Prescriptions – How the System Works

Recently, President Trump made news with an Executive Order designed to decrease the cost of prescriptions for Americans. He told a story that articulates the problem best:

A friend of mine who’s a businessman, very, very, very top guy, most of you would have heard of him. Highly neurotic, brilliant businessman, seriously overweight … and he takes the … fat shot drug. He called me up and he said, ‘President… I’m in London and I just paid for this fat drug I take…I just paid $88 and in New York I pay $1,300.’

Unfortunately, this problem is all too common for most Americans who take medications that have not been released in a generic form. President Trump’s first paragraph of the Executive Order describes the problem:

 The United States has less than five percent of the world’s population and yet funds around three quarters of global pharmaceutical profits. This egregious imbalance is orchestrated through a purposeful scheme in which drug manufacturers deeply discount their products to access foreign markets and subsidize that decrease through enormously high prices in the United States.

For as long as I remember the argument for the disparity of the cost of what Americans pay for non-generic medications compared to the rest of the world is that we need to fund research and development. There is no doubt that American drug companies’ revolutionary drugs have developed incredible solutions to many health problems. However, the question remains why must Americans shoulder most of the costs?

The Current System
It takes years to develop a new drug and then test it for efficacy and safety. Drug studies are very expensive involving thousands of people. The FDA then evaluates the results to determine if the new drug should be approved for use. The system only works if the FDA evaluators are independent of the pharmaceutical companies. For years there has been a revolving door of evaluators serving in the FDA then accepting positions at pharmaceutical companies. Questions have arisen regarding the objectivity of these affiliated members.

Generic Drugs
After 20 years or so the new drug’s recipe becomes available to other manufactures and generic drugs are born. They are significantly cheaper than the trade name or newer patent protected drug. Most healthcare providers utilize generic drugs whenever they can to reduce costs for their patients. Currently many are made in other countries. There is a move to bring that manufacturing back to the United States.

Pharmacy Benefit Managers: The Middlemen
Compounding the problem are the large pharmacy benefit managers or also known as middlemen who go-between the drug company and the pharmacy. The Federal Trade Commission issued an interim report in 2024: The report details how prescription drug middlemen profit at the expense of patients by inflating drug costs and squeezing main street pharmacies. It’s a complicated system that President Trump is looking into with the recent Executive Order.  

What You Can Do if Your Medications Cost to Much

 Insurance
If you’re on Medicare during the annual enrollment period, you can change your drug plan to one that is more affordable. Rates tend to increase annually so it’s a good idea to examine your plan and change it to a cheaper one that covers your costs better. A Medicare/Secondary advisor can evaluate your plan.

Coupons
Good RX, and others provide coupons that you present to your pharmacist to get a better price on an expensive medication. They usually require a cash payment to use the coupon. As an example, go to goodrx.com and enter your medication. A list of local pharmacies will be displayed and their cost for that drug. Just because you have most of your medications at one pharmacy doesn’t mean you have to remain with that pharmacy when using a cash payment and a coupon. You may pick up the expensive one at one place and use your insurance for the others at a different place.

Hardship Cases
For some people the cheaper generics just simply don’t work and a newer more expensive trade name still under patent is needed but you can’t afford it. You can contact the drug manufacture directly to inquire if you qualify for a major reduction in cost based on your financial situation.

On A Personal Note:
My husband had a slight detached retina a few years ago. It required several repairs, and very expensive eye drops to heal it. With a little bit of homework, we worked with the doctor, pharmacy and insurance company to find solutions and drops that worked but were more affordable.

I’m on an estrogen derivative that is very expensive. I used Good RX for a few years but the price was still very expensive. Surprisingly, I found it much cheaper on the Amazon Pharmacy. It’s easy to use. Amazon provides a form for the healthcare provider to email the prescription. The medication is sent out in the mail.

Finally, Americans have been expected to carry the heavy burden of all the nations around the world on many issues. It’s time that they step up and share these costs as well. The bottom line for this is to pray for our representatives to come up with commonsense Judea Christian governance to solve the problems of today. May they do so…

Let the wise hear and increase in learning, and the one who understands obtain guidance (Proverbs 1:5).

References:

Kinsey Crowley, “Trump Mentions ‘Fat Shot Drug’ in Executive Order Announcement. Will Ozempic Get Cheaper?” USA Today (May 13, 2025). https://www.usatoday.com/story/news/2025/05/13/trump-fat-shot-drug-ozempic-prices-wegovy/83595110007/ .

“Delivering Most-Favored-Nation Prescription Drug Pricing to American Patients,” The White House, (May 12, 2025). https://www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/

Sydney Lupkin, “A Look at How the Revolving Door Spins from FDA to Industry,” NPR Shots Health News (September 28, 2016). https://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry

Ananya Mandal MD, “Drug Patents & Generic Pharmaceutical Drugs, News medical Life Sciences (September 24, 2016). https://www.news-medical.net/health/Drug-Patents-and-Generics.aspx

“FTC Releases Interim Staff Report on Prescription Drug Middlemen,” Federal Trade Commission (July 9, 2024). https://www.ftc.gov/news-events/news/press-releases/2024/07/ftc-releases-interim-staff-report-prescription-drug-middlemen

GoodRX.com. https://www.goodrx.com    

“How It Works” Amazon Pharmacy. https://pharmacy.amazon.com/?nodl=0&ref_=nav_cs_pharmacy

I’m a Christian nurse who helps people navigate the murky waters of healthcare.

Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.