Americans spend more on medication than every other country in the world combined, with the U.S. responsible for 50.6 per cent of global medicine sales in 2024.Fred Prouser/Reuters
Since coming into office again, U.S. President Donald Trump has targeted pharmaceuticals as an industry that he says treats the U.S. unfairly.
And when you put U.S. drug spending in a global context, it is easy to see why.
The United States accounts for about 4 per cent of the world’s population, about one-quarter of the world’s economy and just over half of the world’s spending on prescription drugs.
Or, to put it another way, Americans spend more on medication than every other country in the world combined.
The gap has widened over time, according to data from the Patented Medicine Prices Review Board, a Canadian federal body. The latest report, published Wednesday, showed the U.S. was the source of 50.6 per cent of global medicine sales in 2024. A decade ago, it was 40.4 per cent.
Most developed countries have prices in the same ball park, with Canada tending toward the high end. (Canada was fifth-highest in 2024.) But the U.S. is in a league of its own: Last year the average U.S. drug price was 264 per cent higher than in Canada.
One big reason why the U.S. pays more is that it has not, historically, used its public-health plans to try to negotiate better prices. That began to change under former president Joe Biden, and Mr. Trump is moving even more aggressively.
His administration recently announced a new program that would give drugmakers better access to state and federal Medicaid reimbursement for low-income residents, if drug makers offered most-favoured-nation pricing.
Many major pharmaceutical companies − including Pfizer, AstraZeneca, Eli Lilly & Co. and Novo Nordisk − have also voluntarily cut prices on popular drugs. And Britain recently reached a deal with the U.S. not to impose tariffs on pharmaceuticals, which are a major British export industry.
The United States’ massive share of the global market makes it clear what kind of leverage Mr. Trump has in these deals.
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