I paid 90 dollars for a prescription once because I walked into the pharmacy and just paid the sticker price. The pharmacist handed me the bag, saw my face, and said: you know this is 18 dollars with a discount card, right? I had no idea. Nobody tells you this stuff.

If you pay for prescriptions without insurance, you are almost certainly overpaying. Here is what actually works.

Always ask for the discount card price

Pharmacies run discount card programs that can cut prices dramatically. These are not insurance, they are negotiated rates the pharmacy accepts. The key is that you have to ask, because the pharmacy charges the default price unless you do. Walk up, say the magic words: can you run the discount card price? That single question has saved me more than anything else.

Compare prices between pharmacies

Prices for the same drug vary wildly between pharmacies, even in the same town. A medication can be 40 dollars at one chain and 15 at the one across the street. Call around and ask for the cash price before you fill. I keep a mental list of which pharmacy is cheapest for which of my refills.

Ask your doctor about generics

If your prescription is a brand name, ask the doctor if a generic version is appropriate. Generics can cost a fraction of the brand and they are the same active ingredient. Doctors often prescribe brand by default without realizing the cost difference. One conversation with my doctor cut one of my medications from 60 dollars to 8.

Look into assistance programs

Many drug makers run patient assistance programs that provide their medications free or at low cost to people without insurance. Your doctor or pharmacist can usually point you to the program for your specific drug. It is a little paperwork, but for expensive medications it can be a lifesaver. I know someone on a diabetes medication who gets it free through the manufacturer’s program.

Buy in larger quantities

Ask the pharmacy about the 90-day supply price. Many medications cost barely more for three months than they do for one. If you take something daily, the 90-day fill can cut your yearly cost significantly. The pharmacy usually brings it up, but if they do not, ask.

The whole system is quiet about these options, so you have to be loud. Ask the questions, compare the prices, and never assume the first number you hear is the real one. My prescription costs went from 90 dollars to 18 on the exact same medication, same pharmacy, one question.