It’s no secret that drug prices in the U.S. are significantly higher than in other countries. About a quarter of U.S. adults surveyed last year by the Kaiser Family Foundation Health Tracking Poll reported not filling a prescription, taking a partial dose, or skipping doses altogether because of the cost.

“We see patients who can’t take the full dose. They cut their pills in half. They skip doses,” shared David Mitchell of the nonprofit organization, Patients for Affordable Drugs, during a Commonwealth Fund podcast on the high cost of U.S. drugs.

A 2021 RAND report found prescription prices in the U.S. to be more than 250% higher than those in 32 comparison countries. A JAMA review determined the main factor for this price discrepancy to be market exclusivity, with 72% of the money spent on prescriptions going toward brand-name drugs, which make up just 10% of dispensed medications.

U.S. drugmakers typically retain patents and market exclusivity for an average of 12.5 years after FDA approval and often longer by tweaking a formulary and delaying the drug patent’s expiration.

For these reasons, thousands of Americans cross the northern border into Canada every year to fill their prescriptions at a significantly lower cost than U.S. medications.