The United States spent $487 billion on prescription drugs in 2024. Americans pay 278% of the average price in other developed countries for the same medications. These are not outlier figures. They are the baseline of a system where manufacturers set prices without government review, middlemen profit from opacity, and patients absorb the cost.

Eighty-two percent of Americans say drug costs are unreasonable. One in three adults skip doses, split pills, or leave prescriptions unfilled because they cannot afford them. Support for reform crosses party lines: 88% favor capping price increases to inflation, 85% want Medicare to negotiate directly with manufacturers. The political consensus exists. The policy response does not match it.

This site covers the full pricing chain. Each article takes one piece: how list prices are set and why they diverge from what insurers actually pay, how pharmacy benefit managers profit from that gap, what Medicare drug negotiation has changed so far, and why the US remains the only wealthy democracy without national price regulation. Where a reform has passed, we cover what it does and what it leaves out.

The sources are public: OECD pricing data, RAND international comparisons, IQVIA spending reports, CMS records, and federal court filings. Every claim is traceable. This is a reference built for patients trying to understand their costs, journalists covering the industry, and researchers who need sourced data without a paywall or a sales funnel.