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News / Health


FACT CHECK: BIDEN IS RIGHT. THE US GENERALLY PAYS DOUBLE THAT OF OTHER COUNTRIES
FOR PRESCRIPTION DRUGS

By Samantha Putterman, PolitiFact, KFF Health News
Published: March 11, 2024, 9:07am
Share:




If you went “anywhere in the world,” you could get a prescription filled for 40%
to 60% less than it costs in the U.S.

Joe Biden on Feb. 22, 2024, at a campaign reception

It’s well documented that Americans pay high prices for health care. But do they
pay double or more for prescriptions compared with the rest of the world?
President Joe Biden said they did.

“If I put you on Air Force One with me, and you have a prescription — no matter
what it’s for, minor or major — and I flew you to Toronto or flew to London or
flew you to Brazil or flew you anywhere in the world, I can get you that
prescription filled for somewhere between 40 to 60% less than it costs here,”
Biden said Feb. 22 at a campaign reception in California.

He followed up by touting provisions in the 2022 Inflation Reduction Act to
lower drug prices, including capping insulin at $35 a month for Medicare
enrollees and limiting older Americans’ out-of-pocket prescription spending to
$2,000 a year starting in 2025. The law also authorized Medicare to negotiate
prices directly with drug companies for 10 prescription drugs, a list that will
expand over time.



Research has consistently found that, overall, U.S. prescription drug prices are
significantly higher, sometimes two to four times as high, compared with prices
in other high-income industrialized countries. Unbranded generic drugs are an
exception and are typically cheaper in the U.S. compared with other countries.
(Branded generics, a different category, are close to breaking even with other
countries.)

However, such factors as country-specific pricing, confidential rebates, and
other discounts can obscure actual prices, making comparisons harder.

“The available evidence suggests that the U.S., on average, has higher prices
for prescription drugs, and that’s particularly true for brand-name drugs,” said
Cynthia Cox, director of the Peterson-KFF Health System Tracker, which tracks
trends and issues affecting U.S. health care system performance. “Americans also
have relatively high out-of-pocket spending on prescription drugs, compared to
people in similarly large and wealthy nations.”

Andrew Mulcahy, a senior health economist at Rand Corp., a nonpartisan research
organization, agreed that Biden’s overall sentiment is on target but ignores
some complexities.



He said price comparisons his team has conducted reflect the amounts wholesalers
pay manufacturers for their drugs, which can differ sharply from prices
consumers and their drug plans pay.

“In many of those other countries, [patients] pay nothing,” Mulcahy said. “So I
think that’s part of the complication here when we talk about prices; there are
so many different drugs, prices, and systems at work.”


WHAT INTERNATIONAL DRUG PRICING COMPARISONS SHOW

A 2024 Rand study that Mulcahy led found that, across all drugs, U.S. prices
were 2.78 times as high as prices in 33 other countries, based on 2022 data. The
report evaluated most countries in the Organization for Economic Co-operation
and Development, or OECD, a group of 38 advanced, industrialized nations.

The gap was largest for brand-name drugs, the study found, with U.S. prices
averaging 4.22 times as high as those in the studied nations. After adjusting
for manufacturer-funded rebates, U.S. prices for brand-name drugs remained more
than triple those in other countries.



The U.S. pays less for one prescription category: unbranded, generic drugs,
which are about 33% less than in other studied countries. These types of drugs
account for about 90% of filled prescriptions in the U.S., yet make up only
one-fifth of overall prescription spending.

“The analysis used manufacturer gross prices for drugs because net prices — the
amounts ultimately retained by manufacturers after negotiated rebates and other
discounts are applied — are not systematically available,” a news release about
the report said.

People with health insurance pay prices that include both markups and discounts
negotiated with insurers. Uninsured people may pay a pharmacy’s “usual and
customary” price — which tends to be higher than net prices paid by others — or
a lower amount using a manufacturer discount program. But many of these
adjustments are confidential, making it hard to quantify how they affect net
prices.

