Why Drug Prices Are Rising on 350+ Medications Despite White House Pressure

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Pharmaceutical manufacturers announced price increases on at least 350 branded medications for 2026, including vaccines against COVID, RSV, and shingles. The median increase: 4 percent. This happened despite the Trump administration’s highly publicized “deals” with drugmakers and repeated promises to bring down costs.

Nine major pharmaceutical companies agreed in late 2025 to slash prices on select high-profile drugs—Ozempic dropping from $1,000 to $350 monthly, Repatha falling from $573 to $239. Yet these same companies, along with dozens of others, simultaneously raised prices across hundreds of medications that didn’t make the administration’s shortlist.

The system isn’t broken in the way most people assume. It’s functioning exactly as designed—which is the problem.

Price Increases on 350 Medications

According to data from healthcare research firm 3 Axis Advisors, the 350-drug figure represents an acceleration. At the same point in 2025, drugmakers had announced increases on 250 medications. Pfizer led with roughly 80 different drugs receiving higher prices, including cancer drug Ibrance and its COVID vaccine, which jumped 15 percent.

These are list price increases—the starting point before rebates and discounts that pharmacy benefit managers negotiate behind closed doors. What patients pay depends on their insurance, their pharmacy, and contractual arrangements they’ll never see.

The 4 percent median increase exceeds the 2.7 percent inflation rate from December 2025. Manufacturers have learned that increases hovering just above inflation generate minimal political backlash while delivering billions in additional revenue when applied across millions of patients taking these drugs for years.

How U.S. Drug Pricing Works

In most developed countries, governments set drug prices or negotiate them for their entire population. The United States doesn’t do this. Pharmaceutical manufacturers set their own prices, constrained primarily by what the market will bear rather than by regulatory limits.

This reflects American skepticism toward government price controls, but it creates a situation where U.S. prices run 278 percent of those in 33 other wealthy countries. For brand-name drugs, American prices hit 422 percent of comparison countries. Even after accounting for rebates and discounts, the gap persists.

The government’s negotiating authority, granted through the Inflation Reduction Act of 2022, applies to exactly 10 drugs in 2026. Medicare can negotiate prices only for medications meeting specific criteria: high Medicare spending, no recent generic competition, covered under Part D rather than Part B. The negotiated prices for these 10 drugs will save beneficiaries $1.5 billion annually in out-of-pocket costs. But 340 other drugs receiving price increases fall outside this program.

The Trump administration’s most-favored-nation deals operate differently. They’re voluntary agreements with individual manufacturers to match prices in other countries for specific drugs sold through the TrumpRx platform. Amgen agreed. Bristol Myers Squibb agreed. Gilead agreed. They also raised prices on dozens of other medications in their portfolios.

Pharmacy Benefit Managers and Price Incentives

Pharmacy benefit managers—PBMs—occupy the space between drug manufacturers and insurance companies. Three companies control drug benefits for 270 million people: CVS Caremark, Express Scripts, and OptumRx.

PBMs negotiate rebates with manufacturers. They process claims. They decide which drugs appear on formularies and which pharmacies join networks. They make money from the difference between what they charge insurers and what they pay pharmacies—the “spread.”

When manufacturers raise list prices, they typically increase rebates to maintain formulary access. Higher list price, bigger rebate, larger spread for the PBM. PBMs captured $60.6 billion in margins in 2022—31.2 percent of total drug spending, more than any other intermediary.

The system rewards higher prices, not lower ones.

Patients see none of this. Your copay at the pharmacy counter bears no relationship to the drug’s actual cost or the discounts negotiated on your behalf. Some pharmacies pay different prices for identical medications depending on their negotiating power. Pharmacy reimbursement rates often ignore actual acquisition costs. The City of Philadelphia recently sued PBMs alleging they manipulated insulin pricing through these mechanisms, enriching themselves while patients struggled to afford a century-old medication.

Patent Extensions Beyond Original Terms

Drug patents theoretically last 20 years from filing. In practice, manufacturers have become sophisticated at extending exclusivity far beyond that.

