Out-of-Pocket Costs for Patients Using Generic Versus Brand-Name Prescription Medications
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By
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Christopher L. Cai
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Aaron S. Kesselheim
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Benjamin N. Rome
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September 11, 2026
Clinical Scorecard: Out-of-Pocket Costs for Patients Using Generic Versus Brand-Name Prescription Medications
At a Glance
| Category | Detail |
|---|
| Condition | Out-of-Pocket Costs for Prescription Medications |
| Key Mechanisms | Comparison of out-of-pocket spending between generic and brand-name medications. |
| Target Population | US noninstitutionalized population using prescription medications. |
| Care Setting | Pharmacy dispensed medications. |
Key Highlights
- Generic medications accounted for 90% of prescriptions filled in the US.
- Mean annual out-of-pocket spending was $51 for generic drugs and $41 for brand-name drugs.
- 51.91% of individuals filled generic medications, while 15.81% filled brand-name medications.
- Nationally, estimated out-of-pocket spending was $16.8 billion for generics and $13.7 billion for brand-names.
- Out-of-pocket spending varied significantly by insurance type and age.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
US residents using prescription medications.
Higher out-of-pocket spending for generics despite lower per-drug costs for brand-name medications.
Clinical Best Practices
- Consider strategies to reduce out-of-pocket costs for both generic and brand-name medications.
- Evaluate insurance benefit designs to improve medication access and adherence.
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