No Surprise: Highest Drug Prices Across the Board in the US

Roxanne Nelson, RN, BSN

December 17, 2019

Once again, new findings reveal that drug costs are highest in the United States, with medications costing +306.82% more than the global median.

Germany has the second highest costs, but they are substantially lower than in the United States, at +125.64% of the global median. In third place is the United Arab Emirates, close on the heels of Germany at +122.03%.

In contrast, drugs in Thailand are the cheapest, costing –93.93% the median price, followed by Kenya (-93.76%) and Malaysia (–90.8%).

For all of the drugs evaluated in this report, the United States had the highest prices.

Of note, the medication with the highest difference in price from the global median is lisinopril (Prinivil, Zestril, marketed by Merck and Zeneca), an ACE inhibitor used in the treatment of hypertension, which costs +2682.56% more in the United States than the global median price.

The study was conducted by Medbelle, a UK-based digital healthcare provider.

"At Medbelle, we believe that the digitalization of medicine and transparency in price and quality can improve healthcare performance and lower costs across the board," said Daniel Kolb, cofounder and managing director of the company. "By indexing the costs of the same medications around the world, it becomes apparent that countries like the US fall short on transparency when it comes to the reasons behind inflated medicine prices."

Kolb noted that even without including the most expensive medication on their list ― the arthritis medicine adalimumab ― the study shows that the United States "is miles above the rest of the world. Although it is beyond the scope of the study to recommend what can be done to improve, it is our hope that the results can lead to more transparency on behalf of every player involved in pricing of medicine."

The Survey

Medbelle conducted the study to highlight the price of medicines, for which disparities are greatest among the world's countries when it comes to access to care. They hope to "help shed light on this imbalance” and that addressing this important global issue "will provide a pathway to greater medical accessibility."

A selection was made of 13 common agents, and costs were compared in 50 countries. Their comparison was made on a "pound-for-pound basis" of the cost of each drug, whether or not it was paid for by a health system or out of pocket. The drugs that were chosen cover a range of common health problems, from heart disease and asthma to anxiety disorders and erectile dysfunction. The average prices of both brand compounds and their generic versions were included so as to have a complete profile for each drug.

The following drugs were evaluated: sildenafil (Viagra), pregabalin (Lyrica), atorvastatin (Lipitor), salbutamol (Ventolin), azithromycin (Zithromax), insulin glargine (Lantus), tacrolimus (Prograf), rospirenone/ethinylestradiol (Yasmin), fluoxetine (Prozac), alprazolam (Xanax), lisinopril (Zestril), tenofovir (Viread), and adalimumab (Humira).

Price differences were particularly pronounced for some drugs. For example, for insulin glargine, the deviation from the global median is +557.86% in the United States. In Argentina, which was second highest, the cost is substantially lower than in the United States (+169.96%). The lowest is in Egypt, at –43.51%.

Another drug with dramatic price differences is sildenafil. The most expensive is in the United States (+660.24%), followed by Taiwan (+152.18%) and Switzerland (+132.69%). The least expensive is in Ireland (–90.57%), followed by Egypt (–89.24%) and Argentina (–89.24%).

Highest Costs

As previously reported by Medscape Medical News, the United States has the dubious honor of paying the highest costs for drugs in the world. Prices are substantially higher even in comparison with other wealthy nations, such as Canada, Germany, and Japan. The differences in price can often be dramatic, especially for the newer and very costly agents that have recently come on the market.

The current study excluded cancer drugs, although they include some extremely expensive products. New cancer drugs are coming onto the market with price tags that often run in excess of $150,000 per year. Costs for cancer drugs have steadily increased during the past 2 decades, from more than $54,000 in 1995 to more than $200,000 in 2013, with no sign of slowing down. These high costs often result in high out-of-pocket costs for patients, and financial toxicity is a well-established problem within cancer care.

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