The AARP Public Policy Institute found that list prices for 25 leading brand-name drugs have soared an average of 81% in the U.S. since launch, while dropping 13% across 19 peer nations through April 1, 2026. These therapies represented more than $100 billion in 2024 Medicare Part D spending for around 15 million beneficiaries. The disparities were striking. Amgen’s Enbrel rose 873% in the U.S. but fell 27% abroad. Incyte’s Jakafi gained 160% domestically, slipping 9% overseas, and Merck’s Januvia climbed 126% in the U.S. yet dropped 40% internationally. The lone exception: Amgen’s Repatha, which fell below its launch price after a 2018 cut. Six drugs currently under Medicare negotiation trimmed list prices by roughly 40% between 2024 and 2026. Still, AARP said the overall U.S. trend line points higher.
That divergence underscores how the structural rules differ between American and foreign pricing systems. In the U.S., drugs launch high and keep rising; in most peer markets, price reviews eventually drive them down. Early reductions among the Medicare-negotiated products indicate that the Inflation Reduction Act’s new authority is already shifting postlaunch behavior. Whether it becomes a broad correction or stays limited to a few high-profile categories is unclear, the data remains mixed. But with the White House pushing for Most Favored Nation-style benchmarks, the groundwork for a market adjustment is visible, especially where Medicare Part D dominates sales volume.
For investors, the message cuts two ways. Aging brands face real erosion in postlaunch pricing power as negotiation expands, while global firms must manage a widening gap between U.S. and ex-U.S. margins that can’t be leveled by simple rebate tactics anymore. Payers will use this data to negotiate more aggressively, pressing for larger concessions or tighter formularies. If 2026 ends up as the first year of sustained list-price decline for these benchmark drugs, it could reset commercial expectations entirely. Or not, but either way, the market is watching closely. For deeper comparisons on PBM and employer pricing strategies, see RxPBM.ai.
