Prescription Drug Cost Comparisons

Americans pay roughly 2.78 times what people in other wealthy countries pay for prescription drugs, and that single number hides the more interesting finding underneath it. RAND, in an analysis of 2022 data released in February 2024 and sponsored by the Department of Health and Human Services, compared U.S. prices against 33 other OECD nations. Brand-name drugs cost 4.22 times the comparison average. Unbranded generics, which account for about 90 percent of U.S. prescription volume, cost about 67 percent of the comparison average. The United States pays far more for branded medicine and slightly less for generic medicine than its peers.

Below are the prescription cost figures published through 2026, each attributed to its source.

The international comparison

RAND found U.S. prices averaged 2.78 times those in the 33 comparison nations using 2022 data. Adjusting U.S. prices downward to account for rebates and discounts, which are not public, RAND found brand-name prices remained more than three times higher than the comparison average.

The country-level range runs from 1.72 times in Mexico to 10.28 times in Turkey, per the same RAND analysis. Across the nations studied, RAND put total drug spending at $989 billion in 2022, with the United States accounting for 62 percent of sales but only 24 percent of volume.

Anyone quoting the 2.78 figure without the generic finding is reporting half the result. RAND’s own framing is that the gap sits almost entirely in branded products.

What people do when they cannot pay

KFF’s Health Tracking Poll, fielded February 24 to March 2, 2026, found 43 percent of adults did not take medication as prescribed in the past year because of cost. The behaviors break down as 31 percent taking an over-the-counter drug instead of filling a prescription, 27 percent not filling a prescription at all, and 19 percent cutting pills in half or skipping doses.

KFF recorded that same measure at 33 percent in 2025 and 31 percent in July 2023. The figure rose twelve points in under three years.

By income, KFF found 52 percent of adults under $40,000, 47 percent between $40,000 and $90,000, and 30 percent at $90,000 or above reported cost-related non-adherence. Among adults under 65, the figure was 58 percent for the uninsured and 43 percent for the insured. Women reported 49 percent against 36 percent for men.

Federal survey data produces smaller numbers on narrower questions. The Peterson-KFF Health System Tracker, analyzing the CDC’s National Health Interview Survey for 2024, found 8 percent of adults rationed prescribed medication due to cost and 6 percent did not get needed medication in order to save money. The two instruments ask different questions and should not be averaged.

What Medicare Part D costs in 2026

CMS published the final CY 2026 Part D redesign parameters in April 2025. The annual out-of-pocket threshold is $2,100, indexed upward from the $2,000 cap that took effect in 2025. The annual deductible is $615. Enrollee coinsurance in the initial coverage phase is 25 percent, and cost sharing in the catastrophic phase is zero.

That $2,100 ceiling is the structural change worth noting. Before the cap existed, Part D had no upper limit on what a beneficiary could spend in a year.

Negotiated prices, cycle by cycle

The Medicare Drug Price Negotiation Program is running in staggered cycles, and the figures are now public for the first three.

The first cycle covered ten Part D drugs with negotiated prices effective January 1, 2026: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and NovoLog.

The second cycle covered fifteen drugs, with negotiations concluding November 1, 2025 and prices taking effect January 1, 2027. CMS published the resulting prices in a November 2025 fact sheet. A 30-day supply of the semaglutide products Ozempic, Rybelsus and Wegovy was set at $274 against a 2024 list price of $959, a 71 percent discount. Trelegy Ellipta moved from $654 to $175, a 73 percent discount. Breo Ellipta moved from $397 to $67, 83 percent. Tradjenta moved from $488 to $78, 84 percent. Janumet moved from $526 to $80, 85 percent. At the other end, Austedo moved from $6,623 to $4,093, a 38 percent discount, and Calquence from $14,228 to $8,600, 40 percent.

CMS reported that 5.3 million of roughly 53 million Part D enrollees used these fifteen drugs in 2024, accounting for $42.5 billion in gross covered prescription drug costs, about 15 percent of all Part D gross covered costs. Enrollees paid $1.7 billion out of pocket on them. CMS estimated that had the negotiated prices been in effect in 2024, net spending would have been $12 billion lower excluding Coverage Gap Discount Program spending, or $8.5 billion lower including it, and projected $685 million in enrollee out-of-pocket savings in 2027.

The third cycle was announced January 27, 2026 and covers fifteen more drugs, the first cycle to include drugs covered under Part B. CMS listed Trulicity, Biktarvy, Orencia, Cosentyx, Erleada, Kisqali, Entyvio, Verzenio, Botox, Lenvima, Xolair, Rexulti, Xeljanz, Anoro Ellipta and Cimzia. Approximately 1,777,000 Medicare enrollees used them between November 2024 and October 2025, accounting for $27.0 billion, about 6 percent of total Part B and Part D expenditures in that period. Negotiated prices take effect January 1, 2028. CMS also selected one previously negotiated drug, Tradjenta, for renegotiation.

Insulin

Cost sharing for covered insulin products under Medicare Part D has been capped at $35 per month’s supply since January 1, 2023, under the Inflation Reduction Act.

HHS modeling using 2019 data found the national average out-of-pocket cost was about $58 per insulin fill, typically a 30-day supply, with privately insured or Medicare patients paying roughly $63. HHS found 37 percent of Medicare insulin fills in 2019 required cost sharing above $35, including 24 percent above $70. Applying the cap to 2020, HHS estimated 1.5 million Medicare beneficiaries would have benefited, saving roughly $734 million in Part D and $27 million in Part B, averaging about $500 per beneficiary.

No equivalent federal cap applies to commercial or employer plans.

What employers report

KFF’s 2025 Employer Health Benefits Survey found 36 percent of large firms with 200 or more workers said prescription drug prices contributed a great deal to higher premiums in recent years, and 22 percent said the same about coverage for new prescription drugs.

On GLP-1 drugs specifically, KFF found 19 percent of large firms cover them for weight loss, rising to 43 percent among firms with 5,000 or more workers, up from 28 percent in 2024. Among the largest firms offering that coverage, 59 percent said costs exceeded expectations and 66 percent reported a significant impact on prescription drug spending. Only 1 percent of large non-covering firms said they were very likely to begin covering them.

Reading the figures together

Three things hold across every source above. Branded drug prices in the United States sit far above peer-country prices while generic prices sit slightly below. Cost-related non-adherence is rising and is no longer confined to the uninsured, with 43 percent of insured adults under 65 reporting it. And the negotiated-price program has produced discounts between 38 and 85 percent off 2024 list prices for the drugs CMS selected, which indicates how much room existed between list and negotiated price to begin with.

Organizations tracking household costs, including the nonpartisan grassroots 501(c)(3) Fight For A Living Wage, treat medicine alongside housing, food and childcare as a basic that full-time work should cover. The figures above are what that claim is measured against.