The strategy: file patents on minor formulation changes, delivery devices, manufacturing processes, or other incremental modifications. None represent genuine clinical innovation, but each creates legal complexity that deters generic manufacturers. “Product hopping”—reformulating a drug so existing generics are no longer equivalent—forces generic companies to restart development from scratch.

Manufacturers also file Citizen Petitions with the FDA requesting additional requirements for generic approval. These rarely succeed on their merits but delay generic entry through regulatory rather than legal means. The result costs patients and taxpayers billions while extending pricing power on medications that may differ only trivially from existing therapies.

For the newest expensive medications, patent protection extends into the mid-2030s or beyond. Generic competition won’t constrain their pricing for decades.

Biologic Drugs and Biosimilar Competition

Biologic drugs—medications derived from living cells rather than chemical synthesis—represent only 5 percent of prescriptions but 51 percent of total drug spending. Competitors can’t simply copy them. They must develop biosimilars through reverse-engineering and parallel clinical studies costing roughly $24 million and requiring one to three years.

The FDA has approved 76 biosimilars. Their market share remains below 20 percent despite therapeutic equivalence to branded products. Physicians stick with known medications. Insurance formularies favor branded drugs. Patients prefer the familiar. High development costs, complex regulatory pathways, and market inertia combine to limit biosimilar competition even when it theoretically exists.

Humira, a rheumatoid arthritis medication costing over $50,000 annually, maintains substantial market dominance despite available biosimilars. The FDA announced actions in December 2025 to accelerate biosimilar development by simplifying studies and reducing unnecessary testing.

Medicare Drug Price Negotiations: Results and Limitations

The first round of Medicare drug price negotiations produced substantial reductions on 10 medications. Januvia dropped 79 percent from $527 to $113 for a 30-day supply. Eliquis fell 56 percent from $521 to $231. Other drugs achieved similar or larger percentage cuts.

These reductions will save Medicare beneficiaries $1.5 billion annually in out-of-pocket costs and the program $6 billion overall. But they also demonstrate the limitations of negotiation as a comprehensive solution.

The program excludes drugs with recent generic competition, drugs covered under Part B rather than Part D, and drugs below specified spending thresholds. It addresses established medications rather than preventing high launch prices on newly approved drugs. The median net launch price for new drugs increased 51 percent between 2022 and 2024, after accounting for inflation and discounts.

Fifteen additional drugs enter negotiations for 2027, including Ozempic and Wegovy. That’s 25 drugs total receiving negotiated prices while 335+ others continue increasing according to manufacturer decisions. The negotiation program addresses excessive pricing on established medications while leaving unaddressed the problem of excessive launch prices that establish new baselines for future negotiations.

Who Bears the Cost of Price Increases

Medicare beneficiaries who’ve reached their $2,100 annual out-of-pocket maximum pay nothing for additional medications. The increase hits Medicare program costs and federal spending instead.

Privately insured individuals see modest copay increases at renewal, but annual increases of 4 percent blend into general healthcare cost inflation. Employers absorbing increased drug costs through health plans pass them to employees through higher premiums or reduced benefits, but the attribution of specific premium increases to specific drug price increases remains opaque.

The uninsured pay cash prices directly. They absorb the full impact of list price increases at the pharmacy counter.

According to the World Health Organization, nearly 50 percent of patients don’t take medications as prescribed, with approximately 30 percent failing to fill their first prescription. In the United States, cost-driven medication non-adherence leads to roughly 125,000 preventable deaths annually and $300 billion in avoidable healthcare costs.

Patients with cardiovascular disease who improve medication adherence by 20 percent experience 8 percent fewer cardiovascular events and 12 percent lower mortality. Yet cost remains a primary driver of non-adherence. People ration medications, skip doses, delay refills. They experience worse health outcomes, higher rates of emergency care, and ultimately higher total healthcare costs when untreated conditions manifest as acute events requiring hospitalization.

