Cover: International Prescription Drug Price Comparisons

International Prescription Drug Price Comparisons

Estimates Using 2022 Data

Published Feb 1, 2024

by Andrew W. Mulcahy, Daniel Schwam, Susan L. Lovejoy

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Research Questions

  1. In 2022, what were the differences in drug prices between the United States and other countries?
  2. How do price comparisons differ across categories of drugs and with different methodological approaches?
  3. How do these prices compare with data from 2018?

Understanding the extent to which prescription drug prices are higher in the United States than in other countries—after accounting for differences in the volume and mix of drugs—is useful when developing and targeting policies to address both growth in drug spending and the financial impact of prescription drugs on consumers. This report summarizes findings from comparisons of drug prices in the United States and other high-income countries based on 2022 data and presents results for specific types of drugs, including brand-name originator drugs and unbranded generic drugs, and from sensitivity analyses.

Key Findings

  • Except for unbranded generics, manufacturer gross drug prices in the United States were substantially higher than those in other countries.
  • Across all drugs, U.S. prices were 278 percent of other countries’ prices.
  • U.S. gross prices for brand-name originator drugs were 422 percent of prices in comparison countries.
  • After applying an adjustment for rebates paid by manufacturers, U.S. net prices for brand-name originator drugs were relatively lower but still over three times as high as prices in other countries.
  • The United States had lower prices for unbranded generics than most countries. Unbranded generics accounted for 90 percent of U.S. prescription drug volume—a much larger share than the 41 percent for the comparison countries—but only 8 percent of U.S. prescription drug spending at manufacturer gross prices (compared with 13 percent in other countries).
  • In contrast, brand-name originator drugs accounted for only 7 percent of U.S. prescription drug volume and 87 percent of U.S. prescription drug spending (compared with 29 percent of volume and 74 percent of spending in other countries).
  • Overall, the United States' considerable unbranded generic market share and low average unbranded generic prices did not fully offset higher brand-name originator prices.

Research conducted by

This research was sponsored by the Office of the Assistant Secretary for Planning and Evaluation and conducted within the Payment, Cost, and Coverage Program within RAND Health Care.

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