Americans paid more out of pocket for generic drugs than for brand-name drugs, according to a study published September 11 in JAMA Network Open. Using the 2022 Medical Expenditure Panel Survey, a national survey of health spending, the researchers estimated that patients paid $16.8 billion for generics, 55.2% of the total, and $13.7 billion for brand-name drugs.
Generics are not more expensive per prescription. The total is larger because far more people take them, and many people take several.
If you fill several generic prescriptions, ask your pharmacist to compare your insurance copay with the cash or discount-card price for each one. The authors cite an estimate that insured patients’ out-of-pocket cost is higher than the cash price for a sizeable minority of generic prescriptions among people with Medicare or private insurance. This finding is about price, not about which medicines you need. It is not a reason to skip, split, or stop a pill to save money, or to swap one drug for another. Those decisions belong with your doctor.
Key takeaways
- Americans paid $16.8 billion out of pocket for generic drugs and $13.7 billion for brand-name drugs.
- Per user, brand-name drugs still cost more: $260 a year among people who filled one, versus $97 for generics.
- People on Medicare filled about 10 times as many generics as brand-name drugs and paid about the same for each group, $129 versus $143 a year.
What the study found
Christopher Cai, Aaron Kesselheim, and Benjamin Rome analyzed prescriptions filled at pharmacies in the 2022 survey, with results weighted to represent the US population. Dollar figures are adjusted to 2026 dollars.
About 52% of people filled at least one generic medication during the year. About 16% filled at least one brand-name drug.
Among the people who used them, brand-name drugs cost $260 a year out of pocket, nearly three times the $97 spent on generics. The authors describe brand-name drugs as much more expensive “on a per-drug basis.”
Generics made up for it in volume. About 14.3% of people paid more than $100 a year for generics, compared with 6.1% for brand-name drugs.
The national generic total is very likely between $15.4 billion and $18.3 billion, and the brand-name figure between $11.5 billion and $15.8 billion.
The pattern was clearest in Medicare. Beneficiaries filled an average of 4.1 generic and 0.4 brand-name medications a year and paid $129 and $143 out of pocket for them. The likely ranges for those two amounts overlap ($120 to $138 for generics, $125 to $161 for brand-name drugs), so the two are close.
Dr. Kumar’s take
The easy misreading is that generics have become expensive. They have not. What adds up is repetition: a modest copay on one pill, another on the next, refill after refill, across several medicines. Each new long-term prescription adds one more recurring charge, and eligibility for some of them keeps widening, as with the 23 million more US adults who may now qualify for blood pressure medication.
Timing matters too. These data come from 2022, before Medicare’s redesigned Part D benefit set an annual out-of-pocket limit of $2,000 starting in 2025. That limit counts generics, but a $2,000 bill is far easier to reach with brand-name drugs than with generics that averaged $97 a year per user. With the largest brand-name bills now capped, I expect generics make up an even bigger share of what many seniors pay today. That is a prediction; this study cannot test it.
The authors argue that policies to lower out-of-pocket costs must target both brand-name and generic drugs. For generics, they point to changes in insurance design, such as barring plans from charging more than the cash price, capping costs for some high-value generics, or dropping generic copays altogether.
The study has limits. It is a snapshot of a single year, not a trend. It counted only drugs dispensed at pharmacies, so drugs given by a clinician, such as infusions, were left out. It also did not cover people living in institutions such as nursing homes.
What it means for you
- If you take several generics, ask your pharmacist to price each one two ways: through your insurance and at the cash or discount-card price. Your plan is not always the cheapest way to fill them.
- Ask whether a cash purchase still counts toward your plan’s deductible or yearly out-of-pocket limit, since that can change which option saves more over the year.
- If cost is making it hard to keep taking a medicine, tell your doctor. Do not cut back on your own.