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One key factor for high medicine prices in the United States is a lack of government negotiation—unlike most nations, the United States permits manufacturers to set prices with little control, and Medicare only recently gained negotiating power (CBO, 2021). Strong patent protections also allow pharma corporations to block or delay cheaper generics, which the FDA warns keeps prices high for years. Intermediaries, such as pharmacy benefit managers (PBMs), complicate matters by negotiating secret rebates that do not necessarily reduce patient costs (GAO, 2021). Lastly, while pharmaceutical companies say that high costs are necessary to fund research and development, studies reveal that they frequently spend more on marketing than R&D (JAMA, 2019). These factors raise the cost of medications in the United States by two to three times that in other wealthy countries (RAND, 2021).

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High drug prices in the United States have a direct impact on patients, with roughly three in ten people admitting that they skip doses or do not complete prescriptions due to cost (Kaiser Family Foundation, 2022). This leads to poorer health outcomes and, in many cases, hospitalizations that could have been avoided with reasonably priced medication. The burden is particularly high on the elderly and chronically ill, who frequently require many medications to treat ailments such as diabetes, arthritis, and heart disease. Medicare beneficiaries, many of whom are on fixed incomes, regularly face difficult decisions between paying for medicine and meeting other necessities. High drug prices also contribute to rising insurance rates, since insurers pass on costs to customers, increasing overall healthcare spending (Congressional Budget Office, 2021). Employers face increasing costs for providing health insurance, which can reduce earnings and increase out-of-pocket spending for employees. Overall, the high cost of pharmaceuticals damages not only individual patients but also the larger US healthcare system by increasing spending for families, insurers, and taxpayers (RAND, 2021).

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When Drug Costs Are High, Patients Skip Doses

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Drug Price Reforms: Current vs Projected Savings

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One approach gaining favor is allowing Medicare to negotiate prescription pricing, as allowed by the Inflation Reduction Act of 2022, which targets high-cost pharmaceuticals and mandates refunds when prices climb faster than inflation. Another way is to impose price caps or transparency regulations, which require corporations to justify price increases and provide more pricing information. Encouraging generic and biosimilar competition is also vital, as increased rivalry routinely lowers costs for both patients and insurance. Generics and biosimilars saved the US health-care system around $445 billion in 2023, with biosimilars alone accounting for more than $12 billion in savings. These reforms—negotiation, caps/transparency, and competition—all provide viable strategies to balance cost with ongoing innovation in drug research.

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Millions of Americans are affected by high drug prices, with many having to pick between treatment and necessities. Recent measures, such as Medicare prescription price discussions in the Inflation Reduction Act of 2022, are a significant step toward affordability, although their reach remains limited (Congressional Budget Office, 2021). At the same time, pharmaceutical corporations claim that high pricing is required to fund costly R&D, fueling continuous discussions about how to sustain innovation (JAMA, 2019). Balancing these two priorities—affordable access for patients and incentives for innovative medication development—is still one of the most challenging tasks in health policy. The primary question for classmates is whether the government should play a larger role in determining or capping medicine pricing, or should the market continue to decide.

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. Association for Accessible Medicines (2024). 2024 Generic and Biosimilar Savings Report.

. Congressional Budget Office (2021). Federal Subsidies for Health Insurance.

. Centers for Medicare & Medicaid Services (2023). Medicare Drug Price Negotiation Program.

·  U.S. Food and Drug Administration (2020). Generic Drugs: Savings and Challenges.

·  Government Accountability Office (2021). Pharmacy Benefit Managers and Prescription Drug Spending.

·  JAMA (2019). Pharmaceutical Industry Expenditures on Research vs. Marketing.

·  Congressional Budget Office (2021). Effects of Drug Price Negotiation on Federal Spending.

·  Kaiser Family Foundation (2022). Public Opinion on Prescription Drugs and Their Prices.

·  RAND Corporation (2021). International Prescription Drug Price Comparisons.