Bactrim is the brand name people remember, but almost every prescription filled in the United States today is the generic, sulfamethoxazole-trimethoprim. It is one of the cheapest drugs in the pharmacy: CMS lists a national pharmacy acquisition cost of $0.04478 per double-strength (800/160 mg) tablet, effective August 19, 2026. A 20-tablet prescription costs the pharmacy about ninety cents.
What you pay at the counter is a different number, and it varies more than the drug cost can explain. This guide prices generic Bactrim DS alongside the other prescriptions that commonly get filled in the same visit: nitrofurantoin and its brand Macrobid, and fluconazole, the single-tablet antifungal often prescribed as a follow-on. All figures were read on September 3, 2026 from CMS NADAC, the Drugs.com cash price guide, Cost Plus Drugs’ own product pages, and Walmart’s published program document.
What Does Bactrim Cost Without Insurance?
Each row shows three reference points: CMS pharmacy acquisition cost (a floor, not a retail price), a real published cash price, and a high-end figure. Cost Plus Drugs publishes a “retail price at other pharmacies” benchmark on every product page, which serves as the ceiling.
| Product (cash, no insurance) | Low | Average | High |
|---|---|---|---|
| Generic Bactrim DS 800/160 mg, 20 tablets | $0.90 (CMS NADAC acquisition cost, $0.04478 per tablet) | $7.68 (Drugs.com price guide) | $17.00 (Cost Plus retail benchmark, $0.85 per tablet) |
| Generic Bactrim DS 800/160 mg, 30 tablets | $1.34 (CMS NADAC) | $6.17 (Cost Plus Drugs, before $5.25 shipping) | $25.50 (Cost Plus retail benchmark) |
| Generic nitrofurantoin macrocrystals 100 mg, 30 capsules | $6.64 (CMS NADAC, $0.22133 per capsule) | $8.07 (Cost Plus Drugs, before $5.25 shipping) | $87.00 (Cost Plus retail benchmark) |
| Nitrofurantoin 100 mg, price per capsule | $0.27 (Cost Plus Drugs, $8.07 for 30) | $0.29780 (CMS NADAC, monohydrate/macrocrystals form, effective August 26, 2026) | $5.89 (brand Macrobid, Drugs.com, $588.93 per 100) |
| Generic fluconazole 150 mg, 1 tablet | $0.43 (CMS NADAC, $0.43349 per tablet) | $6.29 (Drugs.com price guide) | $13.70 (Cost Plus retail benchmark, $411.00 per 30) |
The single-strength (400/80 mg) tablet is cheaper still, at $12.27 for 90 tablets and $12.77 for 100 on the Drugs.com price guide. The oral suspension is the expensive form: Drugs.com lists the 200 mg-40 mg/5 mL liquid at $79.00 for a 473 mL bottle.
What Drives the Price
Almost none of it is the drug
At $0.04478 a tablet, the sulfamethoxazole-trimethoprim in a 20-tablet prescription costs less than a stamp. Drugs.com’s cheapest listed quantity, 2 tablets, is $4.59, and 20 tablets is $7.68. That flat-ish curve tells you the price is a dispensing fee with a few cents of drug attached, which is exactly why quantity barely moves the total and why pharmacy choice moves it a lot.
Brand versus generic on the nitrofurantoin side
Nitrofurantoin is where the brand premium bites. Drugs.com lists brand Macrobid at $588.93 for 100 capsules, or $5.89 each. Cost Plus Drugs sells 30 generic nitrofurantoin macrocrystal capsules for $8.07, about $0.27 apiece, and publishes $87.00 as the retail benchmark for the same 30. The brand costs roughly 20 times the generic at Cost Plus’s rate.
Note that nitrofurantoin comes in two closely related forms. The monohydrate/macrocrystals version is the Macrobid formulation and carries a higher acquisition cost ($0.29780 per capsule, effective August 26, 2026) than plain macrocrystals ($0.22133, the Macrodantin formulation). They are not interchangeable and the choice is the prescriber’s, but the price difference is small either way.
Form matters more than strength
Liquids cost far more than tablets and capsules across all four of these drugs. Sulfamethoxazole-trimethoprim suspension is $79.00 for 473 mL on Drugs.com against $14.05 for 100 DS tablets. Fluconazole oral powder for reconstitution is $13.56 for 35 mL of the 10 mg/mL strength and $23.55 for the 40 mg/mL, against $6.29 for a single 150 mg tablet.
