What 33 countries pay for the same medicines, why brand-name drugs cost so much more in America, and why its generics are among the cheapest.
Researched with AI assistance; every figure is checked against the primary source cited on this page before publishing. How we work →
The most complete comparison is a study RAND carried out for the US Department of Health and Human Services, using 2022 sales and volume data. It compares manufacturer prices for the same drugs — 4,690 presentations and 1,646 active ingredients — and weights them by how much of each drug is actually used, so a country is not made to look cheaper by buying different medicines.
BRAND-NAME ORIGINATOR DRUGS · 2022 DATA
US prices as a share of each country’s prices
Manufacturer gross prices, matched for volume and mix of drugs. 100% would mean the US pays the same; 422% means about 4.2 times as much.
100% = same price as the other country
UNBRANDED GENERIC DRUGS · 2022 DATA
Here the US pays less
Same method. Below 100% means US prices are lower: 67% means the US pays 67 cents for every dollar paid elsewhere.
100% = same price as the other country
Across all drugs, US prices were 229% of Canada's, 294% of Germany's, 270% of the UK's, 326% of France's and 347% of Japan's. RAND notes that France and Japan generally had the lowest prices among these countries, while Canada, Germany and the UK tended to be higher. These are manufacturer gross prices. RAND also recalculated the index in several other ways, and its main findings held: higher US prices for all drugs and for brand-name originators, lower US prices for unbranded generics.
The study is from 2022. To show where things stand today, here are official prices we collected for eleven medicines in October and November 2026 — what US pharmacies pay to acquire them, against France's official price for the same product.
| Medicine | Amount | US pharmacy cost | France, official price | Full comparison |
|---|---|---|---|---|
| Eliquis 5 mg | 30 days (60 tablets) | $331 | $66 (€58.95) | All countries → |
| Jardiance 10 mg | 30 days | $336 | $41 (€36.59) | All countries → |
| Xarelto 20 mg | 30 days | $586 | $28 (€23.25 / 28) | All countries → |
| Januvia 100 mg | 30 days | $317 | $17 (€15.33) | All countries → |
| Farxiga 10 mg | 30 days | $362 | $41 (€36.57) | All countries → |
| Entresto 97/103 mg | 30 days (60 tablets) | $696 | $132 (€110.03 / 56) | All countries → |
| Ozempic 1 mg | one pen, one month | $996 | $86 (€76.58) | All countries → |
| Humalog insulin | one 10 mL vial | $64 | $16 (€14.31) | All countries → |
| NovoLog / NovoRapid | one 10 mL vial | $69 | $14 (€12.83) | All countries → |
| Enbrel 50 mg | 4 pens | $8,334 | $528 (€472.63) | All countries → |
| Stelara 45 mg | one syringe | $14,937 | $1,668 (€1,493.04) | All countries → |
US: CMS National Average Drug Acquisition Cost (NADAC), October 28, 2026 (Ozempic and Humalog: October 21, 2026), scaled to the amount shown. France: official price excluding the dispensing fee (Base de données publique des médicaments). Converted at European Central Bank rates of October 30, 2026 (Ozempic and Humalog: October 20, 2026); where France sells packs of 28 or 56 we scale to the amount shown (our calculation). Each drug page lists the exact source entries.
In most of the countries RAND compared, a public body assesses a new medicine and sets or negotiates what the health system will pay for it. Germany is a clear example: the Federal Joint Committee checks whether a new drug brings an added benefit over the standard treatment, and that result is the basis for what statutory health insurers pay. The maker's own price applies only for the first six months after launch; after that, the negotiated reimbursement amount applies, backdated to the seventh month (G-BA). In the US, Medicare's first negotiated prices, set under the Inflation Reduction Act, took effect only in January 2026 (CMS). Private insurers still negotiate behind closed doors, through the middlemen we explain in who sets US drug prices.
