How Generic Combinations Save Money: Comparing Individual Generics vs. Combination Drugs

When you pick up a prescription, you might assume all generics are created equal. But that’s not true. Some generic drugs cost 15 times more than other generics that do the exact same thing. And when you compare single-drug generics to combination products, the savings can be even bigger-sometimes over 90%.

Why Some Generics Are Way More Expensive Than Others

Not all generics are cheap. A 2022 study of 1,000 top-selling generics in Colorado found 45 of them were shockingly expensive-far pricier than other drugs that work just as well. One example: a generic version of a common blood pressure pill was priced at $7.50 per dose, while another generic with the same active ingredient cost just $0.40. That’s a 95% difference for the same effect.

The reason? It’s not about quality. It’s about competition. When only one company makes a generic, they can keep prices high. But when five or six companies start making the same drug, prices crash. The FDA found that with three or more generic makers, prices drop by about 20% in three years. With ten competitors? You’re looking at 80% off the original brand price.

Take Crestor. When the brand-name version lost patent protection in 2015, the price per pill dropped from $5.78 to just $0.08. That’s a 99% drop. Prilosec followed the same path: from $3.31 to $0.05. These aren’t rare cases. They’re the rule when enough manufacturers enter the market.

Combination Drugs: One Pill, Big Savings

Combination drugs-medications that pack two or more active ingredients into one pill-are often cheaper than buying each drug separately. This isn’t just convenient. It’s financially smarter.

Take asthma inhalers. Before generic versions of Advair Diskus hit the market, patients paid around $334 per inhaler. Then Wixela Inhub, a generic combination of the same two drugs (fluticasone and salmeterol), arrived. The price dropped to $115. That’s a 66% cut in cost per prescription. Across the U.S., monthly spending on Advair and its generics fell from $337 million to $233 million in just one year. That’s over $1 billion saved annually.

The same pattern shows up in diabetes, high blood pressure, and arthritis. A single pill with metformin and sitagliptin costs less than buying metformin and sitagliptin separately. Same with lisinopril and hydrochlorothiazide for blood pressure. Why? Manufacturing, packaging, and distribution costs are shared. Pharmacies and insurers prefer them because they’re easier to manage-and cheaper.

Therapeutic Substitution: Swap the Drug, Not the Result

You don’t always need to stick to the exact generic your doctor prescribed. Sometimes, switching to a different generic-same active ingredient, different strength or form-can slash your bill.

The Colorado study found that 62% of high-cost generics could be replaced with a lower-cost version of the same drug, just in a different dosage. For example, switching from a 10mg tablet to a 5mg tablet (and taking two) saved 95% on average. Or switching from a capsule to a tablet. These aren’t experimental swaps. They’re FDA-approved and clinically identical.

Your pharmacist can help. The FDA’s Orange Book lists which generics are rated as therapeutically equivalent (marked with an “A”). If your prescription says “A,” you can safely swap it for another “A” rated version-even if it’s made by a different company. Ask your pharmacist: “Is there a cheaper generic that works the same?”

Who Saves the Most? Uninsured Patients See the Biggest Gains

Savings aren’t spread evenly. A 2023 study of nearly 844 million prescriptions found that uninsured patients saved the most. On average, they paid $6.08 less per prescription when switching to a lower-cost generic. That’s because they’re paying full price-no insurance cushion. For them, a $10 saving isn’t just a number. It’s a meal, a bus ticket, or a skipped co-pay.

Medicare patients saved $4.64 per script. Private insurance saved $3.69. Medicaid patients? Almost no savings were found. Why? Because Medicaid already negotiates deep discounts upfront. There’s not much room to go lower.

The bottom line: if you’re paying out-of-pocket, your savings potential is huge. If you’re on Medicare or private insurance, you’re still saving-just less dramatically. Either way, asking “Is there a cheaper option?” is always worth it.

Why Aren’t More People Doing This?

You’d think everyone would switch to the cheapest generic. But barriers exist.

Some doctors don’t know about the price differences. Others are used to prescribing one brand of generic and don’t think to change. Pharmacies sometimes stock only the most expensive version because their supplier pushed it. And sometimes, insurance plans don’t update their formularies fast enough.

Also, some companies use tricks to keep prices high. They tweak the pill shape, change the inactive ingredients, or file small patents to delay competition. These aren’t new drugs-they’re just slight changes to keep the cash flowing.

The fix? Plan sponsors (like employers or insurers) should review their top 20 most expensive generics every quarter. Look for drugs where a cheaper alternative exists. Push for formulary changes. Educate prescribers. And empower pharmacists to suggest swaps.

What You Can Do Right Now

You don’t need a degree in pharmacology to save money on generics. Here’s what works:

• Ask your pharmacist: “Is there a lower-cost generic version of this drug?”
• Check if your drug is a combination product. If you’re taking two pills, ask if one combination pill exists.
• Don’t assume your current generic is the cheapest. Compare prices at different pharmacies-even Walmart and Costco often beat specialty pharmacies.
• If you’re uninsured or on Medicare, use services like Mark Cuban Cost Plus Drug Company or GoodRx. They show real-time cash prices.
• Request the FDA’s Orange Book ratings if you’re unsure if two generics are interchangeable.

The Bigger Picture: Billions Saved, But the System Is Fragile

Over the last decade, generic drugs saved the U.S. healthcare system $3.7 trillion. In 2023 alone, the top 10 generics saved $89.5 billion. That’s money back in patients’ pockets, lower premiums, and less strain on public programs.

But the system is under pressure. Generic drug shortages jumped from 166 in 2012 to 258 in 2022. A few big companies control 40% of the market. When one factory shuts down, prices spike. The FDA approved over 800 new generics in 2017. By 2023, that number dropped to 724. Less competition means less pressure to lower prices.

The future of savings depends on keeping competition alive. More manufacturers. More transparency. Fewer patent tricks. Until then, the best tool you have is your own awareness. Ask questions. Compare prices. Push for better options. Your wallet-and your health-will thank you.