Prescription Medication Expenditures and Policy Challenges in the U.S.: A Narrative Review of Economic and Legislative Solutions

The purpose of this paper is to discuss factors responsible for prescription medication expenditures and the challenges in their control with a focus on the US healthcare system. Prescription medication expenditures continue to rise in part through the introduction of blockbuster medications. Most factors necessary to control prescription medication expenditures in the US necessitate implementation at the federal level. Other countries with similar income levels negotiate prescription medication pricing at the national level. The US has begun to exert some of this control via the Inflation Reduction Act of 2022, but there is a long way to go to reduce overall medication prices. There are other measures to help control costs besides increasing the number of medications subject to negotiation by the Centers for Medicare & Medicaid Services (CMS). Examples of federal measures that have the potential to reduce prescription medication expenditures include increasing pricing transparency throughout the system, continuing to incentivize value-based care, and patent reform. Besides self-education about medication-related cost concerns, there are practices that pharmacists can employ to help optimize medication use while controlling costs for patients under their care.