Are online pharmacies cheaper than your local drugstore? How to decide what's best for your healthcare - and your wallet.

By Genna Contino

Insurance often determines where we get our prescriptions. As open-enrollment season approaches, here's what to consider when shopping for a plan.

Patients have to weigh cost and convenience when deciding between a brick-and-mortar pharmacist and an online pharmacy service.

Emmabella Rudd took the same brand of life-sustaining insulin for nearly two decades, paying around $100 for each 90-day supply. But after she switched health-insurance companies in 2023, she was shocked to hear from her pharmacist that her next refill wasn't covered by her insurance - and would cost an eye-popping $3,000.

The now-24-year-old Rudd, who has Type 1 diabetes, was running low on insulin at the time and faced a difficult choice: find a way to cough up the cash for the medicine her body was used to, or switch to a different insurer-approved brand that would be cheaper. Rudd took a risk and tried the new drug brand.

"I didn't have issues with it, but that's not the case for everyone," said Rudd, who has been an advocate for insulin accessibility and diabetes research since she was diagnosed at a young age. "When your insurance changes and they're forcing you to make that change, your life sometimes depends on it."

Rudd's experience at the pharmacy counter is an example of the financial shocks and logistical nightmares many Americans face, as they navigate a healthcare system where their insurance plans often dictate their access to prescription medications.

As open enrollment begins this Wednesday for Medicare, on Nov. 1 for Affordable Care Act plans, and throughout the fall for those with employer-sponsored coverage, rising healthcare costs are top of mind for consumers seeking the best policies.

The insurance policies that patients choose often determine specific pharmacy chains or mail-order services where they can get their medication for an affordable price - forcing a difficult trade-off between cost, convenience and the trusted care of a local pharmacist.

Read more: Medicare open enrollment begins amid the government shutdown. Here's everything you need to know.

Beyond community pharmacies and chains like CVS (CVS) and Walgreens, digital pharmacies like Capsule and Amazon Pharmacy (AMZN) have established themselves in the market over the past decade. Amazon will soon begin offering in-office pharmacy kiosks at One Medical offices in the Los Angeles area, where patients can pick up prescriptions immediately after their doctor's appointment.

Here's what experts you say you should consider when deciding between a delivery service and a traditional brick-and-mortar pharmacy to fill your prescriptions.

Should you get your medication from a pharmacy chain, independent pharmacist or online service?

The best pharmacy for you ultimately comes down to your individualized priorities, experts say. Take time to think about what matters most to you - whether that's cost, convenience or quality of service.

-- Are you extremely busy, with zero time in your day to wait in line at a pharmacy? Consider a mail-order service.

-- Worried that your refrigerated insulin might not survive in the mail if you live in a hot climate? Picking it up from an in-person pharmacist might provide some peace of mind.

-- Does CVS or Walgreens offer the best prescription price with your insurance? Maintaining a relationship with a chain pharmacy might make the most sense.

-- Do you need personalized advice on how to administer medication for yourself or someone you're caring for, and want flexibility on cash prices? Check out the independently owned pharmacies in your area.

The stakes around finding the cheapest drug prices have risen, as millions of Americans are expected to pay more for health insurance in 2026.

No matter where you end up getting your prescription, it's always a good idea to ask what the cash price is and compare it with the insurance price; in some cases, it can be lower. And if you're still unsure, talk about your options with your primary-care provider.

"The relationship with their family physician is probably the most important thing for patients, because they can help them, especially with their prescriptions and with medication adherence, and to keep their health as optimal as they can," said Mike Sevilla, family physician based in Salem, Ohio.

'You could pay $10, you could pay $220 for the same drug'

Many insured consumers aren't affected by changes in drug prices because they typically have one pharmacy they use and pay a copay, or the fixed dollar amount a policyholder pays for covered prescription drugs, said Geoffrey Joyce, director of health policy at the University of Southern California's Schaeffer Center for Health Policy and Economics.

Pharmacy-benefit managers, or PBMs, act as an intermediary between drug manufacturers and insurers, and are often vertically integrated with insurance giants. The top three PBMs - CVS Caremark (owned by CVS), Express Scripts (owned by Cigna (CI)) and Optum Rx (owned by UnitedHealth (UNH)), controlled 80% of prescriptions dispensed by U.S. pharmacies in 2023, according to the Federal Trade Commission.

