The Most and Least Expensive Cities for Prescription Medications

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You might expect prescription medications to cost the same across the country. But this isn't the case. In fact, the average price of a medication varies from city to city.

So while some people may have sticker shock for common generic medications, others may pay substantially less, simply because of where they live.

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

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

The 5 most expensive cities for prescription medications

Little Rock-Pine Bluff, New Orleans, New York, Milwaukee, and Lexington

Over the past 5 years, the GoodRx Research team has tracked medication prices in cities across the U.S. to locate "low-cost" and "expensive" areas for prescription medications.

Large cities with high costs of living, such as New York and Los Angeles, have unsurprisingly landed near the top of the list. However, this pattern seems to be changing.

In this year's update, New York replaced Los Angeles on the top five list. Residents of the Big Apple pay nearly 18% more than the average American at the pharmacy.

However, similar to last year's update, Southern cities made up the majority of the top five most expensive cities. Little Rock, New Orleans, and Lexington came in at positions one, two, and five, respectively. All three are midsized cities with higher-than-average rates of multiple chronic health conditions. That means that residents in these cities may have a high need for prescription medications but are paying higher prices for them.

Milwaukee, Wisconsin also reappeared on the list of most expensive cities. Residents of this Midwestern city pay 16% more than the national average at the pharmacy.

The 5 least expensive cities for prescription drugs

Denver, Houston, Atlanta, Dallas-Ft. Worth, and Tampa-St. Pete (Sarasota)

The five least expensive cities list also looks similar to last year's list. Cities in Sunbelt states made up the majority of the list.

For example, Houston, Texas, and Atlanta, Georgia are among the least expensive cities again. Prices there are 27% and 21% below the national average, respectively.

Denver, Colorado, has been the least expensive city for prescription medications since GoodRx Research began this analysis 5 years ago. In Denver, residents pay 37% less for their prescriptions than the national average.

The Tampa-St.Pete metro area also remains on the least expensive cities list this year. Prices there hover around 14% below the national average.

Why do prices differ so much by city?

It's not shocking that prescription medication prices are well above the national average in places like New York - a city with a high cost of living.

The relationship between cost of living and prescription cash prices seems to hold for a few more cases, too. In cities like St. Louis, Missouri, and Greenville, North Carolina - where the cost of living is relatively low - medication costs also remain relatively low compared to the national average.

But cost of living doesn't fully explain the differences that we see in the price of medications around the country.

In Atlanta, the cost of living is relatively high. But prices are 21% lower than the national average. And while the cost of living in Denver has increased in recent years, its medication prices are the lowest in our analysis compared to the national average.

When it comes to the Midwest, medication costs vary significantly between nearby cities. Prices are below the national average in cities like Indianapolis, Chicago, and Minneapolis-St. Paul. But prices in Milwaukee are higher than the national average. In Cincinnati, prices are 3% below the national average. But just 100 miles south, in Lexington, Kentucky, prices are 15% higher than the average.

GoodRx Health

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 large big-box stores, such as Walmart, offer popular brand-name and generic medications for lower 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 other states, giving residents more opportunities to save on their 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.

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

Read previous most expensive cities reports:

• March 2023

Methodology

To determine the most and least expensive cities for prescription medications, we tracked cash prices for the 500 most commonly prescribed medications in 30 U.S. cities fromJanuary 1, 2023 to January 1, 2024. 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.

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