US list prices are not what insurers end up paying: drug makers pay rebates to insurers and pharmacy benefit managers. RAND adjusted for that. Even after estimated rebates, US prices for brand-name originator drugs were still over three times those in the other countries.
The same research program found that most new drugs were available in the US before they launched in other countries, and that the US spends a higher and growing share of its drug spending on new drugs (ASPE). During those years of patent protection, there is no cheaper copy to compete with.
Once a patent expires, the picture flips. US prices for unbranded generics were 67% of other countries' in 2022 — Americans paid 67 cents for every dollar paid elsewhere — and generics made up 90% of US prescriptions, against 41% in the other countries (RAND).
What drives the price down is the number of makers. The FDA looked at generics launched from 2015 to 2017: with one generic maker, the generic's manufacturer price was 39% below the brand's price before competition; with two makers, 54% below; with four, 79% below; with six or more, more than 95% below. A newly launched generic with little competition can therefore stay expensive. In October 2026, US pharmacies paid $3.85 a tablet for unbranded sitagliptin, the generic of Januvia — about $115 for 30 — while England's Drug Tariff paid £2.05 for 28 tablets (see our Januvia comparison).
That is why "the US pays more for medicine" and "US generics are cheap" are both true: the bill is driven by the 7% of prescriptions that are brand-name originators, which account for 87% of US spending.
For Medicare, yes. The first ten negotiated prices took effect on January 1, 2026, between 38% and 79% below their 2023 list prices — Eliquis, for example, at $231 for a 30-day supply against a $521 list price in 2023 (CMS). Fifteen more follow on January 1, 2027, including semaglutide (Ozempic, Wegovy) at $274 for a 30-day supply (CMS). On the same date, Novo Nordisk cuts the US list price of Ozempic and Wegovy to $675 a month. We track each change, with its date and source, on our price changes page.
None of this reaches the patterns the RAND data describe overnight: negotiated prices apply to Medicare, and the list prices most commercial plans start from are still set by the makers.
In 2022, US manufacturer prices across all prescription drugs were 278% of prices in 33 OECD countries combined — for every dollar paid elsewhere, $2.78 in the US. For brand-name originator drugs the figure was 422%. The study was carried out by RAND for the US Department of Health and Human Services (ASPE) and matches drugs by volume and mix.
On average, yes. In the same RAND study, US prices for unbranded generics were 67% of other countries' prices — 67 cents for every dollar. Unbranded generics made up 90% of US prescriptions but only 8% of US drug spending at manufacturer prices. The exception is a newly launched generic with few competitors, which can stay expensive.
In RAND's 2022 comparison of 33 countries, the biggest gap was with Turkey: across all drugs, US prices were 1,028% of Turkish prices. Among the large economies RAND highlights, France and Japan generally had the lowest prices; Canada, Germany and the UK tended to be higher. Every one of the 33 countries paid less than the US overall.
Most of them set or negotiate what their public health system pays. In Germany, for example, the Federal Joint Committee assesses whether a new drug adds benefit over the standard treatment, and that result is the basis for what statutory insurers pay; the maker's own price applies only for the first six months (G-BA). In the US, Medicare's first negotiated prices took effect only in January 2026 (CMS).
No. Rebates lower what US insurers and their pharmacy benefit managers pay, but RAND found US prices for brand-name originator drugs were still over three times those in other countries after adjusting for estimated rebates.
For some drugs and some patients. Medicare's first ten negotiated prices took effect on January 1, 2026, 38–79% below 2023 list prices, and 15 more follow on January 1, 2027, semaglutide among them at $274 for a 30-day supply (CMS). Novo Nordisk is cutting the US list price of Ozempic and Wegovy to $675 a month from the same date. These are cost facts, not advice — talk to your doctor or pharmacist about your own prescriptions.
Wellness Vision does not sell medicine, recommend pharmacies or suppliers, or take payments from drug makers. The country ratios are RAND's published figures; the 2026 prices come from the official sources cited on each drug page, and conversions and pack scaling are our calculation. This is a cost comparison, not medical advice.
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