That's why many Aetna policyholders get their prescriptions from CVS, Cigna policyholders use Express Scripts' mail-order pharmacy and UnitedHealthcare policyholders use Optum Rx Home Delivery.

From the archives (January 2025): FTC takes fresh swipe at drug middlemen, says some prices marked up over 1,000%

Uninsured consumers, however, have to be more savvy, Joyce said, "because the price they face can vary dramatically from pharmacy to pharmacy."

"You could pay $10 [or] you could pay $220 for the same drug, depending on the pharmacy you went to," he said. "They're in a snake pit, and they've got to be very careful."

Online pharmacy services offer convenience - but keep this in mind

Online pharmacies that deliver your medicine to your door can sometimes be the cheapest in-network option with your insurance, and they offer the convenience of not having to wait in line, in person.

Capsule is an online service that takes most insurance plans - including Medicare and Medicaid - and just charges a copay, which varies depending on your insurance plan. The digital pharmacy says it sends prescriptions with free same-day delivery and manages refills.

The company offers customers the ability to communicate with pharmacists "in a way that's private, secure and on their own terms," via text, in-app chat or voice call, Capsule founder and chief executive Eric Kinariwala told MarketWatch in an email. "What we've found is that people actually prefer engaging with the pharmacist digitally."

For those without insurance, billionaire Mark Cuban's Cost Plus Drugs sells generic medication but cuts out the middleman - offering price transparency by breaking down how much the company paid for the drug from the manufacturer, plus a 15% markup and pharmacy labor and shipping costs.

From the archives (January 2021): 'Manufacturers and middlemen have created a vicious cycle of price increases': Mark Cuban pledges to sell this $225 medication for $20

"You go on their website and you see, 'Oh my God, my cholesterol-lowering medicine only costs 60 cents,'" Joyce said.?"For 9 out of 10 generic drugs, the cost of the medication is largely getting it to the consumer. It's not [the cost of] manufacturing the generic - they're dirt cheap."

Cost Plus Drugs did not respond to MarketWatch's request for comment.

Experts say to keep in mind that opting in to pharmacy delivery means sacrificing the in-person relationship you can build with a pharmacist if you have questions about your medication. Mail delivery also presents a risk of compromised safety and efficacy if the package encounters extreme weather conditions, said Douglas Hoey, CEO of the National Community Pharmacists Association.

New technology like mail-order services and kiosks try "to put medicine on an assembly line, and patients don't fit on assembly lines," said Hoey, a licensed pharmacist in Oklahoma, Virginia and Texas.

Amazon says its pharmacy services "make medications more accessible and affordable."

"Every prescription filled through Amazon Pharmacy - whether through home delivery or a kiosk - is reviewed by a licensed pharmacist, just as it would be at a traditional pharmacy, and patients can consult with a pharmacist," an Amazon spokesperson said in an emailed statement provided to MarketWatch. "Amazon Pharmacy Kiosks is an optional service that can simplify getting treatment faster - helping patients leave their doctor's office informed and with medication in hand, not a to-do list."

Another concern is medication adherence, which is the extent to which a patient follows their provider's guidance for taking a prescription drug, taking into account frequency, timing and dosage.

When patients go in person to a local pharmacy, Sevilla said he's noticed "better adherence in taking [medication] more regularly than they do for a mail-away pharmacy."

Kinariwala said Capsule's software, plus the ability to easily engage with a pharmacist through the website and app, have been key for prioritizing medication adherence.

"We partner with insurance plans and physicians specifically to drive adherence, and we have substantially better adherence rates than the overall industry because we've built specific software our team uses to make sure people don't run out of their medications," he said.

Chain pharmacies vs. independent pharmacies

If you feel more comfortable picking up a prescription from a pharmacist in person, you're not alone.

The majority of patients - 80% - prefer face-to-face interactions over digital options, according to CVS's fall 2025 Rx Report released Tuesday, while 48% said they would consider switching pharmacies if they were forced to use digital-only options.

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