Every week the federal government publishes what pharmacies actually pay for drugs. Not a list price, not an estimate: a survey of real invoices from real pharmacies, averaged nationally and released as a public file. It is called the National Average Drug Acquisition Cost, and it exists so Medicaid can work out what to reimburse.
Almost nobody shows it to the person paying. This page does, because the number beside it is the interesting one.
What we compared
We hold this week's NADAC file — 29,394 products, effective 26 August 2026 — and cash prices from two mail-order pharmacies that publish them: Cost Plus Drugs and HealthWarehouse. Both are licensed US pharmacies. Both will fill a normal prescription. Matching them by national drug code gives 4,703 tablet and capsule products where we know what the pharmacy paid and what a cash payer is asked.
The same tablets, three ways
Per 30 tablets, so the numbers are comparable. The first column is what pharmacies paid on average; the other two are what you would be charged.
| Per 30 tablets | Pharmacies paid | Cost Plus | HealthWarehouse |
|---|---|---|---|
| Acyclovir 800 mg | $5.54 | $3.00 | $16.20 |
| Acarbose 50 mg | $5.09 | $2.99 | $15.30 |
| Felodipine ER 10 mg | $3.74 | $3.29 | $18.30 |
| Bupropion ER 100 mg | $2.06 | $0.83 | $12.90 |
Markup is not theft
It is worth saying plainly, because the numbers above invite the opposite conclusion. Dispensing a prescription costs real money: a pharmacist's time, the licence, the premises, the insurance, the software, the phone call to your doctor when something does not add up, and — for mail order — the postage. A pharmacy that bought a tablet for eighteen cents and sold it for eighteen cents would close by Friday.
Cost Plus sells below the national average because of how it buys and what it adds: it purchases direct and applies a flat markup plus a pharmacy fee, rather than pricing each drug against what the market will bear. NADAC is also an average, and a large buyer pays less than a single independent store. Both things are true at once.
The argument is not that one of these pharmacies is dishonest. It is that the gap between two legitimate sellers of the identical tablet is about fourfold, that gap is invisible at the counter, and it is your money.
The figure we did not publish
Running this comparison across everything rather than just tablets produces some spectacular numbers — one product came out at 419 times acquisition cost. We left them out, because they are almost certainly wrong.
NADAC prices an oral solution per millilitre. A pharmacy may price the bottle. Divide one by the other and you get a markup that never happened. The tell is in the shape of the data: for tablets and capsules the median multiple is 2.67 and the 95th percentile is 10.7, while for everything else the median is a similar 2.45 but the 95th percentile is 74.6. A middle that agrees and a tail that does not is a units problem, not a pricing scandal.
So this page reports tablets and capsules only. It is the less dramatic number and the one that survives being checked.
What to do with it
Every drug page on this site shows what pharmacies paid, beside what each option charges, with the markup named. That is the whole product: not a coupon, not a discount card, just the two numbers next to each other so the decision is yours.
Look up something you take and see the gap for yourself — start with the price search. If your medicine has a generic, the spread is usually worth more than any coupon.