The Rising Cost of Prescriptions: Unveiling the Causes and Potential Solutions

Nomi Health
Nomi Health
July 12, 2023

The soaring prices of prescription medications have become impossible to ignore.  

A recent study from the National Library of Medicine stated that the high cost of prescription drugs threatens healthcare budgets, and limits funding available for other areas in which public investment is needed. In countries without universal healthcare, the high cost of prescription drugs poses an additional threat: unaffordable out-of-pocket costs for individual patients. It also noted that “Approximately 25% of Americans find it difficult to afford prescription drugs due to high out-of-pocket costs.”  

We’re exploring the reasons behind the escalating cost of prescriptions and delving into potential solutions that could help alleviate this burden. By understanding the underlying factors contributing to this issue, we can better advocate for change and work towards a future where essential medications are affordable and accessible to everyone.

Pharmaceutical Industry Dynamics  

One significant factor influencing the high cost of prescriptions is the complex dynamics within the pharmaceutical industry. Extensive research and development costs, stringent regulatory requirements, and the need to recoup investment expenses all contribute to the elevated prices of drugs. The patent protection system also allows pharmaceutical companies to maintain exclusivity for a specific period, limiting competition and pricing negotiations.

It’s also important to realize that the pharmaceutical industry spends billions of dollars to lobby in their own favor. Individual pharmaceutical companies and their trade organization spent approximately $220 billion in lobbying in the United States in 2018. Although nations recognize the major problems posed by high prescription drug prices, little has been accomplished in terms of regulatory or legislative reform because of the lobbying power of the pharmaceutical and healthcare industry.

Lack of Price Transparency

The lack of transparency surrounding prescription drug pricing is another contributing factor. Manufacturers, insurers, and pharmacy benefit managers often keep pricing details confidential, making it challenging for consumers to compare prices and make informed choices. Additionally, the convoluted rebate system in the pharmaceutical supply chain can distort prices, with middlemen potentially pocketing a significant portion of the savings.

Expensive Research and Development

Developing new medications involves substantial investments in research and development (R&D). The cost of conducting clinical trials, ensuring regulatory compliance, and navigating a lengthy approval process significantly impacts drug prices. Additionally, the high failure rate of drug development and the need to compensate for unsuccessful ventures further contribute to the overall expenses.

Prescription Drug Pricing Policies  

Government policies and regulations play a crucial role in determining prescription drug prices. Variations in pricing policies among countries result in significant disparities in costs. In the absence of strict price controls, pharmaceutical companies have greater leeway to set prices according to market demand, leading to inflated costs. The influence of lobbying groups and campaign contributions can also affect policy decisions related to drug pricing.

Potential Solutions

  1. Enhancing Price Transparency: Implementing measures to improve transparency within the pharmaceutical industry, including mandating price disclosures, would enable consumers to make informed decisions and foster competition.
  2. Addressing Patent System Flaws: Revisiting the patent system to strike a balance between incentivizing innovation and ensuring affordable access to medications is crucial. Encouraging generic competition through streamlined approval processes and shorter patent exclusivity periods can help lower prices.
  3. Negotiating Drug Prices: Empowering the government to negotiate drug prices directly with pharmaceutical companies could bring about significant cost savings, as demonstrated by several countries with centralized pricing systems.
  4. Investing in Research Efficiency: Promoting research efficiency and prioritizing resources towards innovative drug development methodologies, such as precision medicine and artificial intelligence, could reduce the overall cost of bringing new drugs to market.
  5. International Collaboration: Encouraging international collaboration to collectively negotiate drug prices and share research costs can help drive down prices and ensure equitable access to medications on a global scale.

The exorbitant cost of prescription medications is a multifaceted problem with no easy solution. By addressing the underlying causes and exploring potential remedies, we can work towards a future where essential medications are more affordable and accessible to all. Collaboration among stakeholders, policy reforms, and innovation within the pharmaceutical industry are all crucial elements in combating the rising cost of prescriptions and safeguarding the well-being of patients worldwide.  

At Nomi Health we’re taking it a step further and cutting through all of the red tape and monopolies. We’ve built our own PBM and pharmacy, helping organizations save 25% on annual PBM spend and reduce the cost of generic drugs for patients by 75%-85%. You can check it out and learn more here.