Paths for lowering U.S. prescription drug prices: An evidence-based guide for journalists

A nonpartisan guide to help journalists separate drug-pricing policies that are already lowering costs from those still being proposed, avoid common reporting errors, and find local story ideas–created with help from researchers who have studied the pharmaceutical industry for many years.

By Kerry Dooley Young

Many people in the United States have experienced shock at the price charged for a prescription drug. There’s widespread concern even among people with health insurance about managing the cost of medicine.

In a nationally representative poll conducted earlier this year, the nonprofit KFF found that six in 10 adults worry about being able to afford prescription drugs. Four in 10 said they had skipped doses, not filled prescriptions, or taken other steps to save money on medicines in the past year.

The cost of prescription drugs has been popping up as a talking point in the lead-up to the 2026 midterm elections, and it likely will remain a key concern of voters for years to come. We created this guide to help journalists go beyond the political back-and-forth and look at what research shows about various efforts to lower drug prices in the U.S.

Journalists covering the issue need to be able to distinguish between actions taken that already have reduced drug costs for some people and the plans and proposals still in their start-up phases or under consideration.

It’s also important to note who will most benefit from any given cost-reduction program or proposal. Most measures so far benefit people covered by government-run health insurance programs.

Adults with private insurance or no insurance, a group that includes most Americans under 65, have seen relatively little relief from federal cost-reduction proposals and plans so far, but there are many state-level efforts bubbling up across the nation. In this guide we’ll look at federal and state government efforts to reduce drug prices for people covered by:

• Medicare: a federal health insurance program that serves people age 65 and older and some younger people with disabilities. About 70.7 million people are currently enrolled in Medicare, according to U.S. government data.
• Medicaid: a joint federal and state program that provides free or low-cost health insurance to low-income Americans. About 66 million people are enrolled in Medicaid, along with about 7 million enrolled in the Children’s Health Insurance Program. (NOTE: About 12 million people, known as “dual-eligible” individuals, are enrolled in both Medicare and Medicaid.)
• Private insurance: U.S. Census data shows that the most common form of insurance in the U.S. are plans provided as part of employment compensation. These plans cover about 181 million workers and their family members, or more than half of the nation’s population. Another 35 million people in the U.S. are covered by plans that they purchase directly, including coverage through the government-run exchanges created by the Affordable Care Act (ACA), which in some cases have government-subsidized premiums.
• No insurance: About 30 million people in the U.S. are uninsured, lacking any health insurance coverage, according to the Congressional Budget Office.

The Inflation Reduction Act of 2022 already has made a notable dent in drug costs for many people enrolled in Medicare’s Part D plans, which cover medication prescriptions for many people on Medicare. Some 56 million Medicare recipients were enrolled in Part D plans as of early 2026, according to KFF.

As is common with major federal laws, it has taken a few years for the federal government to implement the mandates set in the IRA. One of the first major provisions of the law took effect in 2024, creating a cap on how much people on Part D plans would have to pay out of pocket for drugs.

When Medicare Part D first went into effect in 2006, it included a final phase called “catastrophic coverage,” which kicked in after their out-of-pocket spending met a certain threshold. Before 2024, people were still on the hook for 5% of drug costs even after meeting the “catastrophic coverage” threshold.

A 2023 explainer from KFF, published before the IRA provisions took effect, illustrates the burden that presented. “The current 5% coinsurance requirement for catastrophic coverage may seem like a small amount, but with many drugs coming to market priced at $150,000 or more, that 5% translates into thousands of dollars in annual out-of-pocket costs for expensive drugs,” wrote researchers Juliette Cubanski and Tricia Neuman.

The IRA created a hard cap on the total amount Medicare Part D participants would pay for drugs each year. The cap started at $3,300 for 2024 and then dropped to $2,000 in 2025, and will thereafter be adjusted according to the average cost of Part D drugs. For 2026, the cap is $2,100. The IRA also expanded some subsidies to help people with low incomes buy drugs.

These measures appear to have reduced the number of Medicare enrollees who skipped taking prescribed medicines or skimped on doses due to costs, according to a research paper published in JAMA Internal Medicine in May 2026. Over the same time period, people with private health insurance reported more difficulty affording their prescriptions.

The researchers analyzed responses to the National Health Interview Survey from 2021 to 2024, and created two comparison groups of people aged 62 to 67: one with people with Medicare Part D who did not get extra financial help and another composed of people with private insurance. They classified as “non-adherence” the times when people reported that the price of a medication kept them from taking it as prescribed. This included delaying refills, reducing medication doses, and doing without medication altogether.