These consequences remain invisible to manufacturers setting prices or intermediaries capturing increased revenues. The costs fall on patients, emergency care systems, and society broadly rather than on companies making pricing decisions.

Strategies to Reduce Your Out-of-Pocket Costs

Check whether your medications are among the 10 drugs receiving Medicare negotiation in 2026: Eliquis, Enbrel, Entresto, Farxiga, Fiasp and NovoLog, Imbruvica, Januvia, Jardiance, Stelara, and Xarelto. If so, expect lower negotiated prices effective January 1, 2026—reductions of at minimum 38 percent from 2023 list prices.

For Medicare beneficiaries, the Part D out-of-pocket cap means after reaching $2,100 in 2026, you pay nothing for covered medications for the remainder of the calendar year. Medicare beneficiaries eligible for Extra Help based on income can receive copayments as low as $5.10 for generics and $12.65 for brand-name drugs.

Manufacturer patient assistance programs provide drugs for free or at reduced cost to patients meeting income and insurance criteria. Eligibility varies by program, but many manufacturers offer assistance worth investigating. Copay cards reduce out-of-pocket costs for specific brand-name medications, though understand that copay assistance doesn’t count toward deductibles or out-of-pocket maximums in plans using copay accumulator programs.

Generic medications almost uniformly cost substantially less than branded equivalents. Generics accounted for 90 percent of prescriptions filled in the U.S. in 2024 but only 12 percent of total prescription drug spending. Ask your healthcare provider whether therapeutic alternatives or generic medications might adequately treat your condition before accepting high-cost branded drugs as necessary.

The 340B Drug Pricing Program provides reference pricing through participating safety-net providers. State pharmaceutical assistance programs offer coverage for people meeting income criteria in states with such programs. Price comparison tools like GoodRx and Pharmacy Rx identify the lowest prices among different pharmacies, which can vary substantially for identical medications.

Why Price Increases Continue Despite Government Pressure

The announcement of 350+ drug price increases despite intense government pressure reveals policy choice rather than policy failure. The United States has deliberately chosen a system permitting manufacturer pricing autonomy, protected by patent laws and regulatory exclusivity provisions, subject to relatively weak constraints from government negotiation and market competition.

Manufacturers employ sophisticated strategies extending patent protection far beyond genuine innovation periods. PBMs simultaneously negotiate rebates while benefiting financially from higher prices. Intermediaries throughout the supply chain profit from price increases while patients face access barriers and non-adherence driven by cost.

Recent government interventions—Medicare price negotiation, executive orders directing most-favored-nation pricing for select drugs, proposed PBM reforms—all address important elements of this system. None transforms the fundamental incentive structure that allows manufacturers to raise prices across 350+ medications despite political pressure to reduce them.

Medicare price negotiation will reduce costs for beneficiaries using the 10 drugs negotiated in 2026 and the growing list in subsequent years. It doesn’t address drugs outside Medicare, doesn’t affect launch prices for newly approved medications, and affects only a subset of the total pharmaceutical market.

The Trump administration’s most-favored-nation deals provide meaningful reductions on select high-profile drugs. They leave the vast majority of medications subject to manufacturer pricing decisions unconstrained by government action.

Continuation of current trends—350+ annual price increases, maintenance of U.S. prices three times higher than in other developed nations, expanding medication non-adherence driven by cost—appears likely absent more comprehensive reform. Comprehensive reform requires political will to challenge pharmaceutical industry interests through either direct price regulation, mandatory price controls tied to international reference pricing, or substantial reform of patent and regulatory frameworks that permit indefinite extensions of manufacturer pricing power.

The PBM Reform Act of 2025 passed the House in July, seeking to delink PBM compensation from drug prices and establish transparency requirements. State-level drug pricing transparency laws now operate in more than a dozen states. Some states including Colorado and Oregon have established prescription drug affordability boards with authority to review high-cost drugs and potentially set payment limits.

The system functions exactly as designed. That’s what needs to change.

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