Lower Prescription Drug Prices

Millions of Americans Cannot Afford Their Medications

One in four Americans report difficulty affording their prescription medications, with many skipping doses, cutting pills in half, or forgoing treatment entirely due to cost.¹ These are not abstract statistics—they represent real people choosing between lifesaving medications and rent, between insulin and groceries, between survival and bankruptcy. Meanwhile, pharmaceutical corporations report record profits, executives receive multimillion-dollar compensation packages, and the industry spends nearly $150 million annually on federal lobbying to protect these profits.²

Americans pay two to three times more for prescription drugs than patients in other wealthy countries for identical medications.³ A vial of insulin that costs $300 in the United States sells for $30 in Canada.⁴ Cancer drugs priced at $10,000 per month in America cost a fraction of that price in Europe.³ This price disparity reflects neither research costs nor drug quality—it reflects pharmaceutical industry market power and political influence that prevent the federal government from negotiating drug prices on behalf of Medicare beneficiaries.

The consequences prove deadly. Approximately 1.3 million Americans annually do not fill prescriptions due to cost.⁵ Diabetics ration insulin, cancer patients delay chemotherapy, heart disease patients skip medications—all because pharmaceutical corporations prioritize profit maximization over patient survival. Studies estimate that thousands of Americans die each year from inability to afford medications that could have saved their lives.⁵ This constitutes a moral atrocity enabled by congressional failure to challenge pharmaceutical industry power.

Massachusetts Residents Face Crushing Drug Costs

Massachusetts residents, despite living in one of the wealthiest states with extensive health insurance coverage, struggle with prescription drug costs comparable to national averages. Approximately 16% of Massachusetts adults report difficulty affording medications, with higher rates among low-income residents, people of color, and those with chronic conditions requiring multiple prescriptions.⁶

Massachusetts seniors face particularly acute medication cost burdens. While Medicare Part D provides prescription drug coverage, it includes significant gaps—the notorious “donut hole”—leaving many seniors paying thousands of dollars out of pocket for medications after reaching coverage limits. Massachusetts has one of the highest costs of living in the nation, meaning that medication expenses consume an even larger share of fixed incomes for elderly residents who must also afford housing, food, and utilities.

The Commonwealth’s high concentration of biotechnology and pharmaceutical companies creates economic tension around drug pricing policy. While these companies provide jobs and contribute to the state economy, they also aggressively lobby against price controls and negotiate tax incentives from state government. Massachusetts workers employed by pharmaceutical corporations deserve good jobs—but not at the expense of patients who cannot afford medications. We can maintain biopharmaceutical employment while demanding that corporations price drugs affordably.

Massachusetts has attempted state-level responses, including prescription drug transparency laws requiring manufacturers to justify price increases.⁷ However, state action proves insufficient without federal policy. The pharmaceutical industry operates nationally and internationally; only federal intervention through Medicare negotiation and price controls can effectively constrain drug costs. Massachusetts representatives must champion federal legislation rather than accepting pharmaceutical industry campaign contributions and echoing corporate talking points against negotiation.

The Inflation Reduction Act: Progress and Limitations

The Inflation Reduction Act of 2022 included historic drug pricing provisions that, for the first time, authorized Medicare to negotiate prices for certain prescription drugs.⁸ This represented significant progress after decades of pharmaceutical industry success in blocking negotiation authority. The legislation caps out-of-pocket Medicare Part D spending at $2,000 annually beginning in 2025, limits monthly insulin costs to $35 for Medicare beneficiaries, requires manufacturers to pay rebates if drug prices rise faster than inflation, and permits Medicare to negotiate prices for a limited number of high-cost drugs.⁸

However, the Inflation Reduction Act’s drug pricing provisions remain far too modest. Medicare can initially negotiate prices for only 10 drugs in 2026, expanding to 20 drugs by 2029.⁸ These limitations mean the vast majority of prescription medications remain exempt from negotiation. Pharmaceutical corporations maintain monopoly pricing power for thousands of drugs, continuing to extract maximum profits from captive patients who face the choice between paying extortionate prices or foregoing treatment.

The $35 monthly insulin cap applies only to Medicare beneficiaries, excluding millions of Americans under age 65 who also struggle with insulin costs. The out-of-pocket spending cap similarly applies only to Medicare Part D, leaving those with employer-sponsored insurance or Affordable Care Act marketplace plans facing potentially unlimited medication costs. These eligibility limitations reflect political compromise rather than policy logic—if capping insulin costs makes sense for seniors, it makes equal sense for younger diabetics.

Republican attacks on the Inflation Reduction Act’s drug pricing provisions demonstrate pharmaceutical industry political power. GOP legislators have introduced bills to repeal negotiation authority, weaken price controls, and expand exemptions for specific drug categories.² The recent Republican rollback delivered $8.8 billion in savings to pharmaceutical corporations by exempting categories of high-cost drugs from negotiation.² Every exemption protects corporate profits at patients’ expense, illustrating how campaign contributions and lobbying translate directly into legislative outcomes favoring industry over constituents.

