Definition
What Is the Usual and Customary Price?
Last updated
The usual and customary price, sometimes abbreviated U&C, is the standard retail price a pharmacy charges the general public for a drug, without any insurance discount or negotiated network rate applied. It's the baseline cash price you'd typically be quoted if you have no insurance and no discount card, and it can serve as a reference point insurers sometimes use in reimbursement calculations.
How it affects what you pay
If you're uninsured or choosing to pay cash, the usual and customary price is usually the default amount a pharmacy will quote you unless you use a discount card or ask about a lower-cost program. HealthCare.gov's glossary describes the related "usual, customary, and reasonable" concept as the amount paid for a service based on what providers in an area typically charge for the same or similar service (HealthCare.gov Glossary, UCR). Because each pharmacy sets its own usual and customary price independently, this number can vary meaningfully from one pharmacy to another for an identical drug and quantity, which is part of why comparing pharmacies matters.
Example
Consider a hypothetical generic medication. One local pharmacy's usual and customary price might be higher than another pharmacy's usual and customary price for the exact same drug, strength, and quantity, purely because each set its own standard rate independently. A discount card at either pharmacy might undercut both. This is a general illustration, not real quoted prices.
Why this number matters even if you have insurance
Some pharmacy benefit contracts reimburse pharmacies based on whichever is lower: the plan's negotiated rate or the pharmacy's usual and customary price. KFF Health News reporting has highlighted cases where a copay tied to an insurance contract exceeded what an uninsured cash customer would pay at the same pharmacy's usual and customary or discount-card rate for certain generics (KFF Health News, Filling A Prescription? You Might Be Better Off Paying Cash). This is one reason it's worth asking your pharmacist for the cash price even when you have coverage.
Comparing usual and customary against other prices
The usual and customary price is one of at least three numbers worth comparing for any given prescription: your insurance copay, the pharmacy's usual and customary cash price, and any discount card or savings program price. Our guide on same drug, different price: how pharmacies set cash prices goes into more detail on how pharmacies arrive at this number. Compare prescription prices on BetterBuyRx to see how usual and customary pricing compares with discount options at pharmacies near you.
Getting below the usual and customary price
A prescription discount card is one of the most common ways to access a price below a pharmacy's standard usual and customary rate. Search your medication on BetterBuyRx to compare both numbers before you decide where and how to fill your next prescription.
Frequently asked questions
Is the usual and customary price the same as the cash price?
They're closely related. The usual and customary price is generally the pharmacy's standard, publicly charged rate, which is what an uninsured customer paying cash without a discount card would typically be quoted.
Does insurance ever pay based on the usual and customary price?
Sometimes. Some pharmacy reimbursement formulas use the lower of the plan's negotiated rate or the pharmacy's usual and customary price, though the specific formula depends on the plan and PBM contract.
Can a discount card get me a price below the usual and customary price?
Often yes. Discount cards and pharmacy savings programs are frequently priced below the pharmacy's standard usual and customary rate, since they route the purchase through a separately negotiated network price.
Sources
Compare prices & find savings
This page is for cost and savings education only. It is not medical advice. Talk to your doctor or pharmacist about your specific medications and coverage. Prices vary by pharmacy, location, quantity, and eligibility.
Related terms & guides
- What Is the Cash Price for a Prescription?
Cash price definition: what you pay for a prescription without insurance, how it differs from the usual and customary price, and when it can be cheaper.
- What Is NADAC?
NADAC definition: what the National Average Drug Acquisition Cost measures, who publishes it, and how it differs from what you pay at the counter.
- What Is a Prescription Discount Card?
A prescription discount card definition: how these free cards work, what they cost, and how they differ from insurance. Plain-language answer plus FAQs.