Supply is thinner than it looks
The FDA’s openFDA drug shortages database, queried September 3, 2026, returns one active nitrofurantoin record: Amneal’s nitrofurantoin oral suspension, posted April 10, 2026, with the reason listed as discontinuation of the manufacture of the drug. There are no current shortage records for sulfamethoxazole, trimethoprim, fluconazole or cephalexin. The liquid form of nitrofurantoin is the one to expect trouble sourcing.
The visit usually outweighs the prescription
A $6 antibiotic behind a $200 clinic bill is a $206 problem. That ratio is the real cost story for this category, and it is why the pharmacy comparison matters less than where you get evaluated. See our pricing for urgent care and a cash-pay doctor visit.
Cash Price vs. Insurance
At these prices, insurance is often the more expensive option. A standard $10 or $15 generic copay is above the $6.17 that Cost Plus charges for 30 tablets and above the $7.68 that Drugs.com lists for 20. Running the claim can literally cost you money.
Ask the pharmacist for the cash price before the claim goes through and compare it to your copay. Pharmacists are permitted to tell you which is lower. The tradeoff is that cash and discount-card spending generally does not apply to your deductible, though at $6 to $9 that is not a meaningful loss.
If you have a high-deductible plan and have not met the deductible, you are paying the full negotiated rate anyway, so the cash price is simply the smaller number. Our comparison of GoodRx vs. SingleCare covers how the discount-card channel prices generics like these.
How to Pay Less
1. Get a quote from a transparent-pricing pharmacy first. Cost Plus Drugs shows its whole calculation on the page: for 30 tablets of the generic Bactrim DS, $1.02 in drug cost plus $0.15 in 15% markup plus a $5.00 pharmacy labor fee equals $6.17, with $5.25 standard shipping added at checkout. Delivered, that is $11.42. It is a published number you can hold a local counter quote against.
2. Call three pharmacies before you fill. The spread between $6.17 and the $25.50 retail benchmark for the same 30 tablets is entirely pharmacy pricing policy. Use the fair price checker to see what a reasonable cash number looks like, then ask for it by name.
3. Skip the Walmart $4 list myth. The Walmart Prescription Program drug list linked from Walmart’s own $4 Prescriptions page, dated effective March 24, 2025 and read September 3, 2026, lists no antibiotics at any tier. Sulfamethoxazole-trimethoprim, nitrofurantoin, fluconazole and cephalexin are all absent, as is every other anti-infective. The list is built around chronic-condition generics and tops out with a $24 albuterol inhaler tier. Walmart’s counter cash price may still be fine, but it will not be a $4 program price.
4. Ask whether the generic is being dispensed. Brand Macrobid at $5.89 per capsule versus roughly $0.27 for the generic is the single largest avoidable cost in this category. Pharmacies substitute automatically in most states, but confirm it, especially if the prescription was written with the brand name on it.
5. Look at sliding-scale clinics for the visit, not just the drug. Federally funded health centers charge based on income and often dispense common generics on site. Our guide to free and sliding-scale clinics explains how to find one and what documentation they ask for.
6. Do not ignore a bill that already arrived. The prescription is usually paid up front, but the clinic or lab charge behind it is not. If the number looks wrong or you cannot pay it, our walkthrough on negotiating medical bills has the specific asks that work, and hospital charity care covers the write-off programs nonprofit systems are required to run.
The Bottom Line
Generic Bactrim DS should cost $5 to $9 cash, and if you are quoted more than about $25 for 30 tablets you have found a high-markup counter rather than a market price. Nitrofurantoin costs a little more, roughly $8 for 30 capsules at Cost Plus, and brand Macrobid at $5.89 a capsule is the one number in this category worth actively avoiding. Fluconazole is about $6.29 for a single 150 mg tablet.
Which of these is appropriate for a given infection is a clinical decision, not a shopping decision, and self-treating a suspected urinary infection is not something this guide recommends. What you can control is where you get evaluated and where you fill. For related pricing, see our guides to antibiotic costs generally, cephalexin, doxycycline, azithromycin and STD testing.