The rate of the cost-related medication non-adherence rates in the Medicare group dropped to 5.7% in 2024 from about 8.2% in the three years preceding the implementation of the Part D cap, the researchers report. During the same time period, the rate rose to 6.8% from 4.5% in the group with private insurance

The results were more notable when the researchers compared results for people with multiple chronic health conditions. The non-adherence reports decreased from 11.0% to 6.1% in the Medicare group, while increasing from 5.7% to 8.7% in the private insurance group.

“These early improvements may have important implications for chronic disease management and downstream clinical outcomes,” the authors write.

The IRA gave Medicare the power for the first time to do some limited direct negotiations with drugmakers for the price of medicines. Previously, the federal government had been barred from such negotiations by law.

Democrats passed the IRA in 2022 against significant Republican opposition, and Trump criticized the law when he ran for president for the third time, in 2024. But instead of scrapping the Medicare drug-negotiation program, the Trump administration has built on it, defending it in court against drugmakers’ lawsuits and proposing a federal rule to strengthen its regulatory framework.

The first negotiated prices took effect in 2026 for 10 drugs, including the widely used blood thinner Eliquis. New negotiated prices for another 15 drugs, including the GLP-1 diabetes and obesity drugs Ozempic and Wegovy, take effect in 2027. Under current law, the maximum number of new drugs negotiated each year rises to 20 for 2029 and stays at that level for each subsequent year.

Rachel Sachs, a professor of law at Washington University in St. Louis, says the success of the early negotiations has significance even beyond the initial savings.

“It is a very important step, not only in controlling costs in the Medicare program, but also in showing that the government in the U.S. has the capacity to do this, just like governments in other countries already do this,” Sachs says.

In the run-up to the 2026 election, President Donald Trump has made several public announcements about deals he’s struck with drugmakers to lower drug prices.

Perhaps the best known of these is the TrumpRx website, which allows patients to purchase select medicines directly from manufacturers at discounted cash prices. This is intended for people with no health coverage or plans that don’t fully cover the tab for medicines, as explained in a July article for the journal Health Affairs.

“Whether TrumpRx improves pricing is uncertain, with some analyses finding its prices often exceed those on existing cash-pay platforms,” the authors write.

Trump also has brought attention to his direct talks with drugmakers, such as an August statement saying he’s reached agreements with 26 pharmaceutical firms. The White House says those firms cover 89% of the branded drug market.

Trump is promoting a strategy known as the most favored nation approach, or international reference pricing. The idea is that U.S. consumers should pay prices for pharmaceuticals no higher than those charged in other rich nations.

It’s important to note that the White House’s “MFN” deals so far apply mainly to Medicaid programs. And in reporting on these efforts, journalists also should note that while state budgets may benefit from the deals, the impact of MFN-based negotiations for Medicaid drug prices may not be noticeable to people enrolled in Medicaid.

Medicaid already typically pays the lowest prices for drugs in the United States due to previously established policies, as health economist Jeromie M. Ballreich and coauthors explain in a May analysis in the Journal of Managed Care & Specialty Pharmacy, which examines a 2025 drug pricing deal with Pfizer. The Medicaid Drug Rebate Program, first established in 1990 as part of a major budget law, allows states to get discounts from drugmakers in exchange for coverage of their products.

“In addition, the deal does little for patient affordability because cost sharing is minimal in Medicaid,” they write.

The Centers for Medicare & Medicaid Services (CMS) has several drug price reduction efforts in the works. These address the same aims of Trump’s less formal discussions with drugmakers, seeking to negotiate prices paid for drugs by other rich nations.

The difference is that CMS is using a path that involves more transparency and, sometimes, a formal rulemaking process. These institutionalized steps are more likely to continue after a change of  presidential administration. For this work, CMS is using what’s known as the Innovation Center, created under the ACA. This center allows CMS to test different approaches to improving the quality of medical care and lowering costs. There are established procedures for creating these models, often involving formal rulemaking and a public comment period.

In the past year, CMS has introduced three models to test approaches that tie U.S. drug prices to what other wealthy countries pay. One, which applies to Medicaid, is voluntary for drugmakers. The other two, which apply to Medicare, are designed to be mandatory for the manufacturers of qualifying drugs.

