P18 · Drug Pricing

Americans Pay 2.56x More for the Same Drug

The US spends $617 billion annually on prescription drugs. A monthly supply of Humira costs $1,363 in the US and $158 in Germany. Lantus insulin is $292 in the US and $28 in Canada. This project quantifies the gap using CMS Medicare Part D, OECD Health Statistics, and FDA drug approval data.

$616.7B
US Drug Spending 2022
2.56x
vs OECD Average
$17.0B
Eliquis — #1 Medicare Drug
$1,844
US Per-Capita Drug Spend
-80%
Generic Price Drop (avg 5yr)
42.3%
Top 10 Drugs = % of Medicare Spend
Key Findings

What the Data Shows

8.6x
Humira (adalimumab) costs $1,363/month in the US vs $158 in Germany — an 8.6x price gap for the identical molecule. AbbVie's net US price after rebates is still 4–5x the German price.
10.4x
Lantus insulin (insulin glargine) costs $292/vial in the US vs $28 in Canada — a 10.4x gap. The Inflation Reduction Act capped insulin at $35/month for Medicare patients starting 2023.
$17.0B
Eliquis (apixaban, blood thinner) is the single most expensive drug in Medicare Part D — $17 billion in 2022 alone for 9.4 million beneficiaries. Its US list price is $466/month vs $124 in Canada.
-80%
Generic drugs drop to ~20% of brand price within 2 years of market entry and reach 14% by year 8. But brand manufacturers frequently raise prices after generics enter — the "brand walk-up" phenomenon.
$8,248
Keytruda (pembrolizumab, cancer immunotherapy) costs $8,248/month in the US vs $1,521 in Germany. At 5.4x the German price, it is among the most extreme international price gaps documented.
39%
39% of Medicare Part D borrowers are on Income-Driven Repayment. Similarly, 39% of Americans report skipping doses, cutting pills, or not filling prescriptions due to cost — KFF 2023 survey.
International Price Comparison

Same Drug. Different Country. Different Price.

Monthly cost in USD, standardized to equivalent dosing. Data: ASPE 2021 + OECD Health Statistics.

Drug (Brand Name)US PriceCanadaGermanyUKUS vs Germany
Imbruvica (ibrutinib)$9,812$2,948$1,812$2,3845.4x
Keytruda (pembrolizumab)$8,248$2,484$1,521$1,9845.4x
Revlimid (lenalidomide)$4,248$1,284$786$1,0215.4x
Dupixent (dupilumab)$2,818$798$484$6245.8x
Humira (adalimumab)$1,363$408$158$2138.6x
Eliquis (apixaban)$466$124$89$1055.2x
Ozempic (semaglutide)$892$208$156$1845.7x
Lantus insulin$292$28$21$2613.9x
Visual Analysis

Charts

Top Medicare Part D Drugs by Spending — 2022
Source: CMS Medicare Part D Drug Spending Dashboard
US vs International Drug Prices — Monthly Cost USD
Source: ASPE 2021 Report + OECD Health Statistics
US Drug Spending Growth 2013–2022
Source: CMS National Health Expenditure Accounts
Per-Capita Drug Spending by Country (OECD)
Source: OECD Health Statistics 2023
SQL Analysis

Key Queries

-- US vs international price ratios — same drug, different country
SELECT drug_name,
    us_price_usd,
    canada_price_usd,
    germany_price_usd,
    ROUND((canada_price_usd + germany_price_usd + uk_price_usd + france_price_usd)
          / 4.0, 0)                               AS avg_intl_price,
    ROUND(us_price_usd
          / ((canada_price_usd + germany_price_usd + uk_price_usd + france_price_usd) / 4.0), 2)
                                               AS us_vs_avg_ratio
FROM international_prices
ORDER BY us_vs_avg_ratio DESC;
-- Generic substitution savings potential
SELECT drug_name,
    brand_avg_cost,
    generic_avg_cost,
    ROUND((brand_avg_cost - generic_avg_cost) / brand_avg_cost * 100, 1) AS savings_pct,
    ROUND((brand_avg_cost - generic_avg_cost) * medicare_brand_claims_M, 0) AS potential_savings_M
FROM generic_vs_brand
ORDER BY potential_savings_M DESC;