NerdWallet's Smart Money Podcast

Episode: How to Pay Less for Your Prescriptions and Brace for a Health Insurance Shake-Up

Date: August 18, 2025
Hosts: Sean Pyles & Elizabeth Ayoola
Expert Guests: Dan Weissman (host of "An Arm and a Leg"), Kate Ashford (NerdWallet Personal Finance Nerd)

Episode Overview

This episode takes on two vital topics for American consumers:

1. How to navigate the high and often confusing costs of prescription drugs in the U.S., featuring actionable strategies from investigative healthcare journalist Dan Weissman.
2. How to prepare for a potential shake-up in the Affordable Care Act (ACA) health insurance marketplace, especially with enhanced tax credits set to expire, in an in-depth Q&A with NerdWallet’s Kate Ashford.

Section 1: Why Are Prescription Drugs So Expensive in the U.S.?

Guest: Dan Weissman, host of NPR’s "An Arm and a Leg"
Segment Start: [03:24]

Key Discussion Points

• Unique U.S. Healthcare System:
  The U.S. stands apart from other countries by relying heavily on free-market pricing, with only limited government regulation (e.g., Medicare, Medicaid).
• Two Main Industry Players:
  • Pharmaceutical Companies: Can set prices freely, serving shareholder interests.
  • Pharmacy Benefit Managers (PBMs): Intermediaries (often owned by or owning insurance companies like Cigna, Aetna, UnitedHealth) determine which drugs are covered, what you pay, and negotiate prices—often benefiting corporate interests, not patients.

Notable Quote:

"The system is not designed to give us the care we need at a cost that we can afford." — Sean Pyles [06:21]
"It's designed to create profits, and it does that really, really well." — Dan Weissman [06:25]

Common Consumer Challenges

• Prescription drugs may not be covered by insurance.
• Prices can fluctuate wildly—even for the same drug at different pharmacies.
• Out-of-pocket costs can be astronomical even with insurance.

Section 2: Strategies for Paying Less for Prescriptions

Segment Start: [07:07]

Actionable Tips & Resources

• At the Pharmacy Counter — Ask Questions:
  • Make sure the pharmacist has the correct, up-to-date insurance information. Sometimes, this simple step can drop your cost dramatically (e.g., $400 to $5).
    • “Hey, could you run my insurance one more time just to see if it's up to date?” — Dan Weissman [08:04]
  • Ask if there are manufacturer coupons or discount programs for your medication, especially for brand-name drugs.
• Compare Prices Using Apps and Websites:
  • Use resources like GoodRx, Mark Cuban’s Cost Plus Drugs, and other similar tools to compare prices at various pharmacies—even nearby locations. Sometimes paying cash without insurance is cheaper.
    • “I could have gone a couple miles down the road to another place with no insurance and paid $20 for this.” — Dan Weissman [08:05]
  • Each program negotiates different deals, so check several to find the best price.
• Ask About Alternatives:
  • Inquire whether your insurance covers a similar but more affordable or preferred medicine.
  • “Is there some other version of this kind of drug that my insurance will cover?” [10:20]
• Try Manufacturer Assistance and Doctor’s Samples:
  • Your doctor might have free samples to tide you over during insurance negotiations or appeals.
  • Requesting samples is a short-term fix but can fill a gap if you're fighting a denial.
• Escalate When Necessary:
  • If insurance denies a prescription, treat it as the start of a negotiation, not the end.
  • Enlist your healthcare provider to help with insurance appeals; multiple appeal rounds are possible.
• Advanced Step — Super Sleuthing:
  • For expensive regular medications, consider making a spreadsheet to track prices across various pharmacies, discount programs, and insurance options.

Notable Quote:

“When Dan pays $5 at the counter for this medicine, like you get $2 out of that and you know you can kick us a nickel, it’s fine. Right? That’s how that works for them.” — Dan Weissman on how PBMs and apps like GoodRx profit [09:15]

Memorable Moment:

“Your mileage may vary — so do the easy things first, right there at the pharmacy counter: coupons, alternatives, checking nearby prices. If you need to, then dig in with appeals or spreadsheets.” — Dan Weissman [10:28–13:23]

Section 3: How to Ensure Prescriptions Are Covered for Next Year

Segment Start: [14:14]

Open Enrollment Preparation Advice

• Check the Formulary:
  • Every insurance plan is required to publish a "formulary," a list (often a long PDF) specifying which drugs are covered and at what cost (broken into coverage tiers).
  • Use Control+F to search for your prescriptions and see if they are included and what tier/cost applies.
• Comparative Shopping:
  • Before open enrollment, compare new plans to see if alternate coverage offers better support for your medications.
  • If an affordable preferred drug won’t be covered next year, talk to your doctor about switching, or seek another plan if possible.

Notable Quote:

“If you are lucky enough to be able to choose an insurance policy and that formulary tells you, hey man, next year your inhaler is going to be $500 ... see if there’s another policy that covers it for less.” — Dan Weissman [15:09]

Section 4: The ACA Health Insurance Subsidy Shake-Up

Listener Q&A Start: [19:17]

Listener Question from Rebecca (Vermont):
Concerned about expiring enhanced ACA tax credits, losing access to affordable insurance as a partially self-employed worker. Wanted to know:

1. The outlook for ACA subsidies post-2025.
2. Strategies to reduce health insurance costs.
3. Whether to seek a job mainly for insurance, even at lower pay.
4. The risks of going uninsured.

