US brand-name drug prices climb after launch while falling abroad, AARP finds
List prices for top brand-name drugs in the US have risen an average of 81% since launch, while prices for the same medicines fell an average of 13% across 19 other high-income countries, according to a report released by the AARP Public Policy Institute.
The analysis, which tracked 25 brand-name drugs without generic or biosimilar competition through April 1, 2026, highlights postlaunch pricing as a key driver of the international pricing gap. US prices often start higher and continue to rise, compounding costs over time, while peer countries are more likely to use pricing systems that push costs down after launch. The 25 drugs — those with the highest Medicare Part D spending in 2024 — accounted for more than $100bn in Medicare prescription drug spending and were used by nearly 15mn beneficiaries.
The disparities were stark in individual cases. Enbrel, Amgen's (AMGN) blockbuster autoimmune drug, posted the largest US increase, with its list price up 873% since launch against a 27% decline abroad. Incyte's (INCY) blood cancer treatment Jakafi rose 160% in the US while falling 9% internationally, and Merck's (MRK) diabetes drug Januvia climbed 126% domestically while dropping 40% in comparison countries. The only drug with a US list price below its launch level was Amgen's cholesterol treatment Repatha, down 46% following a 60% cut in 2018 amid market competition — though its price has since risen 30% from that reduced level.
The report also found early signs that Medicare price negotiation under the Inflation Reduction Act may be pressuring some list prices. Six of the 25 drugs — Linzess, Jardiance, Eliquis, Januvia, Imbruvica and Ibrance — saw one-time US list price cuts averaging 40% between 2024 and 2026, all after being selected for Medicare negotiation. Linzess had the steepest drop at 50%.
But the cuts were not universal: another six drugs with Medicare-negotiated prices showed no corresponding list price decreases. "Those savings aren't necessarily going to reach other payers," said Leigh Purvis, the report's author and prescription drug policy principal at AARP. "There's more work that needs to be done."
Purvis noted the findings apply specifically to brand-name drugs, with US generic prices typically lower than in other countries thanks to a more competitive market.
The report lands as the Trump administration pushes "most favored nation" pricing as a centerpiece of its drug affordability agenda, with the White House claiming voluntary agreements with 17 major drugmakers could generate $529bn in savings over the next decade by tying future US launch prices to those in other high-income countries. AARP suggested international price comparisons could be incorporated into Medicare negotiations to amplify savings, alongside negotiating prices sooner after approval and expanding the number of eligible drugs.