To help explain these models, we’re sharing insights from Dr. Thomas Hwang, a physician and  health policy researcher who is on the faculty of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women’s Hospital and Harvard Medical School. He suggests journalists make clear in their reporting that these CMS Innovation Center programs would apply only to Medicaid and Medicare. They will not bring down costs for people with private insurance or for those who lack insurance.

GENEROUS (GENErating cost Reductions fOr U.S. Medicaid)

How it works: Under this test program, drugmakers voluntarily give participating state Medicaid programs an extra rebate on brand-name drugs whenever Medicaid’s price (after existing rebates) is higher than the most-favored-nation price. State participation is also voluntary. GENEROUS is intended to save money for state and federal Medicaid budgets. It likely would not have much direct effect on people enrolled in Medicaid, for whom cost-sharing is minimal.

Where it stands: GENEROUS launched in January 2026. As of September, all 50 states had applied to join the program, and 40 states plus Puerto Rico had signed agreements confirming participation, according to a CMS announcement. CMS lists this program as being in the “announced” and not yet in the “active” stage on its Innovation Models page, which includes information on CMS test programs. CMS has not announced when participating states will receive their extra rebates.

What Dr. Hwang says about it: Applying this approach could result in an annual savings for 47 states and Washington, D.C. of $8.6 billion, representing 34.7% of net Medicaid spending in 2025 ($24.8 billion after existing rebates), according to a research letter by Hwang and Aaron S. Kesselheim of Harvard Medical School and Lisa Clemans-Cope of the Urban Institute, published in JAMA in July. “States with little or no existing supplemental rebates, such as Alaska, Hawaii, Massachusetts, and Rhode Island, would see the largest percentage reductions (59 to 66 percent of net drug spending),” the authors write in a separate article about the research. “States that already negotiate substantial rebates would gain less. Three states — Oklahoma, Mississippi, and North Dakota — already negotiate supplemental rebates that exceed what the model would offer, so they would not benefit.”

GUARD (Guarding U.S. Medicare Against Rising Drug Costs)

How it would work: Under this test program, also based on the most favored nation idea, Medicare would change how it sets the prices it pays for certain Part D pharmacy program drugs, basing its calculations on the lower prices other affluent countries pay for them. This would be a mandatory program, applied to selected drugs and would be used in randomly selected geographic areas representing 25% of people who have a Medicare Part D plan.

Where it stands: GUARD remains a proposal, which CMS published in December 2025 and for which it accepted comments through February. CMS has proposed that the model would run for several years, starting in January 2027.

What Dr. Hwang says about it: This model would result in estimated annual net savings of $6.4 billion, according to a cohort study of payment models that Hwang and coauthors published in the Lancet in October 2026.

GLOBE (Global Benchmark for Efficient Drug Pricing)

How it would work: This test program applies the international-pricing approach to drugs administered in clinics and doctors’ offices, which are covered by Medicare’s Part B instead of the Part D pharmacy program. So-called Part B drugs include costly medicines for cancer and diseases of the immune system, such as rheumatoid arthritis. CMS describes GLOBE as “a mandatory model that will assess a rebate for certain drugs payable under Original Medicare Part B if the prices exceed those paid in economically comparable countries.”

Where it stands: CMS greatly scaled back its initial plans for the GLOBE model.The finalized version of the rule for the program estimates savings of $440 million over a 7-year period, down from the $11.9 billion estimate in the draft rule released last year. CMS ultimately whittled down the pool of drugs that could be included in the new model. Even in this reduced form, the GLOBE model faces a legal challenge. On Oct. 2, CMS finalized its rule for GLOBE, with an intent to put it into effect by the end of November. The drugmaker’s lobbying group, the Pharmaceutical Research and Manufacturers of America (PhRMA) on Oct. 7 filed a complaint in the United States District Court for the District of Columbia, arguing that CMS does not have legal authority to put GLOBE into effect.

What Dr. Hwang says about it: The fact that the rule was finalized marks “a sea change” in the federal government’s approach to drug pricing, even with a scaled-back model, Hwang says.

“Referencing prices paid by other countries is something that’s always been talked about but never actually operationalized,” Hwang says. “The finalized GLOBE model marks the very first time that [most favored nation status] is being connected to Medicare.”

Efforts to rein in drug costs for people with private insurance are happening mostly at the state level.

