Generic Drug Costs Burdening Patients as Much as Brand Name Options

The consensus that nonbranded drugs are always the affordable option is being challenged by new data showing that US aggregate out-of-pocket (OOP) spending on generics actually exceeds what patients spend on brand name medications, according to JAMA Network Open.¹

Despite the common knowledge that generics often represent around 90% of US prescriptions filled, these findings indicate a new challenge for policymakers now tasked with improving OOP costs across the board.

“Generic drugs represent 90% of filled prescriptions in the US and, because they are generally inexpensive, are often accompanied by lower patient OOP payments than brand-name medications,” wrote the authors of the study.¹ “However, some patients take multiple generic drugs, and the relative contributions of brand-name vs generic drugs toward OOP spending has not been described.”

READ MORE: The Drug Price Paradox: PBMs, Pharmacies, and the Path to Affordability

The cross-sectional study examined data from the Medical Expenditure Panel Survey to evaluate national prescription drug utilization patterns. Researchers found that aggregate national OOP spending reached $16.8 billion for generic drugs compared with $13.7 billion for brand name medications.

Aggregate Spending Reveals a Growing Polypharmacy Burden

Although brand name drugs carry higher individual costs, averaging $260 annually for active users, generics accumulate significant overall expenses because patients frequently take multiple prescriptions simultaneously.¹

Overall, adults filled a mean of 2.19 generic prescriptions annually, and Medicare beneficiaries filled an average of 4.1 generic drugs per year. Among Medicare beneficiaries, annual OOP generic spending reached $129, which closely rivaled their $143 in brand-name drug expenses.

Total pharmaceutical expenditures across the US reached $915.2 billion in 2025, driven largely by a 9.3% increase in utilization volume across all health care sectors. Retail pharmacies accounted for $378.1 billion of this total expenditure, highlighting the massive volume of prescription processing passing through community pharmacy channels.²

Clinical Practice and Patient Adherence Challenges

For community pharmacists, these financial realities directly impact patient compliance and clinical outcomes. Rising OOP expenses force 29% of patients to forgo their prescribed treatments entirely, while 41% modify or skip doses to stretch their supply.³

Pharmacists play an essential role in evaluating drug bioequivalence, ensuring generic formulations deliver identical active ingredients at matching rates under FDA standards.⁴

However, pharmacists must remain vigilant regarding inactive ingredients such as fillers or dyes, which can cause unexpected allergies or tolerability issues in sensitive individuals. Additionally, medications with a narrow therapeutic index require extra monitoring when patients transition between brand and generic versions to maintain safe drug levels.

State generic substitution laws routinely allow pharmacists to switch brand prescriptions to generics, unless prescribers specify DAW 1 on the order. When pharmacists utilize digital prescription support tools with real-time price transparency at the point of sale, patient medication fulfillment adherence increases by 19%.^3,4

Policy Interventions and the Evolving Role of Pharmacy Care

Addressing high drug costs requires structural changes to health plan designs and federal policy frameworks. Recent provisions under the Inflation Reduction Act established a $2000 OOP cap for Medicare Part D beneficiaries in 2025, expanding to $2100 in 2026.^1,2

Health policy experts caution that while capping monthly OOP copays at $50 is politically feasible, it fails to lower overall drug acquisition costs paid by health systems and payers. High OOP costs remain a leading driver of specialty drug abandonment as well, frequently precipitating preventable emergency room visits and inpatient hospitalizations.⁵

Researchers note that restructuring benefit designs to eliminate generic copayments or capping OOP spending on essential generic medications could significantly improve overall treatment adherence. Because over 50% of patients actively consult their pharmacist when facing high medication costs, expanded provider autonomy enables pharmacy teams to guide patients toward effective affordability solutions.^1,3

“For brand-name drugs, policies to lower drug prices may have a large impact on OOP costs, particularly for those with deductibles and coinsurance that are directly tied to the drug’s cost,” concluded the authors of the current study.¹ “For generic drugs, which are typically less expensive, benefit design changes may be needed, such as limiting OOP costs for some high-value generic medications, preventing payers from setting OOP costs that exceed cash prices (which was estimated to occur for a sizeable minority of generic prescriptions among patients with Medicare or private insurance) or eliminating copayments for generic drugs altogether.”

READ MORE: Specialty Drug Costs and Complexity Steadily Rising Since 2025

REFERENCES

1. Cai CL, Kesselheim AS, Rome BN. Patient OOP spending on generic and brand-name prescription drugs. JAMA Netw Open. 2026;9(9):e2633401. doi:10.1001/jamanetworkopen.2026.33401

2. Tichy EM, Rim MH, Tadrous M, et al. National trends in prescription drug expenditures and projections for 2026. AJHP. 2026;83(14):728-744. doi:10.1093/ajhp/zxag115

3. Marchal M. How pharmacists are helping patients afford their medications. CoverMyMeds. August 13, 2021. Accessed September 17, 2026. https://www.covermymeds.health/articles/access-and-affordability/how-pharmacists-are-helping-patients-afford-their-medications

4. Brooks J. Brand name vs. generic medications: What’s the difference? AARP. September 16, 2026. Accessed September 17, 2026. https://www.aarp.org/health/drugs-supplements/brand-name-vs-generic-medication/

5. Taylor EA, Khodyakov D, Predmore Z, et al. Assessing the feasibility and likelihood of policy options to lower specialty drug costs. Health Aff Sch. 2024 Sep 27;2(10):qxae118. doi: 10.1093/haschl/qxae118