United States | News & Politics

This is the best summary I could come up with:

In the United States, negotiations with drug makers are split among tens of thousands of health plans, resulting in far less bargaining muscle for the buyers.

Pharmaceutical companies argue that the higher prices come with added benefit: Industry-funded analyses have found that patients in the United States get medicines faster, and with fewer insurance restrictions, than those in other countries.

Experts also see misaligned incentives stemming from pharmacy benefit managers, or P.B.M.s, big businesses that negotiate with manufacturers on behalf of the employers and health plans that pay most of the bills for prescription drugs.

“The United States is the only country that allows middlemen, such as P.B.M.s, to profiteer on medicines unchecked,” said Alex Schriver, an official at Pharmaceutical Research and Manufacturers of America, or PhRMA, the drug industry’s main lobbying group.

Manufacturers retain only half the money that health care payers initially spend on prescription drugs before discounts are applied, according to a 2022 study funded by PhRMA.

The system is so confusing that doctors and patients trying to decide between seemingly comparable drugs have no easy way to determine what their actual cost will be at the pharmacy counter.

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