In the U.S., many top brand-name drugs continue to get more expensive with age, while the same medicines often get cheaper in peer countries, according to an AARP Public Policy Institute report released Thursday.
U.S. list prices for 25 top brand-name drugs have climbed an average of 81% since launch, while prices for those same medicines fell an average of 13% in 19 other high-income countries, the report found.
AARP also found an early sign that Medicare price negotiation may be putting pressure on some list prices. Six of the 25 drugs saw one-time U.S. list price cuts between 2024 and 2026, averaging 40%. All six have had their prices negotiated by Medicare.
But those cuts do not change the broader pricing trajectory. The analysis frames postlaunch pricing as a key factor in the international pricing gap, with U.S. brand-name drug prices often starting higher and continuing to rise over time. That creates a compounding effect, making already expensive medicines even more costly, while other countries are more likely to use pricing systems that push down costs after launch.
The AARP analysis, which tracked prices from each drug’s launch through April 1, 2026, covers 25 brand-name drugs without generic or biosimilar competition that had the highest total Medicare Part D spending in 2024. Together, the drugs accounted for more than $100 billion in Medicare prescription drug spending and were used by nearly 15 million beneficiaries.
Across the 25 drugs, U.S. lifetime list price changes ranged from a 46% decrease to an 873% increase. Outside the U.S., the trend moved in the opposite direction. List prices for 24 of the 25 medicines fell after launch, driving an average decrease of 13% across the comparison countries.
Enbrel, Amgen’s blockbuster autoimmune disease drug, posted the largest U.S. increase, with its list price up 873% since launch. By comparison, its price fell 27% outside the U.S. Jakafi, Incyte’s blood cancer treatment, rose 160% in the U.S. while falling 9% abroad. Merck’s diabetes drug Januvia climbed 126% domestically while dropping 40% in the comparison countries.
The only drug in the analysis with a lower U.S. list price than at launch was Amgen’s cholesterol drug Repatha. Its price was down 46%, a decline AARP attributed to a 60% price cut Amgen made in 2018 amid market competition and payer resistance. The drug’s list price has since increased 30% from that reduced level, according to the report.
The findings are specific to brand-name drugs, Leigh Purvis, prescription drug policy principal at AARP’s Public Policy Institute and author of the report, said Thursday during a media briefing at the Association of Health Care Journalists’ Health Journalism 2026 conference in Minneapolis. Generic prices are often lower in the U.S. than in other countries, she said, pointing to a more competitive market for those medicines.
“Our generic prices are actually less here than in other countries,” Purvis said. “We have a robust system.”
The report also offers a more nuanced look at Medicare negotiation under the Inflation Reduction Act. Six drugs in the analysis saw significant one-time U.S. list price cuts between 2024 and 2026: Linzess, Jardiance, Eliquis, Januvia, Imbruvica and Ibrance.
Linzess had the steepest drop, at 50%, followed by Jardiance at 44%, Eliquis at 43%, Januvia at 42%, Imbruvica at 41% and Ibrance at 18%. The negotiated Medicare prices for Ibrance and Linzess take effect in 2027, while the other four drugs’ negotiated prices took effect at the start of this year.
Still, the list price cuts were not consistent across all negotiated drugs. The analysis found that an additional six drugs with Medicare-negotiated prices did not have corresponding U.S. list price decreases.
“Those savings aren’t necessarily going to reach other payers,” Purvis said during the briefing. “There’s more work that needs to be done.”
The findings land as the Trump administration continues to push “most favored nation” pricing as a central part of its drug affordability agenda. The White House has said voluntary agreements with 17 major drugmakers could generate $529 billion in savings over the next decade, largely by tying future U.S. launch prices to prices in other high-income countries.
AARP said international price comparisons could be folded into Medicare negotiations to amplify savings. The group also pointed to other potential reforms, including negotiating drug prices sooner after approval and expanding the number of drugs eligible for negotiation.
