When you fill a prescription, do you ever wonder why two pills cost more than one? It’s not just you. Many people pay more for combination drugs-like asthma inhalers or blood pressure pills that pack two medicines in one-when they could be saving big by switching to separate generic versions. The truth? Generic combinations aren’t always the cheapest option. Sometimes, buying the individual generics separately saves you hundreds of dollars a year.
Why Some Generics Cost More Than Others
Not all generic drugs are created equal. Just because a drug is off-patent doesn’t mean it’s cheap. A 2022 study from JAMA Network Open looked at the top 1,000 generics used in Colorado and found something surprising: 45 of them were costing patients and insurers way more than they should. These weren’t brand-name drugs. They were generics. But they were priced 15.6 times higher than other generics with the same effect.
Take a common example: a generic version of a blood pressure medication might cost $120 for a 30-day supply. But a different generic, with the exact same active ingredient and dosage, might only cost $8. That’s a 93% difference. Why? It’s not about quality. It’s about competition. When multiple companies make the same drug, prices drop. But if only one company makes a particular generic, they can charge more. It’s like having a monopoly on a basic medicine.
The study found that replacing these overpriced generics with cheaper alternatives could cut total spending by 88.3%. That’s $7.5 million down to $873,711 in just one state. And it wasn’t because they switched to a different medicine. They just switched to a different version of the same medicine-different strength, different pill shape, different manufacturer. Same effect. Much lower cost.
Combination Drugs: The Hidden Cost Trap
Combination drugs are designed to make life easier. One pill instead of two. Sounds smart, right? But when those combinations are brand-name products, they’re often priced way above the sum of their parts. Take Advair Diskus, a popular asthma inhaler that combines an inhaled corticosteroid and a long-acting beta agonist. Before generics hit the market, it cost about $334 per inhaler. Then Wixela Inhub, the first generic version, came out. It cost $115. That’s a 65.6% drop.
But here’s the twist: you didn’t need to buy Wixela Inhub to save that much. You could have bought the two individual generic inhalers separately-fluticasone and salmeterol-and combined them yourself. In many cases, the total cost of buying them separately was even lower than the generic combination. And you had more control over dosing. The same pattern shows up with diabetes drugs like Janumet (metformin + sitagliptin) and blood pressure combos like Amturnide (aliskiren + amlodipine + hydrochlorothiazide). The branded combo is expensive. The generic combo is cheaper. But the individual generics? Often the cheapest of all.
How Much Can You Actually Save?
The numbers speak for themselves. The Association for Accessible Medicines reported that the top 10 generic drugs saved $89.5 billion in 2023 alone. Crestor (rosuvastatin) went from $5.78 per pill to $0.08. Prilosec (omeprazole) dropped from $3.31 to $0.05. That’s 98% to 99% savings. And it wasn’t magic. It was competition. When five companies start making the same drug, prices crash.
Even better: a 2023 study from JAMA Health Forum looked at 843 million pharmacy fills and found that 11.8% of them had potential out-of-pocket savings. Uninsured patients saved the most-28.9% of their fills had lower-cost options. Medicare users saved on 5.5% of fills. Private insurance? 7.1%. The average savings per prescription? $4.96. But for some, it was over $10. That’s $60 a month. $720 a year. Just by switching pills.
And it’s not just about pills. A 2022 analysis of inhaled asthma medications showed that switching from branded Advair to generic Wixela saved $941 million in one year. But if patients had gone even further-buying the two separate generics instead of the combo-the savings could have been even higher.
What’s Holding You Back?
So why don’t more people do this? Three big reasons:
- Doctors don’t always know. Many prescribers assume the combo pill is the best-or only-option. They don’t realize the individual components are available as cheap generics.
- Pharmacies don’t always offer it. Some pharmacies default to the combo because it’s easier to dispense. They don’t ask if you want to split it.
- Insurance formularies push combos. Some plans still list the combo as the preferred option, even if the individual generics are cheaper. They get rebates from drugmakers. You don’t.