In 2021, the Government Accountability Office released an analysis of prices of
20 brand-name drugs in the U.S., Canada, Australia, and France. The study found
that retail prices were more than two to four times as high as in the U.S.



Like Rand, the agency adjusted for rebates and other price concessions for its
U.S. estimate, but the other countries’ estimates reflected gross prices without
potential discounts.

“As a result, the actual differences between U.S. prices and those of the other
countries were likely larger than GAO estimates,” the report said.

Another analysis by the Peterson-KFF Health System Tracker that Cox co-authored
compared the prices of seven brand-name drugs in the U.S., Germany, the
Netherlands, and the United Kingdom, and found that some U.S. prices were two to
four times as high. For unbranded, generic drugs, the price gaps were smaller.

“Despite the fact that the U.S. pays less for generic drugs and Americans appear
to use more generic drugs than people in other countries, this did not offset
the higher prices paid for brand-name drugs,” Cox said.



The Peterson-KFF report, using 2019 OECD data, found that the U.S. spent about
$1,126 per person on prescription medicines, higher than any peer nation, with
comparable countries spending $552. This includes spending by insurers and
out-of-pocket consumer costs.

“Private and public insurance programs cover a similar share of prescription
medicine spending in the U.S. compared to peer nations,” the report noted.
“However, the steep costs in the U.S. still contribute to high U.S. health care
spending and are passed on to Americans in the form of higher premiums and
taxpayer-funded public programs.”


WHY IS THE US SUCH AN OUTLIER ON DRUG PRICING?

The U.S. has much more limited price negotiation with drug manufacturers; other
countries often rely on a single regulatory body to determine whether prices are
acceptable and negotiate accordingly. Many nations conduct public cost-benefit
analyses on new drugs, comparing them with others on the market. If those
studies find the cost is too high, or the health benefit too low, they’ll reject
the drug application. Some countries also set pricing controls

In the U.S., negotiations involve smaller government programs and thousands of
separate private health plans, lowering the bargaining power.



“It’s complicated. Everything in health care costs more here, not just
[prescriptions],” said Joseph Antos, a senior fellow at the American Enterprise
Institute, a conservative-leaning think tank, in an email interview. Although
the government’s new Medicare drug negotiation is the United States’ first
attempt to set drug prices, Antos noted that U.S. drug price negotiation still
doesn’t operate as price-setting for prescriptions in Europe does because it’s
limited to a few drugs and doesn’t apply to Medicaid or private insurance.

Drug patents and exclusivity is another factor keeping U.S. drug prices higher,
experts said, as U.S. pharmaceutical companies have amassed patents to prevent
generic competitors from bringing cheaper versions to market.

Drug companies have also argued that high prices reflect research and
development costs. Without higher consumer prices to offset research costs, the
companies say, new medicines wouldn’t be discovered or brought to market. But
recent studies haven’t supported that.

One 2023 study found that from 1999 to 2018, the world’s largest 15
biopharmaceutical companies spent more on selling and general and administrative
activities, which include marketing, than on research and development. The study
also said most new medicines developed during this period offered little to no
clinical benefit over existing treatments.




OUR RULING

Biden said, if you went “anywhere in the world,” you could get a prescription
filled for 40% to 60% less than it costs in the U.S.

He exaggerated by saying “anywhere in the world,” but for comparable
high-income, industrialized countries, he’s mostly on target.

Research has consistently shown that Americans pay significantly higher prices
overall for prescription medication, averaging between two times to four times
as high, depending on the study. The U.S. pays less for unbranded, generic
drugs, but those lower prices don’t offset the higher prices paid for brand-name
drugs, researchers said.

Factors including country-specific pricing, confidential rebates. and other
discounts also obscure true consumer prices, making comparisons difficult.

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Biden’s statement is accurate but needs clarification and additional
information. We rate it Mostly True.

--------------------------------------------------------------------------------

PolitiFact copy chief Matthew Crowley contributed to this report.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national
newsroom that produces in-depth journalism about health issues and is one of the
core operating programs of KFF — the independent source for health policy
research, polling and journalism.



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