Prescription drug prices in the United States

Prescription drug prices in the United States are among the highest in the world, both in total spending and per capita costs. In 2023, the U.S. spent over $600 billion on prescription medications—more than any other country on a per-person basis.

Despite this high level of spending, affordability remains a major issue: nearly one in four Americans report difficulty affording their medications, and about 30% say they have skipped or rationed doses due to cost.^[1][2]These outcomes reflect complex factors including patent protections, lack of price negotiation for public insurance programs, limited generic competition, and opaque pricing practices throughout the supply chain.

Unlike many peer nations, the U.S. does not impose direct price controls or rely on centralized bargaining for most drugs. Instead, prices are set through negotiations between drug manufacturers and private insurers or pharmacy benefit managers (PBMs), often resulting in significant price variation and limited transparency.^[3]

Critics argue that high drug prices are not only an economic burden but also a public health threat—particularly for patients with chronic conditions like diabetes or cancer. In response, recent policy developments such as the Inflation Reduction Act of 2022 have introduced limited federal drug price negotiation, and other proposals like external reference pricing and patent reform continue to be debated.^[4][5]