Known Quantity

Plan Price Check

See what your plan paid for each prescription next to two public prices. Free, no account, no email. Paste a claims export or load our sample, and we line each drug up against what pharmacies pay for it and what one cash pharmacy charges for it.

1. Add your claims

Your file stays on your computer. The file is read in your browser and is not uploaded to us. The only things sent anywhere are the drug code or drug name, to the two public price services named below (the CMS NADAC survey and Cost Plus Drugs). Do not paste member names, IDs or dates of birth. If those columns are present, the tool ignores them and never shows or sends them.

Comma, tab or semicolon separated, with a header row. We look for these columns by name: NDC, drug name, strength, quantity, and the amount the plan paid. Every other column is ignored.

How to read this

  • Pharmacy cost (NADAC) is the National Average Drug Acquisition Cost, a weekly CMS survey of what retail pharmacies pay on average to buy the drug, before any dispensing fee. A pharmacy has to cover its staff and rent too, so some gap above NADAC is normal. We multiply the per-unit price by your quantity.
  • Cost Plus is the cash price at one pharmacy, the Mark Cuban Cost Plus Drug Company, for the same quantity. It includes their markup and pharmacy fee and excludes shipping. Many drugs, especially brands, are not carried there. Cost Plus prices only the NDCs it stocks, so when your claim is for another manufacturer we look for an equivalent generic: the same drug, strength and form from a different manufacturer. We use it only when the name and strength search returns exactly one match in the same form and release type, and we mark those rows. Otherwise we ask you to pick, and we never match a brand to a generic.
  • Plan paid is what your file says the plan paid. It may be before rebates the plan receives later, so the final net cost can be lower than what you see here.
  • A gap is a question, not a verdict. A large gap is something to ask your broker or benefits manager about. It is not proof of wrongdoing.
  • This is not legal, medical or financial advice.

Prices from the CMS NADAC survey (data.medicaid.gov) and the Mark Cuban Cost Plus Drug Company public pricing API. Known Quantity LLC is not affiliated with or endorsed by either. Looking for spread between what the plan was billed and what the pharmacy was paid? Try the PBM spread check.

Want this run on your full claims file?

We run it on every line of your claims export, match the drugs this page could not, and write up what to ask your broker or PBM.

Talk to us about your claims