What Congress Must Do: Aggressive Federal Intervention

Congress should dramatically expand Medicare’s drug price negotiation authority, reject pharmaceutical industry campaign contributions, and implement comprehensive price controls protecting all Americans from medication costs.

Expand Medicare Negotiation: Congress should authorize Medicare to negotiate prices for all drugs covered under Parts B and D, eliminating arbitrary limitations on the number of drugs subject to negotiation. If Medicare possesses authority to negotiate prices at all—which pharmaceutical industry lobbyists fought for decades to prevent—that authority should extend to every medication Medicare pays for. The current limitation to 10 drugs in 2026 represents a political compromise with no policy justification. Patients need affordable access to all medications, not merely a handful selected through bureaucratic processes.

Allow Medication Importation: Congress should permit Americans to import prescription drugs from Canada, Europe, and other countries with comparable safety standards and lower prices. The pharmaceutical industry claims importation would compromise drug safety, but this argument insults international regulatory agencies in wealthy democracies with rigorous pharmaceutical oversight. If a medication approved by Health Canada or the European Medicines Agency proves safe for Canadians and Europeans, it is equally safe for Americans. The real concern driving industry opposition to importation is that international price competition would undermine U.S. monopoly pricing.

Link U.S. Prices to International Benchmarks: Congress should establish by statute that Medicare drug prices cannot exceed 120% of the median price in comparable wealthy countries. This “international reference pricing” would immediately reduce American drug costs by 50% or more for many medications.⁹ Pharmaceutical companies claim that Americans subsidize drug development for the rest of the world through higher prices, but this framing inverts responsibility. The question is not why other countries pay less but why Americans tolerate being gouged. International reference pricing would force pharmaceutical corporations to justify their pricing rather than exploiting American patients’ captivity.

Extend Protections Beyond Medicare: Congress should extend all drug pricing protections—negotiated prices, out-of-pocket caps, inflation penalties—to Americans with private insurance, not merely Medicare beneficiaries. The $35 monthly insulin cap should apply to all diabetics regardless of insurance type. Out-of-pocket spending caps should protect all patients, not only seniors. Creating a two-tier system where Medicare beneficiaries receive price protections while working-age Americans face unlimited costs contradicts both equity and economic efficiency.

End Pay-for-Delay and Evergreening: Pharmaceutical companies use various tactics to extend patent monopolies and delay generic competition, including paying generic manufacturers to postpone market entry (“pay-for-delay”) and making trivial modifications to existing drugs to obtain new patents (“evergreening”).¹⁰ Congress should ban these practices, establish shorter exclusivity periods, and expedite generic drug approvals. Generic medications typically cost 80-85% less than brand-name versions; accelerating generic competition would dramatically reduce medication spending while maintaining incentives for genuine innovation.

Public Manufacturing of Essential Medications: Congress should authorize federal production of essential generic medications through a public pharmaceutical manufacturer or expanded Veterans Affairs capabilities. When private manufacturers create artificial shortages to raise prices or abandon production of low-profit essential drugs, public manufacturing would ensure continued access at reasonable costs. This is not radical—many countries maintain public pharmaceutical production for similar reasons.

Reject Pharmaceutical Industry Money and Influence

Massachusetts congressional representatives must refuse pharmaceutical industry campaign contributions and commit to supporting maximum drug price negotiation. The correlation between accepting pharmaceutical money and opposing price controls proves too consistent to dismiss as coincidence. Representatives who accept industry contributions reliably echo industry talking points about innovation, research costs, and negotiation dangers—arguments that dissolve under factual scrutiny but serve corporate profit interests.

Senator Elizabeth Warren has championed aggressive drug pricing legislation throughout her Senate tenure.¹¹ Senator Ed Markey similarly supports strong price negotiation authority. Representative Ayanna Pressley has advocated for drug price controls as a health equity issue. However, Representative Jake Auchincloss accepted pharmaceutical industry contributions and opposed strong negotiation provisions, disqualifying himself from credibly claiming to fight for affordable healthcare.¹²

Massachusetts voters must demand that congressional candidates reject pharmaceutical money entirely and pledge to support maximum negotiation authority, importation, international reference pricing, and all other measures to lower drug costs. Any representative who accepts pharmaceutical industry contributions has already chosen whose interests they serve—and it is not patients struggling to afford medications.

The pharmaceutical industry will claim that aggressive price controls would eliminate innovation, reduce drug development, and ultimately harm patients by preventing new treatments. These scare tactics have succeeded for decades in blocking reform. However, the evidence contradicts industry claims. Countries with strong price controls continue to benefit from pharmaceutical innovation. National Institutes of Health funding drives most basic research underlying new drugs. Pharmaceutical companies spend more on marketing and executive compensation than research. The industry remains highly profitable even in countries with aggressive price negotiation.¹³

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