The
US Prescription
Drug Report
2020
For many Americans, the rising cost of healthcare is a major concern. According to a 2018 study from NORC at the University of Chicago, three-quarters of Americans think they don’t get good value for what they spend on healthcare, while 32% have been unable to fill a prescription or took less of a medication because of its cost.
The US Prescription Drug Report 2020 presents data on prescription drug usage, cost and out of pocket spending across America, compared to the rest of the world. This report draws data from a number of different sources, including the Kaiser Family Foundation (KFF), the Health Care Cost Institute (HCCI), Medicaid, the Commonwealth Fund (CWF) and Medbelle. For the purposes of this report, all figures have been listed in US Dollars.
Key findings include:
Total Annual Cash Spending on Retail Prescription Drugs, by State
According to data from KFF, Texas has the highest level of cash spending on retail prescription drugs, with an annual state total of $926,129,911, followed by California with $744,984,994. Texas also reported the highest level of uninsured residents, with 18% of people living there having no health insurance. Vermont and the District of Columbia have the lowest level of cash spending, with annual totals of $7,762,793 and $16,949,309 respectively.
Explore the map below to see the annual spend on retail prescription drugs in each state. Use the filter to switch between commercial insurance, Medicare, Medicaid, cash and total spend.
Notes:
The data displayed in the above map is for calendar year 2019 and is based on the IQVIA National Prescription Audit (NPA™) database. Sales data refers to any prescriptions paid for by cash only, with no payer involved in reimbursement. This includes prescriptions filled by uninsured patients, as well as insured patients paying cash for prescriptions. Purchases took places in retail pharmacies, including independent pharmacies, chain pharmacies, food stores, and mass merchandisers.
Total Annual Out of Pocket Spending per Person, by State
The HCCI 2018 Health Care Cost and Utilization Report found that the state of Louisiana recorded the highest level of individual out of pocket spending on prescription drugs, with an annual average of $227.24 per person, followed by Kentucky with $200.38 per person. Louisiana has been the most expensive state for the past five years - in 2014 Louisiana citizens were spending $243 on average. Hawaii and Alaska had the lowest levels of individual out of pocket spending, with an average of $82.08 and $86.04 per person per year.
Explore the bar chart below to see the average annual spend per person in each state. Use the filter to switch between out of pocket and total spend.
Most Expensive Prescription Drugs (Total Cost vs Out of Pocket)
According to the HCCI 2018 Health Care Cost and Utilization Report, anti-depressants carry the highest out of pocket costs for citizens in the US, at $6.74 per prescription on average. However, if you don't have any coverage, antiretrovirals are the most expensive at around $43 dollars per prescription. This is closely followed by insulins ($42 per prescription) and other diabetes treatments ($41 per prescription).
Explore the bar chart below to see the most expensive prescription drugs, split by drug type. Use the filter to switch between out of pocket and total cost.
Looking at ailment categories ‘skin’ has the highest out of pocket cost, at $5.95 per prescription. Meanwhile, for those without coverage, rheumatoid arthritis medication is the most expensive, at $96.11 per prescription on average.
Explore the bar chart below to see the most expensive prescription drugs, split by ailment. Use the filter to switch between out of pocket and total cost.
Notes:
The above figures are calculated using data drawn from more than 2.5 billion medical and prescription drugs claims for approximately 40 million individuals who receive insurance coverage through an employer between 2014 and 2018.
‘Out of pocket’ spending refers to direct payments for prescription drugs from the household’s primary income or savings, made by the user at the time of purchase.
Most Prescribed Drugs by State
The below figures are taken from Medicaid’s State Drug Utilization Data 2019, reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate Program. All drug names are capped at 12 characters.
Changes in Drug Prices Over Time
To further develop our understanding of the prices US consumers face for prescription drugs, and how they can fluctuate on a month-to-month basis, we analyzed price data from GoodRx around five key pharmaceutical compounds; Lantus, Humira, Elquis, Xarelto and Januvia.
Tracking prices since the start of the calendar year, we noticed a steep decline in prices for Humira, an arthritis treatment, which dropped by around $150 dollars from January ($5,989.35) to May ($5,836.82). Of the five key drugs analyzed, Xarelto – an anticoagulant medication that prevents blood clots – was the only one to increase in price, rising from $498 in January to $506 in May, but peaking in March at $510.
Explore the chart below to track the change in drug prices over time. Use the filter to switch between different drug types.
Global Retail Pharmaceutical
Spending, per Capita
The Commonwealth Fund compared drug spending levels in the US with nine other high-income countries — Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom.
The US has the highest level of individual spending on prescription drugs, with an annual average of $1,011 per person, followed by Switzerland with $783 per person.
Notes: Final pharmaceutical spend includes wholesale and retail margins and value-added tax. Total pharmaceutical spending refers in most countries to “net” spending, i.e., adjusted for possible rebates payable by manufacturers, wholesalers, or pharmacies.
Global Drug Price Deviations
The Medbelle Medicine Price Index compares the average cost of 13 common pharmaceutical compounds in 50 countries around the world. The study took an average of the branded drug and generic compound price for each medication and compared that to the global median average for each.
Taking an average of all 13 types of medication listed, the US ranks as having the highest rate of overall inflation, with prices recorded at 306.82% the median global average. Germany has the second highest price deviation, at 125.64% of the median global average, followed by UAE at 122.03%.
Thailand ranks as having the cheapest medication, with the average price being 93.93% less than the median global average, followed by Kenya with 93.76%.
Explore the chart below to see how much the average price of prescription drugs deviates from the median global average in countries around the world.
Zestril (lisinopril) reported the highest rate of inflation, with the US average price being 2682.56% higher than the global average. Xanax (alprazolam) saw the second highest rate of inflation, at 2513.8% of the global average, followed by lipitor (atorvastatin) at 2175.83%.
Explore the bar chart below to see which drugs have the highest deviation from the median global average price.
Sources
KFF Data
HCCI Report
healthcostinstitute.org/annual-reports/2020-02-13-18-20-19
Medicaid Data via State Drug Utilization Tool (data.medicaid.gov)
data.medicaid.gov/State-Drug-Utilization/State-Drug-Utilization-Data-2019/qnsz-yp89
Commonwealth Fund (CWF) Report
Medbelle Medicine Price Index
