Quote from Alex bobby on August 18, 2025, 4:59 AM

Wealthy Countries Pay More for Essential Medicines, But the Cost Burden Is Far Lower, Study Finds

When it comes to the cost of essential medicines, appearances can be deceiving. Wealthy nations may face higher list prices for life-saving drugs, but in reality, they often shoulder a much lighter financial burden compared to poorer countries. A new study published in the JAMA Health Forum has revealed striking disparities in the affordability of 549 essential medicines across 72 global markets, underscoring the inequalities that shape healthcare access worldwide.

Higher Prices, Lower Burdens

The study found that while rich countries frequently pay steep prices for essential medicines, the affordability gap tilts heavily in their favour once purchasing power is factored in. Simply put, wealthier nations may see higher numbers on paper, but their citizens and healthcare systems are better positioned to absorb those costs.

By contrast, lower-income countries often report cheaper list prices for medicines. Yet, for the people living there—especially those paying out of pocket—those same medicines can represent weeks, or even months, of wages. This affordability divide highlights how income levels, purchasing power, and health infrastructure can drastically reshape what “expensive” really means.

Availability Gaps

Another layer of inequality lies in availability. No single country in the study stocked all 549 essential medicines. Germany topped the list with 438 medicines available, while Kuwait had just 225. Across the 33 European countries surveyed, the average availability was 367 medicines.

These gaps mean that in many regions, patients may not even have access to a critical medicine, regardless of its affordability. For those who do, the cost often becomes the next barrier.

Regional Spending Differences

The disparities become even clearer when examining overall spending on medicines. In 2022, European countries collectively spent the most on essential medicines—around $2 billion (€1.74 billion), equating to $192 (€167) per capita.

By contrast, the Americas spent $1 billion (€868 million) overall, while Southeast Asia recorded just $7 (€6) per capita. These differences highlight not just varying levels of wealth, but also the role governments play in subsidising healthcare and negotiating drug prices.

The type of medicines purchased also varied. Treatments for mental and behavioural disorders and cardiovascular diseases tended to be the most expensive. Meanwhile, drugs for hepatitis B and C were among the cheapest in the study, making life-saving treatments more affordable in certain categories but not others.

Why List Prices Can Be Misleading

At first glance, one might assume that high list prices in wealthy countries mean citizens there are paying the most for medicines. But the study warns against such assumptions.

List prices—the initial “sticker prices” set by pharmaceutical companies—don’t account for discounts, government subsidies, or insurance systems that drastically lower what individuals actually pay. Equally important, the burden of those costs must be measured against the purchasing power of local economies.

Using Germany as a benchmark, researchers adjusted drug prices across the 72 markets to better reflect affordability. What they found was eye-opening:

• Lebanon: Prices were roughly one-fifth of Germany’s, yet the affordability burden was far higher.
• Argentina: Prices reached nearly six times German levels once adjusted for purchasing power.
• Pakistan: List prices looked lower than Germany’s, but once adjusted, they were effectively the same.
• United States: Prices soared to three times German levels, even after accounting for purchasing power.

These findings show that a medicine can be “cheaper” in one country but still less affordable when wages and cost of living are considered.

Real-World Burdens in Poorer Countries

For many lower-income nations, the affordability gap translates into dire real-world consequences. The study gave several striking examples:

• In India, a minimum-wage worker would need to labour about 10 days just to afford a month-long dose of tenofovir disoproxil, a medicine used to treat chronic hepatitis B and to prevent and treat HIV/AIDS.
• For the chemotherapy drug paclitaxel, workers in some lower-income countries would need to work nearly six weeks to pay for a single month-long course.

Such figures underline the stark reality: even when drug prices appear lower in poorer nations, the relative cost to patients can be crushing. Many families must make impossible choices—between medicine and other basic needs—while others simply go without treatment altogether.

The Role of Governments and Policy

The study highlights how much governments matter when it comes to ensuring medicine affordability. Wealthy nations often have robust healthcare systems that negotiate prices directly with pharmaceutical companies, subsidise essential drugs, or provide insurance coverage that shields individuals from exorbitant out-of-pocket expenses.

In poorer countries, where public health budgets are smaller and insurance coverage less widespread, the burden falls disproportionately on individuals. Without systemic protections, even relatively inexpensive drugs can become unaffordable.

The availability gaps also underscore the need for stronger global health coordination. Ensuring that essential medicines are stocked consistently across all regions could be just as important as making them affordable.

A Tale of Two Worlds

Ultimately, the study paints a picture of two very different realities. In wealthy nations, medicines are expensive on paper but manageable in practice. In poorer regions, the reverse is true: medicines may be listed at lower prices, yet the actual financial burden is far heavier—sometimes devastatingly so.

This inequity has profound implications for global health outcomes. In countries where people cannot afford essential treatments, preventable diseases continue to claim lives, undermining progress in healthcare and widening the gap between rich and poor nations.

Looking Forward:
As the debate on medicine affordability continues, policymakers will need to move beyond price tags and address systemic inequalities. Ensuring fair access requires stronger global health cooperation, better wage protections, and more inclusive drug pricing models. Only then can essential medicines truly become accessible to all, regardless of where people live.

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Conclusion

The findings of this new study challenge conventional assumptions about drug pricing. Yes, wealthy countries may spend more per capita on medicines—Europe alone at €167 per person in 2022—but the real story is about affordability, not list prices.

As the researchers conclude, “some poorer countries face a higher burden  medication costs, even if the price for the same medicine is lower compared to richer countries.”

For global health policymakers, the message is clear: tackling disparities in medicine affordability requires more than negotiating lower prices. It means addressing wage inequalities, strengthening healthcare systems, and ensuring universal access to the medicines that millions rely on for survival.

Until then, the paradox will remain: wealthy nations may pay more, but it’s the world’s poorest who continue to bear the heaviest cost.

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A global study finds wealthy nations pay higher prices for medicines but face far lower cost burdens, while poorer countries struggle with affordability gaps.