The nonprofit National Academy for State Health Policy (NASHP) has a handy tracker of state-level legislation that addresses drug costs across several categories, including bills about setting up prescription drug affordability boards, known as PDABs. NASHP supports the PDAB approach, providing technical assistance to states that are trying to stand up these boards.

The idea is for expert panels to review the costs of medicines and create limits on the payment for certain costly drugs. Lawmakers in more than a dozen states have considered forming PDABs, with Colorado, Maryland, and Washington having enacted laws to create these boards.

But implementing cost controls is a complicated process, with no state having yet put in a place a limit. Maryland and Washington PDAB members are working through the start-up processes for creating upper payment limits (UPLs) on drugs.

The leader in these efforts is Colorado, which is now tangled in a legal battle with the biotech company Amgen.

Colorado’s PDAB last year became the first in the United States to try to limit the cost of a prescription drug by setting an upper payment limit for Enbrel, a common treatment for autoimmune diseases, at $600 per weekly dose. Amgen, the maker of Enbrel, sued and won a favorable ruling from a federal district court, which found the upper payment limit was “preempted” by federal patent law, as Andrew Twinamatsiko and Katie Keith of Georgetown’s Health Policy and the Law Initiative at the O’Neill Institute explain in a July 2026 article in Health Affairs.

“The decision is narrow: It applies only to Enbrel and does not bar the PDAB from conducting affordability reviews or setting [upper payment limits] for other unaffordable drugs,” the authors note.

Officials in Colorado and other states are continuing to pursue this idea even after this initial legal setback, Twinamatsiko says.

“I don’t think this has stopped PDABs from moving forward with trying to find out ways to lower drug prices,” he says

Twinamatsiko also points out that there’s an effort underway by Democrats on the Senate Finance Committee to address drug costs for people with private insurance.

These senators issued in July a public call for feedback, known as a request for information (RFI), about ways to lower drug costs. Democrats have stressed affordability, especially about medical care, in the 2026 midterm election.

Competition from generic drugs, which are lower-cost versions of brand-name medicines made by rival manufacturers, is one of the most reliable ways to bring down drug prices. Generics share the same active ingredient as the brand-name drug. The Food and Drug Administration, which decides which prescription drugs can be sold in the U.S., estimates that newly approved generic medicines approved in 2023 alone saved consumers about $18.6 billion in the first 12 months following their approvals.

Rival manufacturers also create lower-cost versions of biologic drugs, which are usually made from living cells. These versions are known as biosimilars. Replicating a branded biologic is more complex than copying a traditional pill, which is made by combining a set of chemical ingredients.

With production dependent on living cells, there can be small variations in the biologic medicine produced. But it’s important to note that the FDA checks that the biosimilars are delivering the same key ingredient as the original biologic. Journalists can better understand and explain this by checking the “DESCRIPTION” section on the drug’s label, also called prescribing information. For example, the labels for branded Humira and biosimilar versions describe these medicines as being “a recombinant human IgG1 monoclonal antibody.”

Journalists can find these labels on the FDA’s Drugs@FDA site, which journalists can look at when reporting on any prescription medicine. (You may find it useful to focus on the information on clinical studies and warnings.)

The FDA approves biosimilar drugs based on evidence that these drugs will behave in the same way as the original biologic medicine and deliver the same benefits.

It can take many years for generics and biosimilars to hit the market, due to temporary FDA-granted periods of exclusivity for brand-name medications and the patent-related tactics that pharmaceutical companies use to extend this exclusivity. It’s important for journalists to note that FDA protections and patent protections are very separate things.

The FDA requires extensive research, including clinical trials on humans, for initial approvals of drugs. That’s why it gives drugmakers a chance to recoup their substantial investment in pharmaceutical research by temporarily blocking competition for their new medicines through an exclusivity period. This is meant to compensate companies for both the time and expense of creating a successful drug, as well as the many setbacks they may experience in research.

The FDA has different approaches for handling approvals of copycat versions of medicines, both generics and biosimilars, depending on whether a drug is fairly simple to make, such as a pill, or more complex, such as a biologic drug. Federal laws intend for companies to get a longer period of exclusivity for a biologic drug than for a traditional medicine, depending on the conditions they treat.

Even after the FDA-granted exclusivity period ends, it very often takes far longer for competitor products to begin sales due to drugmakers’ patents, which are granted by the U.S. Patent and Trademark Office. The Congressional Research Service (CRS) has an excellent primer on drug patents and special exclusivity periods granted for medicines.

