Buying prescription drugs through GoodRx, Amazon and other alternative avenues does not guarantee patients are getting a good deal.

The big picture: More people are purchasing their drugs with cash instead of using their health insurance, in large part because they are getting sizable discounts. But discounted prices often still have no relation to a drug’s actual cost.

How it works: The amount people pay out of pocket for their medication is tied to secretive contracts among pharmacy benefit managers, health insurers, distributors, pharmaceutical companies, pharmacies and other entities.

• When people decide to use discount programs like GoodRx (now a publicly traded company) or go to cash-only pharmacies, they are no longer using their insurance — and thus any amount they pay doesn’t go toward deductibles and out-of-pocket limits.
• People do this because those discounted prices still could be lower than if they were using insurance.

Yes, but: Generic versions of the HIV pill Truvada have significantly brought down the drug’s price, but not for everyone, according to new research from analysts at drug-pricing firm 46brooklyn.

Here’s what a monthly supply of generic Truvada costs someone through a cash-paying program, according to 46brooklyn:

• $1,567 at Amazon, which uses a discount card program owned by Cigna and its PBM Express Scripts.

• $112 at GoodRx, which generates most of its revenue from PBMs.

• $25 at Blueberry, a small, cash-only pharmacy in Pittsburgh that eschews the entire supply chain.

Between the lines: All of these prices are cheaper than the $1,800 per-month cash price of brand-name Truvada, but most drug-discount programs are tethered to the broken drug-pricing system.

• At $25, Blueberry is still making a profit. So at more than four times Blueberry’s rate, the GoodRx price “isn’t even close to the real cost of the drug,” 46brooklyn’s analysts write.

The bottom line: The existence of so many drug-discount programs is an indictment of both America’s insurance and pharmaceutical systems.