states permit clawbacks, and in some of those states, gag clauses also legally prevent pharmacists from voluntarily telling you that you could pay less!
There’s a solution to overpaying that will let YOU get the instead of a PBM:
You MUST ALWAYS ask the pharmacist directly: “Which price is lower? My copay, or the retail cash price?”
Even in states where pharmacists aren’t allowed to offer this information, they are always permitted to tell you your lowest price option, and in fact, must do so – but ONLY IF YOU ASK.
Here's a summary of how clawbacks work.
At your retail pharmacy, if you don't ask the copay price versus retail cash price, in many cases, you'll automatically pay the copay price. If the copay price is higher -- and about 50 percent of the time it is -- the savings between the copay and the retail cash price is going to be "clawed back" by the pharmacy benefit manager.
If you do ask what the copay price is versus the retail cash price, and you pay the lower price, YOU are pocketing the savings.
And remember that if you’re taking a brand name levothyroxine, you’ll also want to have a manufacturer copay card or discount coupon on hand, so that can be factored in to your copay cost. Similarly, do your homework ahead of time to find any outside coupon and discount programs, so that you can get every possible discount on the retail cash price.
And don’t forget that if you have a flexible spending account (FSA) or health savings account (HSA), you can use those accounts to pay for prescription medications, which may offer additional savings.
Are Multi-Month Refills Cheaper?
Don’t forget that you may be able to save by ordering more than a one-month refill for your levothyroxine. How much you save depends on whether it’s a generic or brand name, and where you fill your prescription.
Here are a few examples:
Generic levothyroxine at Walmart is $4 a month ($48 a year), or $10 for a three-month supply ($40 a year). Choosing three-month refills would save you $8 a year.
The retail cash price of Levoxyl® at CVS is $32 a month ($384/year). A three-month supply is $80 ($320/year). Choosing three-month refills would save you $64 a year.
With the Tirosint® Direct program, the retail cash price is $50 a month, or $120 for a three-month supply. Choosing three-month refills would save you $120 a year.
Is Splitting Tablets a Good Option for Levothyroxine?
Whether you split them by hand or with a pill splitter, tablet splitting is rarely precise. You can end up with uneven pieces, small pieces can become powdered, and uneven dosing. But for medications where precise dosing is not important, splitting tablets can be an effective way to cut the cost per dosage.
What about levothyroxine? Research has shown that the act of splitting a levothyroxine tablet can result in inconsistent dosing, and change the surface area of the pill, making the tablets degrade more quickly in terms of potency and stability. Because levothyroxine has a very narrow therapeutic index, splitting tablets is not generally recommended.
Note: levothyroxine in gelatin capsules can’t be split under any circumstances.
Summary: Saving on Brand Name and Generic Levothyroxine
Here are the most important takeaways regarding the costs of levothyroxine drugs:
If you take generic levothyroxine or Unithroid®, you should not be paying more than $4 to $10 a month for your prescription, whether or not you have health insurance.
If you take Levoxyl®, you should not be paying more than around $15-$20 a month for your prescription if you have health insurance.
If you take Synthroid®, you shouldn’t be paying more than around $25 a month if you have health insurance.
If you’re taking Tirosint® or Tirosint®-SOL, you should not be paying more than around $25 a month if you have health insurance. If you’re uninsured, you should not be paying more than $40 to $50 per month.