Cost Savings from Generic Combinations: Comparing Individual Generics vs. Combination Drugs

When you fill a prescription, you might think all generics are created equal. But that’s not true. Some generic drugs cost way more than others-even when they do the exact same thing. And the biggest savings? Often come from switching from one generic to another, or from using a combination drug instead of taking two separate pills. This isn’t theory. It’s real money saved-millions, even billions-just by making smarter choices.

Why Some Generics Cost 15 Times More

In 2022, researchers analyzed over 1,000 of the most commonly used generic drugs in Colorado. They found 45 that were shockingly expensive. Not because they were brand-name. Not because they were new. But because they were generic versions with no real competition. One drug, for example, cost $7.5 million in total spending. But if patients had switched to a cheaper, clinically identical alternative, that number would’ve dropped to just $873,711. That’s an 88% drop. In simple terms: you’re paying 15 times more for the same medicine.

Why does this happen? Sometimes, a manufacturer buys up the rights to a generic and keeps prices high because there’s no other company making it. Other times, it’s just inertia-doctors prescribe it because that’s what they’ve always prescribed, and no one questions the price. The FDA says generic drugs should cost 20% to 80% less than brand-name versions. But that doesn’t mean all generics are cheap. Some are priced like brands with no brand name attached.

Combination Drugs: One Pill, Double Savings

Think about asthma or high blood pressure. Many patients take two pills a day: one for inflammation, one for airway opening. Or one for cholesterol, one for blood pressure. Now imagine one pill that does both. That’s a combination product. And when generics for these combinations hit the market, prices plunge.

Take Advair Diskus, a popular inhaler for asthma. Before the generic version, Wixela Inhub, came out in 2019, each inhaler cost $334. After Wixela arrived, the price dropped to $115. That’s a 66% cut. In just one year, the total monthly cost for all Advair prescriptions in the U.S. fell from $337 million to $233 million. That’s over $100 million saved per month-just from switching to one generic combination.

It’s not just inhalers. The same pattern shows up with heart meds, diabetes drugs, and even antibiotics. A single combination pill often costs less than buying two separate generics. Why? Manufacturing and distribution costs get spread across one product instead of two. And when multiple companies start making the same combo, prices drop even further.

How Competition Drives Prices Down

The more companies make a generic drug, the lower the price. It’s basic economics. If only one company sells a generic, they can keep prices high. But if three or more start making it? Prices tumble. A 2019 FDA study showed that after three years of competition with three or more manufacturers, generic prices fell by about 20%. But if you get five or six companies in the mix? Savings jump to 70% or more.

Look at Crestor. When the brand-name version was still around, each pill cost $5.78. After generics entered the market, that same pill dropped to $0.08. That’s a 99% savings. Prilosec went from $3.31 to $0.05. The same story repeats with Amoxil, Metformin, and Lisinopril. These aren’t rare cases. They’re the rule.

The Association for Accessible Medicines reports that the top 10 generic drugs saved the U.S. healthcare system $89.5 billion in 2023 alone. That’s more than the GDP of many small countries. And it’s all because of competition. More manufacturers. More choices. Lower prices.

Who Saves the Most? It Depends on Your Insurance

Not everyone saves the same amount. A 2023 study looked at nearly 844 million prescriptions. Of those, 11.8% had out-of-pocket savings when patients switched to cheaper generics. But who saw the biggest cuts?

• Uninsured patients saved the most: nearly 29% of their fills had savings, averaging $6.08 per prescription.
• Military insurance saw 9.9% savings.
• Private insurance: 7.1%.
• Medicare: 5.5%.
• Medicaid: almost no savings at all.

Why? Medicaid often pays a fixed rate per drug, so even if the drug price drops, the patient’s out-of-pocket cost doesn’t change. Private insurers and pharmacies negotiate discounts, so savings get passed on. The uninsured? They pay full list price-so when a generic comes out, they see the full drop.

How to Find the Cheapest Option

You don’t need to be a pharmacist to save money. Here’s how to do it:

1. Ask your pharmacist: "Is there a cheaper generic version of this drug?" or "Is there a combination pill that includes this and another medicine I’m taking?"
2. Check the FDA’s Orange Book. It lists which generics are approved as interchangeable (rated "A"). You can search it online for free.
3. Compare prices at different pharmacies. A $10 difference in price isn’t unusual between CVS, Walgreens, and a local independent pharmacy.
4. If you take multiple pills daily, ask if a combination product exists. For example, if you’re on metformin and sitagliptin for diabetes, there’s a combo pill called Janumet that’s often cheaper than buying both separately.
5. Ask your doctor or insurer about therapeutic substitution. Sometimes, switching from one generic to another-even if it’s the same drug, just a different brand-can cut your cost in half.

One real example: A patient in Texas was paying $147 for a single-pill generic of lisinopril. Her pharmacist suggested switching to a different manufacturer’s version of the same drug. Same dosage. Same active ingredient. New price? $12. She saved $1,620 a year.

Barriers to Savings-And How to Bypass Them

It’s not all smooth sailing. Some insurers block cheaper options. Some doctors don’t know about alternatives. Some pharmacies don’t stock the lowest-cost generic because it’s not profitable for them.

Here’s how to push back:

• If your insurer denies a cheaper generic, file an appeal. They’re required to review it.
• Use mail-order pharmacies. They often carry the lowest-priced generics.
• Ask for a 90-day supply. It’s usually cheaper per pill than a 30-day refill.
• Use discount programs like GoodRx or SingleCare. They’re free, and they show you the lowest cash price in your area.

Also, don’t assume your doctor’s first choice is the cheapest. Many prescriptions are based on habit, not cost. If you ask, "Is there a cheaper way to get the same effect?" you’ll often get a yes.

What’s Next? More Savings Coming

The FDA approved 724 generic drugs in 2023. That’s down from the peak in 2017, but still high. More generics mean more competition. More competition means lower prices. And with biosimilars for complex drugs like Humira now entering the market, we’re entering a new wave of savings.

Over the next decade, experts estimate that generics and biosimilars could save the U.S. healthcare system $1.2 trillion. That’s not a guess. It’s based on current trends and regulatory momentum.

The bottom line? You’re not stuck paying high prices just because a drug is "generic." The real savings come from knowing which generics are overpriced, which combinations are cheaper, and how to ask for the best deal. The system isn’t perfect-but you have more power than you think.

Next Steps: Start Saving Today

Don’t wait for your next refill. Call your pharmacy right now and ask: "What’s the lowest-cost generic for my prescription?" If you’re on multiple medications, ask if a combination pill is available. Use GoodRx to compare prices. Talk to your doctor. You don’t need a degree in pharmacology to save hundreds-or thousands-of dollars a year. Just ask the right questions.