Which States Are Cheapest for Prescription Drugs?

Prescriptions can leave a huge dent in a wallet, especially for seniors. According to MedicareGuide, prescriptions cost Americans a whopping $407 billion in 2020, and those 65 and older spent an average of $7,554 each. Medicare helps, but 3 out of 20 people on Medicare still were faced with a drug bill they had trouble paying last year, MedicareGuide has found. A recent report by the insurance technology company compared prices across the country to find the most expensive states for prescription drugs — and the cheapest.

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To rank states on prescription drug costs, MedicareGuide analyzed five things:

• Average annual Medicare Part D drug deductible
• Average Medicare Part D monthly premium
• Percent of taxable earnings going to Medicare Part D drug coverage
• Medicare Part B drug actual costs per capita
• Annual prescription drug prices per capita

States were also evaluated in other categories: access to drugs and quality of insurance coverage. Access to drugs was judged by the number of Medicare Part D plans per state, Part D enrollment by state, pharmacists per capita, and pharmacies per 10,000 residents. Quality of insurance coverage was judged by percent change in Part D enrollment from 2020 to 2021, average Part D penetration, and average Medicare Part D star ratings.

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In the states with the most expensive prescription drugs, there are often other problems, as well, according to MedicareGuide. In at least one case, though, the high drug prices seem like a spoiler for an otherwise good reputation among retirees.

Although Pennsylvania is 10th-worst in the nation for prescription drug costs, the news is better when it comes to access to drugs, where the Keystone State is actually 10th-best among the states.

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Colorado’s poor ranking on prescription drug costs is balanced out, at least a bit, by average showings in other categories: It’s 24th for access to drugs and 17th for quality of insurance coverage. 

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Though the Old Line State is among the most expensive for prescription drug costs, it’s actually the very best place to be for quality of insurance coverage, ranking first in that category.

Everything’s bigger in Texas, including potential prescription costs. The Lone Star State is also lower on the totem pole when it comes to access to drugs and quality of insurance coverage. It’s 35th in both categories.

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The nation’s capital is a notoriously expensive place to live — and also one of the most expensive places to be for prescription drugs. More bad news: It ranks a dismal 49th for quality of insurance coverage.

Nebraska is a pricey place for prescriptions, but it fares much better when it comes to access to drugs, ranking second only to North Dakota.

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Illinois is not known as a particularly tax-friendly state, and you can add drug costs to the list of things that could cost you big time: The state has the worst average annual Medicare Part D drug deductible. For access to drugs and quality of insurance coverage, it lands in the middle.

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Alabama is a dismal third-to-last for drug costs, but the bad news doesn’t stop there. It fares even worse when it comes to quality of insurance coverage, ranking dead last in that category.

Utah’s poor prescription cost ranking is nothing to crow about, but it does do better on quality of insurance coverage, ranking eighth among the states.

Tennessee is a favorite of retirees thanks to its relatively low taxes and moderate climate, but the state is the priciest for prescription drugs, according to MedicareGuide’s data. Helping drag it down: the worst showing of all states on annual prescription drug prices per capita.

Where do seniors stand a better shot of being able to afford prescriptions? MedicareGuide identified the following 11 states as the top performers.

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North Carolina and Michigan score just inside the top 10 states for cheapest prescriptions. Michigan edges out North Carolina when it comes to access to drugs (17th vs. 25th) and quality of insurance coverage (25th vs. 28th).

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Mississippi makes a strong showing on prescription costs, faring particularly well thanks to the best average Medicare Part D monthly premium. But it’s in the bottom half of states for access to drugs and quality of insurance coverage.

Big Sky Country is an all-around strong performer: Aside from its top 10 finish on prescription costs, it’s actually No. 4 among states for access to drugs and quality of insurance coverage.

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Hoosiers make it into the top 10 for prescription drug costs, and finish a respectable No. 15 for quality of insurance coverage. The state is in the middle of the pack for access to drugs.

Louisiana is another all-around solid performer, and it ranks 15th for access to drugs and 21st for quality of insurance coverage.

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Aside from its strong ranking for prescription drug costs, New Hampshire manages a top 10 finish for its quality of insurance coverage, ranking sixth. It’s in the middle of the pack for access to drugs.

New Hampshire’s next-door neighbor fares well in this category, and even better when it comes to quality of insurance coverage, ranking third. Too bad it’s among the bottom 10 states for access to drugs, with the lowest number of pharmacists per capita. 

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Kentucky also finishes in the top 10 among all states for access to drugs, ranking eighth, but it’s in the bottom 10 for quality of insurance coverage.

Missouri cruises to a second-place finish here, bolstered in part by having the best average annual Medicare Part D drug deductible of all states. It’s in the middle of the pack for access to drugs and quality of insurance coverage.

There’s more to like in Maine than lobster and beautiful coastal scenery: The state beats out all others when it comes to the cheapest prescription drug costs. It ranks in the bottom 10 for access to those drugs, though.

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