Drugmakers often seek multiple patents related to a single product, a strategy known as “patent thicket.”  This approach can delay competition for medicines for many years. An extreme example was the drug Humira, used for rheumatoid arthritis, write Timothy Bonis and S. Sean Tu in a September post for the journal Health Affairs. Their article analyzes various government proposals to bring down drug costs by encouraging biosimilar drug competition, including a bipartisan bill called the Eliminating Thickets to Increase Competition Act.

“Humira’s thicket of more than 100 patents contributed to a 75-month gap between FDA approval of biosimilars and their actual market entry during which Humira netted more than $110 billion,” write Bonis and Tu. Lawmakers and consumer advocates see this patent thicket strategy as an unfair gaming of the legal system. There have been bipartisan attempts for many years to address this issue.

Expect lawmakers to return to this topic in the new Congress. You can check on Congress.gov  to see which bills addressing pharmaceutical patents are introduced next year.

We asked researchers for advice on how to improve news coverage of drug prices in the United States. Here’s what they said.

Address the complexity of drug prices, and consider people who don’t have health insurance.

There’s a lot of confusion about what the cost of a medicine is, and journalists can educate their audiences by explaining concepts like list prices and how the list price might differ from what consumers actually pay for medicines.

Think of the list price as a starting point. Insurers and other middlemen in the healthcare system often negotiate different levels of discounts, resulting in lower prices for consumers. For consumers who have health insurance coverage, their out-of-pocket costs for medicines can be pegged to list prices. And for many people, the list price is the actual price they have to pay, leaving many people scrambling to cover pharmacy bills.

“The list price of a drug is important to someone who doesn’t have insurance, and there’s going to be more people without insurance” in the future in the United States, Sachs says.

The number of people in the United States without health insurance coverage may rise from 30 million in 2026 to 37 million in 2036, largely because of provisions of a major 2025 tax law, the Congressional Budget Office has said. Called the One Big Beautiful Bill Act by Republicans, this measure is expected to cut the number of people covered by Medicaid and the private health plans sold through exchanges created by the Affordable Care Act.

“To someone who doesn’t have insurance, the list price of the drug matters,” Sachs says. “Sometimes people’s out-of-pocket costs are based on the list price of a drug, even when they have insurance.”

Keep drug costs in perspective with other rising health expenses.

Media coverage about the costs of health care tends to focus on newer medicines with especially steep costs, such as the popular GLP-1 weight-loss drugs. The average annual per-person cost of GLP-1 medicines has been estimated at almost $7,000.

A recently published analysis of expenses for the Blue Cross Blue Shield of Massachusetts, that state’s largest insurer, found that GLP-1 drugs were a leading driver of the recent rise in total healthcare expenses. Inflation-adjusted prices for medical services paid by the insurer rose by 1.3% in fiscal year 2025, compared with 0.5% in 2019. Spending growth for retail prescription drugs rose during this time by 18.8%, up from 1.7% in 2019. But much of that was driven by spending on GLP-1s, which grew 83.7% compared with a 9.6% growth rate for all other retail drugs.

A sole focus on the high prices of some medicines gives a distorted view of health costs and the misconception that most drugs are very expensive, says Douglas Barthold, a health economist and associate professor at the University of Washington.

“Some of the sticker prices are exorbitant, so they make good headlines,” he says.

In reality, many people rely on low-cost older medicines, with unbranded generics making up about 90% of prescription medicine used in the United States.

It’s also important to note that prices in general have in recent years grown in line with the growth of other healthcare costs, Barthold says. Recent data from the National Health Expenditure report, a key annual analysis done by CMS, showed hospital expenditures grew 8.9% in 2024, while the amount paid to doctors and other clinicians rose by 8.1%. Prescription drug spending increased 7.9%.

“Hospital consolidation has led to a lot more power to dictate high prices to payers,” Barthold says.  “The pharmaceutical industry can be an easy scapegoat. A lot of the stories around the rest of healthcare costs are more complicated to tell.”

Kerry Dooley Young is a freelance journalist based in Washington, D.C. Her work also has appeared in The Journalist’s Resource, STAT, Bloomberg Government, and the Washington Post. Previously she covered the federal budget and health policy for Congressional Quarterly, and the pharmaceutical industry and Food and Drug Administration for Bloomberg. She now focuses on writing for the specialty medical publications Medscape and MedCentral.