A Consumer Guide to Understanding — and Fighting Back Against — High Drug Costs
The cost of prescription drugs is a top health policy issue for consumers of all ages. Whether you have group health insurance through your employer, an individual plan through the ACA Marketplace, or Medicare Part D coverage, you have likely felt the sting of rising drug prices at the pharmacy counter.
Half of the people in the United States take at least one prescription drug. And more than 1 in 4 adults under age 65 report difficulty affording their medication with those numbers climbing sharply for people with individual insurance or no coverage at all.
So why has prescription drug pricing become such a stubborn, complex problem and what can you actually do about it?
How Did We Get Here?
Prescription drug costs in the U.S. began rising sharply in the 1980s, when pharmaceutical companies accelerated the development of innovative new treatments for common diseases. The underlying economics have not changed much since: drug development is an expensive, time-consuming process with a high risk of failure. Companies price their products not just to recoup what they spent, but to fund the next generation of research.
Adding to the pressure, manufacturers have become skilled at extending patents through minor reformulations and other legal strategies keeping brand-name prices elevated long after a drug might otherwise face generic competition. Efforts to combat this trend have resembled a game of whack-a-mole because the factors driving it are so deeply intertwined.
The Hidden Role of Pharmacy Benefit Managers
Once a drug reaches the market, its price is not simply set by the manufacturer and passed to you. There is a powerful intermediary layer pharmacy benefit managers (PBMs) that negotiate discounts and rebates on behalf of health insurers and employers.
The problem? PBMs are paid based on the size of those discounts, which means they have little incentive to push for lower overall drug prices. In fact, drugmakers often raise their list prices to have more room to offer the discounts PBMs are compensated for — sometimes raising prices even beyond what the discount covers.
New federal transparency rules, enacted February 3, 2025, are beginning to change these payment practices, but meaningful reform takes time.
What About International Drug Prices?
In most other developed nations, centralized government negotiators set prescription drug prices resulting in costs that are often a fraction of what Americans pay. The Trump administration has proposed a “most-favored nation” policy that would tie certain U.S. drug prices to the lowest prices paid globally.
This may help in the short term, but manufacturers warn it could reduce investment in new drug development. Some industry experts also worry it could push manufacturers to raise prices in other countries. The debate is ongoing but in the meantime, consumers need practical solutions today.
What You Can Do Right Now to Lower Your Drug Costs
The good news: you do not have to wait for Washington to act. There are practical, proven steps you can take today sometimes saving a significant amount at the pharmacy counter.
The first and most important habit: compare prices before you fill. Check what your drug costs without insurance using a discount program. Many people are surprised to find the cash price is actually lower than their copay.
Here are the top discount programs and resources to know:
- GoodRx: One of the most widely used discount platforms; free to use at thousands of pharmacies nationwide.
- Cost Plus Drugs (Mark Cuban): Transparent, low-cost pricing on hundreds of generic medications, available online.
- Blink Health Online platform with competitive discount pricing at local pharmacies.
- TrumpRx: A newly launched program offering avenues to find discounts on certain medications.
- Manufacturer copay assistance cards. If you have private insurance, drug makers often offer significant savings directly through their websites.
- Patient assistance programs: For uninsured or low-income individuals, manufacturers may provide free or steeply reduced-cost medications.
- Canadian pharmacy research: For brand-name drugs with no generic equivalent, cross-border options can sometimes offer significant savings. It is worth researching licensed Canadian pharmacy options for higher-priced medications.
Visit canadianmedstore.com for more information
The Bottom Line: Check Before You Fill
Before using your insurance or your Medicare Part D plan, look up the price of your medications using GoodRx or another discount program. The discount price is often lower and using it does not negatively affect your coverage or count against your deductible.
With a little comparison shopping, many Americans are reclaiming real money in their household budgets.
If rising prescription drug prices are affecting your budget, call Insurance Connection USA at 940-382-4700 to review your coverage options and find a health plan that may better support your medication needs.
