Americans pay two to three times more for prescription drugs than people in peer countries — not because they use more drugs or get better ones, but because of how the pricing system is structured. This hub documents how that system works, who bears the consequences, and what reform approaches are currently being debated.
The hub is in the early Sentiment stage. The forum space for this issue is open. If you have direct experience with drug costs — rationing medication, navigating prior authorization, choosing between prescriptions and other necessities — that experience is what this hub is designed to surface.
Articles
What Americans Pay and Why: The Basics of Drug Pricing — how US prices compare to peer countries and how the pricing chain works from manufacturer to patient
The Insulin Crisis: A Case Study in Pricing Failure — a drug invented in 1921 whose US list price increased 1,200 percent, and what that produced for patients who depend on it
Who Sets the Price: Manufacturers, PBMs, and the Rebate System — the largely invisible intermediaries that negotiate drug prices and how the rebate system creates incentives for high list prices
What Other Countries Do Differently: International Drug Pricing Models — reference pricing, centralized negotiation, health technology assessment, and what the evidence shows about the innovation tradeoff argument
The Policy Landscape: What Reform Proposals Are on the Table — Medicare negotiation, price transparency, PBM reform, reference pricing, and importation from Canada
Participate
The forum is where deliberative work on this issue takes place. See Getting Started for an orientation to the platform, and What Is Public Sentiment? for why grounded, first-person experience is the foundation of this hub’s work.