Four main tools exist to help Americans afford prescription drugs: manufacturer patient assistance programs, discount platforms like GoodRx, transparent-pricing pharmacies like Cost Plus Drugs, and the federal 340B program. Each one works. Each one fails specific populations by design. No single program covers everyone, and the gaps between them are where patients fall through.

Patient Assistance Programs

Pharmaceutical manufacturers run their own affordability programs. These include free trial supplies, bridge programs that cover the gap between FDA approval and insurance coverage, and copay assistance cards that reduce the patient's out-of-pocket cost at the pharmacy counter.

Every manufacturer sets its own rules. AbbVie's myAbbVie Assist program, for example, caps eligibility at $62,600 for a single individual and $128,600 for a family of four. Other companies draw the line higher or lower. There is no standardised enrollment process. Each program requires a separate application. Both the patient and the prescribing provider must complete paperwork, and providers frequently lack clear information on which patients qualify for which programs.

Structural Problems

The biggest exclusion is Medicaid. Patients enrolled in Medicaid cannot access most manufacturer assistance programs. Federal anti-kickback and best-price regulations block it. This means the lowest-income patients with insurance are shut out of manufacturer help.

Medicare Part D creates a different problem. Assistance from manufacturer copay cards does not count toward true out-of-pocket costs (TrOOP). A patient using a copay card gets help paying each month but does not progress toward the catastrophic coverage threshold. The card subsidises the insurer's obligation without moving the patient closer to the point where Medicare picks up most of the cost.

Then there are accumulator adjustment programs. These are insurer-designed mechanisms that pocket the value of a copay card without crediting the patient. The patient presents their manufacturer copay card at the pharmacy. The card pays. The insurer collects that payment but does not apply it toward the patient's deductible or out-of-pocket maximum. When the copay card runs out, the patient still owes the full deductible.

Maximizer programs take this further. Insurers restructure copay card benefits into monthly installments calibrated to extract the maximum card value each month, stretching the card's benefit across the full year while the insurer captures the savings.

The final problem is systemic. Manufacturers offset the cost of patient assistance by raising list prices. The subsidies get baked into higher prices for the broader market. Free drugs for some patients, more expensive drugs for everyone else.

GoodRx

GoodRx is a free app that compares prescription prices across pharmacies and offers discount coupons at the point of sale. The company claims Americans have saved $85 billion or more through the platform.

The business model exploits a gap in the pricing system. Pharmacies set a retail price (Usual and Customary, or U&C) that is often significantly higher than the rate negotiated through pharmacy benefit managers. GoodRx connects patients to those lower PBM-negotiated rates and collects approximately 15% of the patient's total retail prescription cost through fee-sharing agreements with PBMs.

Who It Actually Serves

Three out of four GoodRx users already have insurance. The platform is primarily a price arbitrage tool for insured patients, not an access gateway for the uninsured. An insured patient may find that GoodRx's coupon price is lower than their insurance copay, particularly for generics with high copays or for patients in the deductible phase of a high-deductible plan.

In 2023, GoodRx became Express Scripts' exclusive discount card partner for commercial beneficiaries. Its Pharma Direct revenue reached $151 million, up 41% from the prior year, as more than 50 brands began using GoodRx's point-of-sale cash buydown programs. GoodRx also launched a telehealth service charging $59 per month for GLP-1 prescriptions.

Limitations

GoodRx does not change underlying drug prices. It works within the existing PBM and pharmacy spread system. The prices that manufacturers set remain untouched. Savings vary by pharmacy, location, and specific drug. The platform also monetises prescription data and user behaviour, raising privacy concerns that have drawn regulatory scrutiny.

Cost Plus Drugs

Mark Cuban and pharmacist Alex Oshmyansky founded Cost Plus Drugs in January 2022. The model is transparent pricing: manufacturer acquisition cost plus a 15% markup, plus a $5 pharmacy fee, plus $5 shipping.

The result, for the drugs it carries, is dramatic. Albendazole retails at approximately $500 at a traditional pharmacy. Cost Plus sells it for roughly $35. That is a 93% reduction. The difference is not a discount or a rebate. It is the removal of every intermediary markup.

Growth and Evidence

The company expanded from 100 medications at launch to 2,200 or more within two years. It has over 2 million members. Cost Plus holds a wholesaler license, meaning it buys directly from manufacturers and bypasses the McKesson/AmerisourceBergen/Cardinal Health distribution oligopoly that controls most US drug distribution.

An "UnPBM" service now offers direct-to-employer pricing, claiming 50 to 90% savings on generic drug spending compared to conventional PBMs.

