Do prescription drug prices ever come down? A new government report says yes. In fact, nearly 1,600 drug products dropped in price between 2022 and 2023, according to the federal Department of Health and Human Services.

That’s the good news for consumers. Here’s the bad: Another 4,200 prescription products rose in price during the same period — sometimes dramatically. Leading the list: Vasopressin, a drug used for Type 1 diabetes and other metabolic issues. In 12 months, its price rose from about $4 a dose to $158 — a 3,558% increase.

The menopause drug Divigel also went up more than 3,000%. Fludarabine, which is used to treat cancers such as leukemia, went from $110 a dose to $2,736 a dose — a nearly 2,400% increase in price.

“At Health Care For All (HCFA) we hear frequently from Massachusetts residents about affordability issues in general — but, in particular, difficulty in affording prescription drug costs,” said Ashley Blackburn, senior director of policy and government relations for the Massachusetts-based organization. “Year after year, prescription drug prices continue to rise both nationally and here in the Commonwealth.”

And that includes drugs that seemingly should be immune from sharp rises — that is older generics that can be made cheaply. However, the new report finds the antifungal drug fluconazole is up 1,100%. The immunosuppressant azathioprine, used to deter organ rejection, rose 900% in price. Even the price of indomethacin, first marketed under the brand name Indocin in 1965, rose more than 200% in the year ending January 2023.

“There are a lot of areas that we don’t have any clear answers for the customers,” said Ali Ardakani, PharmD, pharmacist and owner of Milford Central Pharmacy.

That’s because prescription drug pricing — once it gets to the retail level — passes through unseen layers of interaction involving the drug companies, insurers, and entities known as pharmacy benefit managers — whose supposed job is to keep costs down.

The question is, whose costs?

“Most customers are not happy, especially if the price goes up significantly,” Ardakani said. “I’ve had some situations in which when they notice about the new copay, they turn around and say they are not going to pick up the medications. That’s the area we are kind of concerned about.”

Ardakani has seen this with such critical — albeit expensive — medications as Xarelto and Eliquis, anticoagulants that help prevent the kind of blood clots linked to pulmonary embolism, stroke, and even death.

And apparently, it is not uncommon — even in a healthcare hyper-state such as Massachusetts — to see patients making such hard decisions.

“We know in Massachusetts nearly one in four residents report that they’ve struggled to afford their prescription drugs,” said Blackburn.

But even those who don’t struggle are sometimes baffled by what others go through to stay healthy.

“I just came in to get my prescription and I overheard this man upset because he had to pay almost a hundred dollars,” said Katherine Watson. “I felt bad because he was saying he didn’t have much money.”

Watson said it doesn’t surprise her to hear prescriptions, overall, went up in price.

“My family has blood pressure medications,” she said. “When they first got them, it was like $15. And now it’s been doubled.”

As for the oft-stated drug company claim that higher prices lead to more research and thus more pharmacological breakthroughs… Blackburn is skeptical.

“Research shows that the manufacturers are spending more on marketing and things like executive salaries than they are spending on drug research,” she said.

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