The FDA’s Orange Book lists which generics are therapeutically equivalent. If a drug has an “A” rating, it means you can swap it safely. But that doesn’t mean your pharmacist will suggest it. You have to ask.
How to Find the Cheapest Option
Here’s how to save without risking your health:
- Ask your doctor: “Are the individual components of this combo drug available as separate generics?”
- Ask your pharmacist: “Can I get the two drugs separately instead of in one pill? Which option is cheaper?”
- Use free price-check tools like GoodRx, SingleCare, or Blink Health. Compare the cost of the combo pill vs. the two individual generics.
- Check your insurance formulary. If the combo is listed as “preferred,” ask if the individual generics are covered at the same tier.
- If you’re on Medicare or Medicaid, ask about the 340B program or discount pharmacies. Some savings are hidden.
Don’t assume the prescription you got is the cheapest. A 2023 report found that 50% of all prescriptions with savings had savings under $5. But 28% had savings over $10. That’s the difference between paying $100 a month and $80. That’s $240 a year. Enough for a weekend trip, a new pair of shoes, or a refill you didn’t have to skip.
What’s Changing in the Market
The generic drug market is under pressure. While 90% of prescriptions are filled with generics, they make up only 23% of total drug spending. That’s a win. But there are warning signs. Generic shortages are rising. The top 10 manufacturers control 40% of the market. That means less competition. And less price pressure.
The FDA approved 724 generic drugs in 2023-down from 843 in 2017. Fewer approvals mean fewer competitors. Fewer competitors mean higher prices. That’s why it’s more important than ever to check your options. The system isn’t broken. But it’s not working for everyone.
Meanwhile, biosimilars-generic versions of complex biologic drugs-are starting to enter the market. The first biosimilar for Humira, a top-selling autoimmune drug, hit shelves in 2023. Prices are already 20-30% lower than the brand. More are coming. This is the next wave of savings.
Bottom Line: You Have Power
Generic drugs saved $3.7 trillion over the last decade. But the biggest savings aren’t always in the combo pill. Sometimes, they’re in the two separate generics you never thought to ask for. You don’t need a PhD to save money on your meds. You just need to ask the right questions.
Next time you get a prescription for a combination drug, pause. Look up the ingredients. Compare prices. Talk to your pharmacist. You might be paying way more than you need to. And you don’t have to.
Are combination drugs always more expensive than individual generics?
No, not always. Some generic combination drugs are priced competitively, especially when multiple manufacturers produce them. But in many cases, buying the two individual generics separately is cheaper. For example, Wixela Inhub (a generic combo for asthma) costs $115, but buying fluticasone and salmeterol separately can drop the total cost below $100. Always compare prices using tools like GoodRx.
Can I ask my pharmacist to split my combo prescription into two separate generics?
Yes, absolutely. Pharmacists are trained to help you find the most cost-effective option. If your prescription is for a combination drug, ask: “Can I get the individual components as separate generics? Which option is cheaper?” They can check your insurance formulary and the current prices. Many pharmacies will do this automatically if you ask.
Why are some generic drugs so expensive?
Some generics are expensive because there’s little competition. If only one company makes a particular generic, they can charge more. This often happens when the drug has a complex manufacturing process, or when patents or regulatory delays block other companies from entering the market. The JAMA Network Open study found that 62% of high-cost generics had cheaper alternatives with the same active ingredient-just in a different strength or form.
Do insurance plans encourage generic combinations?
Sometimes, yes. Some insurance plans list combination drugs as “preferred” because they get rebates from drugmakers. But that doesn’t mean they’re the cheapest option for you. Always check your out-of-pocket cost for the combo versus the individual generics. If the individual generics are covered at the same tier, you could save money by choosing them.
Is it safe to switch from a combo drug to two separate generics?
Yes, if your doctor approves it. The FDA’s Orange Book lists drugs that are therapeutically equivalent. If both the combo and the individual generics have an “A” rating, they’re considered interchangeable. Always consult your doctor before making changes, especially for medications like blood pressure, diabetes, or asthma drugs. But switching to separate generics is often safer and cheaper than staying on a high-cost combo.