A September 2025 study in JAMA Network Open compared Cost Plus prices to insurance prices on 33 medications. Cost Plus showed lower total system costs on all 33. For uninsured patients buying generics, Cost Plus delivered average savings of 28.9%.

Critical Limitations

For Medicare beneficiaries filling generics, only 5.5% of fills through Cost Plus beat the insurance price. The program's value proposition is strongest for the uninsured and weakest for those already in Medicare Part D. As with manufacturer copay cards, Cost Plus purchases do not count toward Medicare Part D TrOOP.

The catalogue is primarily generics. Brand-name options are limited. Cost Plus does not offer insulin, which is a critical gap given that insulin is the drug most publicly associated with the US affordability crisis. There is no same-day pickup. The shipping model means patients with urgent prescriptions must look elsewhere.

The 340B Program

Section 340B of the Public Health Service Act, enacted in 1992, requires drug manufacturers participating in Medicaid or Medicare Part B to sell outpatient drugs at or below a ceiling price to qualifying safety-net providers. The ceiling price is calculated as the Average Manufacturer Price minus the Unit Rebate Amount. Typical discounts range from 25 to 50% off average drug prices. Some reach penny pricing, below $0.01 per unit.

Sixteen categories of organisations qualify as covered entities. These include Disproportionate Share Hospitals, Federally Qualified Health Centres, Ryan White HIV/AIDS clinics, children's hospitals, and critical access hospitals.

The Money

Covered entities' collective 340B-related profits doubled from $20.2 billion in 2015 to $40.5 billion in 2019. The mean hospital profit from Medicare Part B drugs alone was $2.5 million per hospital in 2016. This is not a small program. It is a $40 billion revenue stream for hospitals and clinics.

The Accountability Gap

The program's stated purpose is to stretch scarce federal resources and enable covered entities to serve more patients. Research has tested whether it achieves that goal. The answer, with one exception, is no.

Studies have found no discontinuity in care quality at 340B eligibility thresholds. Hospitals that barely qualify show no measurable improvement in care for low-income patients compared to hospitals that barely miss the threshold. There is no demonstrated relationship between 340B participation and increased services for low-income patients at the hospital level. The $40 billion flows to entities. It does not demonstrably flow to patients.

The exception is specific: 340B diabetes and hyperlipidemia clinics show 5 to 7% higher medication adherence rates. In that narrow application, the program achieves its purpose. Rural hospitals also use 340B revenue as a financial lifeline to remain operational, which serves patients indirectly.

Oversight

HRSA conducts over 200 audits of covered entities per year. The FY2024 results: 24% of audited entities were required to repay manufacturers for overcharges. Eight percent were required to terminate contract pharmacy arrangements. These are not trivial compliance failures. One in four audited entities had billing problems significant enough to require repayment.

Emerging Reforms

The limitations of existing programs have pushed both industry and Congress toward structural changes.

CVS launched CostVantage in 2025, a cost-plus pharmacy reimbursement model that applies transparent markups rather than opaque spread pricing. In the same year, CVS Caremark introduced TrueCost, a pricing transparency tool for plan sponsors. Both signal that the industry recognises the status quo is under pressure.

The HELP Copays Act (H.R. 830), introduced in February 2023, would require that copay card payments from manufacturer assistance programs count toward a patient's out-of-pocket maximum. If passed, it would neutralise accumulator adjustment programs. The bill has not advanced as of early 2026.

The Inflation Reduction Act's Medicare drug price negotiation program, which began with 10 drugs in 2026, represents the first direct federal intervention in drug pricing. Its expansion to additional drugs in 2027 and beyond will shape whether systemic pricing changes reach beyond the small set of drugs currently covered.

Which Program Serves Which Population

Situation Best option Key limitation
Uninsured, taking generics Cost Plus Drugs No insulin, no same-day pickup
Insured, high copay on a generic GoodRx Savings vary; does not lower actual prices
Insured, high copay on a brand drug Manufacturer copay card Accumulator programs may void the benefit
Uninsured, taking a brand drug Manufacturer PAP (if eligible) Income limits; complex enrollment
Medicaid enrollee Medicaid formulary (limited alternatives) Excluded from most manufacturer PAPs
Medicare Part D, high spending $2,000 annual OOP cap (2025+) Cost Plus and PAP payments don't count toward TrOOP
Low-income, near a safety-net clinic 340B-participating provider Savings may not pass through to the patient

The table makes the structural problem visible. Every row has a limitation column because every program was designed within a system that treats high drug prices as a given. These tools mitigate cost at the edges. None of them addresses the root: how manufacturers set prices in the first place.