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RxCompare · Patient resource kit
Caregiver prescription cost comparison sheet
Use one column per prescription. Confirm details with the pharmacist and compare the same quantity and days supplied.
| Detail to confirm | Prescription 1 | Prescription 2 | Prescription 3 |
|---|---|---|---|
| Full product name / strength / form | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Quantity / days supplied | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Pharmacy / quote date | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Cash total including fees | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Insurance total | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Discount total / eligibility | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Selected option / confirmed amount | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Ready date / delivery timing | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
| Question for pharmacist or plan | Space for handwritten notes | Space for handwritten notes | Space for handwritten notes |
Before making a decision
- □ Confirm the final total, eligibility, and availability.
- □ Ask the insurer how an outside-plan purchase affects benefits.
- □ Confirm transfer and refill timing with the pharmacy.
- □ Keep medication and dose decisions with the care team.
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Cost worksheet, not medical advice or a medication administration record. Keep completed sheets private.