Key Insights From Kate Ashford (NerdWallet’s Personal Finance Nerd)

• Expiring ACA Subsidies:
  • The enhanced premium tax credits under the ACA will sunset at the end of 2025 absent new legislation. This means millions will get smaller subsidies or none at all, leading to much higher premiums.
    • “Premiums are expected to go up dramatically—the Congressional Budget Office predicts more than 4 million people will lose insurance by 2034.” — Kate Ashford [22:05]
  • Nonprofit KFF predicts premiums will surge by more than 75% on average, with some people facing a doubling of health costs.
• Practical Steps to Prepare:
  • Calculate what your premiums would look like if they jump 75%.
  • Explore shifting income (e.g., using retirement contributions) to qualify for remaining subsidies.
  • Consider moving from a Silver to a Bronze plan or a high-deductible plan—tradeoff: lower monthly premiums but higher costs if you need care.
  • For the self-employed: Health insurance is often a deductible expense, but check with a tax advisor.
• Prescription Drug Savings Recap:
  • Reuse strategies discussed earlier (GoodRx, manufacturer discounts, etc.).
  • Use all preventive care benefits, which ACA-compliant plans must provide at no out-of-pocket cost.

Notable Quotes:

“Can you do back-of-the-napkin math for what your premiums would look like if they went up 75% ... and can you afford that?” — Kate Ashford [23:41]

“Employer-sponsored health insurance ... is likely going to be cheaper if subsidies go away.” — Kate Ashford [26:17]

• Risks of Going Uninsured:
  • Not just financial (potential for bankrupting medical bills from an accident or sudden illness), but also impacts on health outcomes and credit score.
  • Even those in good current health are vulnerable to unexpected events—medical debt is a top cause of bankruptcy.

“It’s a gamble for healthy people too. No one plans to have a serious accident or sudden illness, but it can happen at any time.” — Kate Ashford [27:30]

Why Is U.S. Health Insurance Tied to Employment?

Quick History:

• Originated during WWII wage freezes (insurance offered instead of raises).
• 1943: Employer-provided health insurance declared tax-exempt, supercharging its popularity.
• U.S. stuck with this employer-based model, never achieving universal coverage.

Hosts’ Take:

“So what I’m hearing is that our current situation is somewhere between a mistake and a horribly unhappy accident.” — Sean Pyles [28:40]

Timestamps of Key Segments

• [03:24] Why are prescription drugs so expensive in the U.S.?
• [07:07] Strategies to lower prescription costs (what to do at the pharmacy counter)
• [08:51] How discount programs like GoodRx work, ethical implications
• [10:20] Advanced strategies—spreadsheets, appeals, and leveraging your doctor
• [13:23] Using drug samples to bridge temporary access gaps
• [14:32] Preparing for open enrollment, checking your insurance formulary
• [19:17] Listener Q&A: ACA subsidy expiration & self-employed health insurance dilemmas
• [21:12] Explaining the ACA’s enhanced tax credits and likely impacts
• [22:27] Projections: average premium increases and their impact on consumers
• [24:57] Choosing between ACA, employer-sponsored plans, or going uninsured
• [26:50] Real risks and financial dangers of going without health insurance
• [28:06] History lesson: Why is American healthcare tied to employment?

Memorable Moments & Quotes

• “You show up at the pharmacist, like, ‘That’s going to be $500.’ ... That’s your chance to ask, ‘Hey, could you run my insurance one more time just to see if it’s up to date?’ ... It went from $400 to $5.” — Dan Weissman [08:04]
• “The idea here is not that [free samples] are a kind of permanent supply for you, but that it’s while you’re fighting with your insurance ... to get them to cover this for you.” — Dan Weissman [13:30]
• “Employers started offering health insurance as a fringe benefit because they couldn’t offer higher salaries—then we just ... kept going.” — Kate Ashford [28:06]

Tone & Takeaways

True to NerdWallet’s style, hosts Sean and Elizabeth keep the tone relatable and encouraging, interspersing empathy, humor, and a little frustration (“our current situation is ... a horribly unhappy accident.”). Their expert guests break down complex systems with clarity, offering practical, research-backed strategies for both recurring consumer headaches: prescription drug costs and impending health insurance premium hikes.

Big picture: The U.S. healthcare system remains convoluted and profit-driven, but consumers aren’t powerless. By carefully researching, checking every option, and leveraging timing (open enrollment), pharmacy couponing, and appeals, you can drastically reduce some costs—though not all. But with the ACA landscape poised for turmoil, vigilance and flexibility will be more essential than ever.

If you only have five minutes:

• Always ask the pharmacist to double-check your insurance.
• Use apps like GoodRx to find the best price—even sometimes beating your insurance.
• Appeal insurance denials and seek help from your doctor or clinic (including asking about free samples).
• Ahead of open enrollment, search your plan’s formulary to avoid prescription sticker shock next year.
• If ACA subsidies expire, premiums may jump. Re-calculate your budget and consider employment options offering group coverage.

For more details, see Dan Weissman’s coverage at “An Arm and a Leg” or NerdWallet’s deep dives on the ACA and prescription savings.