The Importance of Lowering Prescription Drug Costs

Our patients cannot afford the life-saving medications they need (1). We witnessed this impact firsthand in a pregnant woman with gestational diabetes at a high-risk obstetrics clinic. She did not have premium health insurance and eventually progressed to preeclampsia due to her inability to afford insulin. Her baby nearly died but was saved by the health care team’s interventions. As medical students, our goal is to educate our peers and future patients regarding prescription drug costs. Approximately 1 in 3 Americans who take prescription drugs cannot continue due to cost (2). The American College of Physicians recommends policies that improve the accessibility and affordability of prescription drugs, including recommendations to modify Medicare plans, such as spending caps for Medicare beneficiaries (3). 

The Inflation Reduction Act (IRA) of 2022 requires negotiation between the U.S. Department of Health and Human Services and drug companies for the cost of drugs under Medicare Part D. In 2026, fifteen drugs, including Eliquis (apixaban), Jardiance (empagliflozin), and Xarelto (rivaroxaban), must be negotiated to ensure fairer prices for Americans insured under Medicare. Medicare access includes various subcategories, including Parts B and D. The coverage of Part B includes outpatient care, preventive screenings, and services from physicians, while Part D covers brand-name and generic prescription drugs and vaccines. In the future, more drugs are expected to be added to this list to prevent and decrease the adverse outcomes of chronic disease. These negotiations are estimated to save Medicare beneficiaries about $1.5 billion in prescription drug costs, ensuring greater affordability (4). The IRA also capped the price of insulin at $35 per month, as well as a $2000 annual out-of-pocket cap for Medicare Part D beneficiaries. The American College of Physicians (ACP) supports capping the cost of prescription drugs, especially those that are specialty drugs for chronic disease (3). Recent efforts are attempting to move Part D drugs to Part B drugs, which could potentially increase the cost of Medicare since most Part B drugs cost more per unit of drug. Therefore, it is essential to advocate for the continuation of the IRA to ensure that patients can access these crucial medications. 

Drug costs are also being inflated by spread pricing, a dangerous new attack on patients’ health. Pharmacy benefit managers can artificially inflate prices, charging Medicaid and insurers more than they reimburse pharmacies and draining public resources while using their position as a middleman to enrich themselves. This opaque practice has already drawn attention in several states like Ohio, which has uncovered that millions are being pocketed as profit (5). As a result, our patients are facing delayed treatment and worsening outcomes as their safety-net programs (Medicaid) lose valuable dollars. Policies that mandate transparent, pass-through pricing models that protect Medicaid’s integrity and prioritize patient health must be implemented. No one should be denied medication because profit was placed before access. 

While medication cost and insurance coverage are both critical to patients’ health, drug supply shortages further exacerbate the challenges of accessing necessary medications. Drug shortages have grown to be a silent crisis in American health care. From vital chemotherapy drugs to commonly used anesthetics, these critical medications are facing a shortage, forcing clinicians to use substitutes that may be less effective or delay care. The American Society of Health-System Pharmacists currently lists 235 medications in shortage, each one representing a potential gap in lifesaving treatment (6). These shortages challenge high-quality, patient-centered care through delays in treatment and inequitable access to essential medications. As health care professionals, we must support ACP’s call for systemic solutions: increased transparency, supply chain resilience, and policy that ensures reliable access to essential medications for every patient. 

Medical students may be overwhelmed by the burden of their studies, using their time to learn more about the human body and clinical studies that will benefit them as they serve their patients. Medical students, residents, and physicians serve individual populations but also have the knowledge to serve all patients across the country through advocacy. To achieve lower prescription drug costs for our patients, medical students and physicians must join the ACP in supporting the continuation of the IRA, providing checks on pharmaceutical companies, and addressing drug shortages. Medical students, residents, and physicians can contact state and national representatives, sharing personal stories to describe how patients could benefit from lower prescription drug prices. Advocating at the state or national level by speaking with legislators, such as during ACP Leadership Day, can provide our lawmakers with stories and statistics, equipping them with evidence as they cast their ballots. By promoting efforts to ensure medication access and affordability, we can improve health and save lives, even before we have the license to write a prescription. 

References

1. Dusetzina SB, Besaw RJ, Whitmore CC, et al. Cost-related medication nonadherence and desire for medication cost information among adults aged 65 years and older in the US in 2022. JAMA Netw Open. 2023;6:e2314211. [PMID: 37200029] doi:10.1001/jamanetworkopen.2023.14211
2. Hughes S, Rapfogel N. Following the money: untangling U.S. prescription drug financing. Center for American Progress. 12 October 2023. Accessed at www.americanprogress.org/article/following-the-money-untangling-u-s-prescription-drug-financing on 17 June 2025.
3. Daniel H, Bornstein SS; Health Public Policy Committee of the American College of Physicians. Policy recommendations for public health plans to stem the escalating costs of prescription drugs: a position paper from the American College of Physicians. Ann Intern Med. 2019;171:825-827. [PMID: 31711137] doi:10.7326/M19-0013
4. Ensuring prescription drug access and affordability. American College of Physicians. Accessed at www.acponline.org/advocacy/where-we-stand/2025-acp-priorities/ensuring-prescription-drug-access-and-affordability on 17 June 2025.
5. Auditor’s report: Pharmacy Benefit Managers take fees of 31% on generic drugs worth $208M in one-year period. Ohio Auditor of State. 16 August 2018. Accessed at https://ohioauditor.gov/news/pressreleases/details/5042 on 12 September 2025.
6. Drug Shortages List. American Society of Health-System Pharmacists. Accessed at www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=CurrentShortages on 17 June 2025.

Julie Centofanti, BS

Julie Centofanti is a second-year Doctor of Medicine candidate at Northeast Ohio Medical University. She received her undergraduate degree in biological sciences from Youngstown State University in Youngstown, Ohio. Julie is inspired to advocate for patients and provide patient-centered care, building upon her experiences speaking with legislators on Capitol Hill during ACP Leadership Day. She is passionate about her research in the field of gastroenterology and is interested in pursuing a residency in internal medicine.

Gabriel H. Mekis, BS

Gabriel Mekis is a second-year medical student at Northeast Ohio Medical University with a deep interest in internal medicine, specifically the complex interaction of the immune system with the rest of our body, such as in oncology and rheumatology. He is also passionate about patient advocacy, working with the Systemic Juvenile Idiopathic Arthritis (SJIA) Foundation to improve access to life-saving medication.

Adeline Whaley, BS

Adeline Whaley is a second-year Doctor of Medicine candidate at Northeast Ohio Medical University in Rootstown, Ohio. She received her undergraduate degree in biological sciences with minors in chemistry and mathematics from Youngstown State University in Youngstown, Ohio. Growing up in a rural community has shaped Adeline’s passion for advocating for vulnerable populations who often face barriers to care. She is exploring specialties including anesthesiology and cardiology.