U.S. drug costs: Why prescriptions are expensive and what you can do

When you walk out of the pharmacy with a new prescription, the price tag can feel like a punch in the gut. U.S. drug costs, the amount Americans pay for prescription medications compared to other countries. Also known as pharmaceutical pricing, it’s not just about brand names—it’s about how the system is built to protect profits over people. The average American spends over $1,200 a year on prescriptions. That’s more than double what people in Canada or the UK pay for the same drugs. And it’s not because we’re sicker. It’s because the rules let drugmakers set prices with almost no limits.

Generic medications, lower-cost versions of brand-name drugs that work the same way. Also known as generic drugs, they’re the best tool most people have to fight high prices. But even generics aren’t always cheap. Some cost hundreds of dollars because of patent games, market monopolies, or lack of competition. That’s where institutional formularies, hospital and clinic drug lists that control which medications are covered and substituted. Also known as therapeutic substitution systems, they’re the hidden gatekeepers of what you can actually afford. These formularies push cheaper options—but only if they’re on the list. And not every pharmacy or insurer plays by the same rules.

Meanwhile, the gap between what a drug costs to make and what you pay keeps growing. A pill that costs 10 cents to produce can sell for $10. Why? Because of patent extensions, marketing tactics, and legal battles that delay generics from entering the market. Tentative approval, when the FDA allows generic makers to prepare for launch before patents expire. Also known as ANDA status, it’s a legal loophole that lets companies wait in line—sometimes for years—until they can finally compete. That’s why some generic versions of life-saving drugs still cost too much: the system is designed to slow them down.

It’s not all doom and gloom. People are fighting back. Digital tools track adherence so you don’t waste money on pills you don’t take. Pharmacists help you swap expensive drugs for safer, cheaper ones. And more folks are asking: Why does this cost so much? The answers are in the system—not in your wallet. Below, you’ll find real guides on how to cut costs without cutting corners: from understanding NSAID safety to comparing ED meds, spotting counterfeit drugs, and using AI-powered tools to spot hidden risks. This isn’t about blaming yourself. It’s about knowing how the game works—and how to win it.