Drug prices by country

Sources and derivations for Figure 2 of One Drug, Many Prices: A Proposal to Reform US Healthcare Pricing. Back to overview.

Nine widely used medications, all selected for Medicare negotiation under the Inflation Reduction Act, cost substantially less in peer developed countries than in the United States. The comparison covers US list prices, estimated US net prices (after rebates and discounts), Medicare's new IRA-negotiated prices, and prices in six peer countries. This page documents every figure shown in Figure 2.

Bar chart comparing drug prices across nine countries for nine medications. Each panel uses its own vertical scale. — Figure 2. Drug prices by country for nine IRA-negotiated medications. Dark red is the US list price (paid by the uninsured); orange is the estimated US net price after rebates and discounts; green is the Medicare IRA-negotiated price (effective 2026); gray bars are six peer developed countries. Each panel uses its own vertical scale.

How to read the sources

For each drug, the nine bars represent:

US (list): the US wholesale acquisition cost (WAC), which is what uninsured patients face at retail pharmacy.
US (est. net): the estimated US net price paid by private insurers after manufacturer rebates and discounts, derived from SSR Health data and SEC filings as reported in Wouters et al. (JAMA 2025).
US (negotiated): the Medicare Maximum Fair Price negotiated under the Inflation Reduction Act, effective 2026.
Australia, Canada, France, Germany, Switzerland, UK: the official reimbursed price in each country, as compiled in the same Wouters et al. dataset.

All prices are denominated in US dollars per 30-day supply at the adult maintenance dose used by Wouters et al. Expand any drug below to view the exact figures.

Notes on scope

The nine drugs are the first ten drugs selected by CMS for Medicare negotiation based on Medicare Part D spending, minus insulin aspart. Insulin aspart is excluded because international prices are reported per unit rather than per 30-day supply, making a direct comparison imprecise.
Every other country shown negotiates drug prices through centralized purchasing (a single government or government-authorized body bargaining on behalf of all covered patients). The United States, until the Inflation Reduction Act of 2022, did not.
The US net price is an estimate because exact rebates are confidential. It is the best publicly available figure, derived from manufacturer SEC filings and SSR Health's gross-to-net model.
The Medicare negotiated prices take effect in 2026 and were announced by CMS in August 2024.

Per-drug figures

Eliquis (apixaban), 30-day supplyIRA Year 1

US (list): $521
US (est. net): $309
US (negotiated): $231
Australia: $57
Canada: $80
France: $64
Germany: $69
Switzerland: $82
UK: $69

Sources: Wouters, Naci, Kesselheim. JAMA 2025;333:85–87; CMS, Selected Drugs and Negotiated Prices.

Xarelto (rivaroxaban), 30-day supplyIRA Year 1

US (list): $517
US (est. net): $261
US (negotiated): $197
Australia: $51
Canada: $71
France: $59
Germany: $86
Switzerland: $86
UK: $65

Sources: Wouters et al. JAMA 2025; CMS MFP.

Jardiance (empagliflozin), 30-day supplyIRA Year 1

US (list): $573
US (est. net): $252
US (negotiated): $197
Australia: $33
Canada: $67
France: $38
Germany: $51
Switzerland: $51
UK: $47

Sources: Wouters et al. JAMA 2025; CMS MFP.

Januvia (sitagliptin), 30-day supplyIRA Year 1

US (list): $527
US (est. net): $196
US (negotiated): $113
Australia: $31
Canada: $76
France: $26
Germany: $36
Switzerland: $44
UK: $43

Sources: Wouters et al. JAMA 2025; CMS MFP.

Entresto (sacubitril/valsartan), 30-day supplyIRA Year 1

US (list): $628
US (est. net): $458
US (negotiated): $295
Australia: $139
Canada: $182
France: $157
Germany: $150
Switzerland: $145
UK: $118

Sources: Wouters et al. JAMA 2025; CMS MFP.

Enbrel (etanercept), 30-day supplyIRA Year 1

US (list): $7,106
US (est. net): $3,572
US (negotiated): $2,355
Australia: $754
Canada: $1,135
France: $646
Germany: $974
Switzerland: $1,177
UK: $852

Sources: Wouters et al. JAMA 2025; CMS MFP.

Stelara (ustekinumab), 30-day equivalentIRA Year 1

US (list): $13,836
US (est. net): $7,860
US (negotiated): $4,695
Australia: $1,342
Canada: $1,813
France: $1,220
Germany: $2,504
Switzerland: $1,730
UK: $1,292

Sources: Wouters et al. JAMA 2025; CMS MFP.

Imbruvica (ibrutinib), 30-day supplyIRA Year 1

US (list): $14,934
US (est. net): $11,571
US (negotiated): $9,319
Australia: $2,137
Canada: $2,320
France: $2,472
Germany: $4,944
Switzerland: $5,172
UK: $4,447

Sources: Wouters et al. JAMA 2025; CMS MFP.

Farxiga (dapagliflozin), 30-day supplyIRA Year 1

US (list): $565
US (est. net): $194
US (negotiated): $179
Australia: $34
Canada: $65
France: $39
Germany: $42
Switzerland: $49
UK: $47

Sources: Wouters et al. JAMA 2025; CMS MFP.

Notes on method

Wouters et al. (JAMA 2025) is the single primary source for the list, net, and peer-country prices. The paper collected drug prices in the US and six other developed nations (Australia, Canada, France, Germany, Switzerland, UK) for the drugs selected in the first round of Medicare negotiation under the Inflation Reduction Act. Peer-country prices are the official reimbursed prices in each country (ex-factory or equivalent), converted to USD at the exchange rates used in the paper.
Net US prices are estimates because exact rebates remain confidential. The figures use SSR Health's gross-to-net model, which draws on manufacturer SEC filings (10-K and 10-Q) and is the most widely cited such model in health economics.
Medicare negotiated prices come directly from CMS's published fact sheet on the first ten drugs selected under the Medicare Drug Price Negotiation Program. They take effect in 2026.
Exchange rates and time points follow Wouters et al. 2025. Peer-country prices can shift modestly with exchange rates, but the ratios shown here are stable across common reference periods.