The Most and Least Expensive Cities for Prescription Medications

Americans are being hit by inflation in the grocery store, at the gas pump, and likely at the pharmacy. 

But prescription drugs don’t cost the same across the country. In fact, the average price of a prescription drug varies by city. So while some are hit with sticker shock for common generic medications, others are paying substantially less, simply because of where they live.

The map below shows the price of prescription drugs relative to the national average in 30 cities across the U.S. While we can see some general trends, there are some cases where drug pricing varies between closely neighboring states or cities. 

The map is based on cash prices for the 500 most commonly prescribed medications in 30 U.S. cities. Prices are based on a representative sample of U.S. prescription fills (not fills using GoodRx).

The most expensive cities for prescription drugs

Over the past 4 years, the GoodRx Research team has been tracking drug prices in cities across the U.S. to understand “cheap” and “expensive” areas for prescription drugs. Since the start, San Francisco and Los Angeles, not surprisingly, have been two of the most expensive cities for prescription drugs. 

But a strange phenomenon, possibly driven by inflation, has led to Lexington, Kentucky, and Little Rock, Arkansas replacing San Francisco and Los Angeles at the top of the list. Both are smaller cities, with higher-than-average rates of multiple chronic conditions, indicating a need for prescription medications.

New York and New Orleans also make the list of top five most expensive cities, with residents paying 10% and 11% more, respectively, at the pharmacy than the national average. 

The least expensive cities for prescription drugs

In stark contrast to the most expensive cities list, there has been little movement on the least expensive cities list. In fact, Denver, Colorado, has been the least expensive city for prescription medications since GoodRx Research began this analysis 4 years ago. In Denver, residents pay nearly 40% less for their prescriptions than the national average.

Why do prices differ so much by city?

Drug pricing across the country is highly variable. It’s not a huge surprise that prescription drug prices rank well above the national average in New York and Los Angeles — cities with a high cost of living. And, unfortunately for Californians, drug costs are higher than the national average across the entire state.

The relationship between cost of living and prescription cash prices seems to hold for a few more cases. In cities like Kansas City, Missouri, and Greenville, North Carolina — where the cost of living is relatively low — drug costs remain relatively low compared to the national average. But this direct correlation between cost of living and prescription drug prices doesn’t fully explain the differences that we see in the cost of medications around the country. 

In Atlanta, the cost of living is relatively high, but prices are almost 19% lower than the national average. And while the cost of living in Denver has increased in recent years, its drug prices are the lowest in our analysis compared to the national average. 

\When it comes to the Midwest, drug costs vary between nearby cities. In cities like Indianapolis, Chicago, and Minneapolis-St. Paul, prices are below the national average. But drug prices in Cleveland, Cincinnati, and Milwaukee are all higher than the national average. In Detroit, prices fall nearly 17% below the national average. But just north, in Flint, Michigan, they are over 5% higher.

The role of inflation

It’s no secret that inflation has reached recent historic highs over the last year. As prices for goods and services increase across the country, prescription drugs are no exception. 

Each year, the U.S. Bureau of Labor Statistics releases the Consumer Price Index report, which details how prices for commodities have changed over the past year on both national and local levels. This year, the category with the largest percent change was energy costs, which increased by nearly 33% in the past 12 months. Consumers like yourself have likely felt the pain of this increase while filling up at the gas pump.

However, while energy may not seem directly related to medication, it is involved in the production of all manufactured goods. Energy plays an integral role in the prescription drug supply chain, ranging from the electricity required to power production plants for these medications, all the way to the fuel that goes into the trucks and planes that ship these goods across the country. 

All of this to say: It takes a lot of energy to get your medications from their manufacturer to your bathroom cabinet. When the cost of such an essential resource increases so dramatically, this added expense is likely reflected in the price you pay at the pharmacy and could be a potential influence on the increase in drug prices. 

Inflation has also had more profound effects on certain regions of the country. Pew found that Sun Belt states had the highest overall inflation at 9.9%. Examples of states in this region include Arkansas and Louisiana, both of which have cities on our top five list — Little Rock and New Orleans — the latter being a new addition.

The big-box store effect

Another factor that could be at play is a phenomenon that we refer to as the “big-box effect.” Many larger big-box stores, such as Walmart, offer popular brand-name and generic drugs for cheaper prices — often $4 for a 30-day supply and $9 for a 90-day supply. Some states have more of these big-box stores than others, giving residents more opportunities to save on medications.

There is also the retail markup that a pharmacy puts on a prescription. Some pharmacies will claim a higher margin to support their business, and those pharmacies may be distributed unevenly across states.

These probably aren’t the only factors at play, but one thing is for sure: Drug pricing is complex.

Co-contributors: Diane Li, Lauren Chase, Jeroen van Meijgaard, PhD, and Tori Marsh, MPH

Methodology

To determine the most and least expensive cities for prescription drugs, we observed the cash prices of the 500 most commonly prescribed medications in 30 U.S. cities from July 1, 2021 to July 1, 2022. These numbers are based on a representative sample of U.S. prescription fills (not fills using GoodRx) and come from several sources, including pharmacies and insurers.