Your Money or Your Life: U.S. Pharmacy Prices 9 Times Higher Than Prices in Other Countries in 2022

Written by Lucia Mueller | Posted January 26, 2023 | Updated January 31, 2023

Dystopia now. In the year 2023, in the richest nation in the world, millions of Americans continue to struggle to afford their prescription drugs. Massive drug companies have effectively captured the U.S. market demanding your money or your health. The average annual cost of new cancer drugs in the United States shot up by 53% between 2017 and 2021, from $185,000 to more than $283,000. 

Much fanfare has been made of changes resulting from the  Inflation Reduction Act (IRA) that allow for Medicare to negotiate drug prices, but these recent provisions only manage to highlight the egregious greed of the revolving door of pharmaceutical interests enmeshed in the very regulatory bodies that are supposed to protect consumers. One might ask why Medicare would be barred from negotiating pricing in the first place. Long story short, back in 2003, during the creation of the Medicare Part D drug program, drug manufacturers were heavily involved. They crafted the rules to their liking and barred Medicare from negotiating drug prices. Twenty years later, we’re singing victory about repealing their non-interference clause. We’re excited about a ramp finally being built over the house we erected in the middle of a highway. 

In the face of such corruption, it’s clear to many Americans who cannot afford their medications that there is little choice but for us to do what we’ve been told we’re best at: pull ourselves up by our bootstraps. We’re finding our own way to affordable medication by ordering our prescription drugs online from other countries.

The savings found from ordering medication from not only Canada – but Turkey, Australia, New Zealand, India, Mauritius, and the UK – is far from insignificant. A new January 2023 drug price report published by PharmacyChecker highlights price comparisons of the most searched prescription drugs on in 2022, showing U.S. patients potentially saved an average of 78.35% off what they would pay out-of-pocket at their local pharmacy by opting to order internationally. 

Download the Report

PharmacyChecker ensures that each of the pharmacies it permits to list prices in its published price comparisons is verified through the PharmacyChecker Verification Program, a credentialing program established by PharmacyChecker’s CEO, noted consumer healthcare expert Tod Coopoerman, MD, and our president, Gabriel Levitt, an advocate for lower drug prices, in 2003 in order to help consumers find trustworthy online pharmacies amid an internet littered with scammers and other insidious characters (especially in the world of purchasing drugs online.) Websites authorized to publish the PharmacyChecker Seal market and sell prescription drugs dispensed from licensed pharmacies in good standing in the countries where they are located.

Key Takeaways

  • Fourteen out of the top 20 most-searched-for medications on in 2022 are sold internationally from PharmacyChecker-accredited online pharmacies, which are accessible to patients in the U.S.
    • Four drugs were generics not yet available in the U.S. at local pharmacies.
    • One drug, Ozempic, was not available for international order from PharmacyChecker-accredited online pharmacies (due to the PharmacyChecker Verification Program’s strict policies on the shipping of products requiring refrigeration ). 
    • One drug, dextroamphetamine, was not available for international order due to the PharmacyChecker Verification Program policy to not grant accreditation to pharmacies that ship controlled substances internationally into the United States.
  • Average U.S. pharmacy retail prices were on average 901.90% higher than international mail-order pharmacy prices. 
    • One drug out of the fifteen available for international mail order, Apoquel, was cheaper to purchase domestically.
  • Four of the generics available on U.S. pharmacy shelves have manufacturing sources in India.
  • Eighty-one percent of the surveyed medication sold in U.S. pharmacies is manufactured outside the U.S. 

The largest international price gap among the drugs surveyed was that of Januvia (sitagliptin). Sold in the United States, Januvia 100mg will cost a patient struggling with type 2 diabetes around $21.30 per tablet out of pocket. PharmacyChecker found that international online pharmacies sell Januvia 100mg, on average, for $0.80 –  96.27% cheaper than the U.S. price. Brand Januvia is available to U.S. patients via international mail order should they choose to avail themselves of PharmacyChecker-accredited online pharmacies. The Canadian online pharmacy price is around $4.50 a tablet; a pharmacy in the UK will ship Januvia to the U.S. for less than $3/tablet; Indian online pharmacies advertise it for around $0.66; Turkish pharmacies sell it for as little as $0.43. Januvia sold in U.S. pharmacies is actually made in Italy and the UK. All of the prices I just listed are those at legitimate pharmacies that the PharmacyChecker Verification Program continuously monitors for compliance with high standards of pharmacy practice. 

Coming in second among the most sought-after medications on in 2022, is Eliquis (apixaban). A brand-name drug prescribed for the prevention of strokes or blood clots in people who have atrial fibrillation, Eliquis is now the drug which we’re asked about most frequently in consumer phone calls and email inquiries. It’s incredibly expensive in the United States and yet patients can find it for 89% cheaper if they decide to order it from an international online pharmacy accredited by PharmacyChecker. The generic of Eliquis, apixaban, is not projected to hit U.S. pharmacy shelves until 2028 but is approved and available in other countries where some PharmacyChecker-accredited dispensing pharmacies are located. The price of the international mail-order generic, however, is comparable to the international mail-order brand Eliquis. U.S.-sold Eliquis is manufactured in Switzerland.

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Price Comparisons of the Top 20 Most Searched Medications on, 2023

Drug Name Average International Price Average U.S. Retail Price How Much International Mail Order Saves Patients in the U.S.
Tadalafil 5mg $1.06 $9.68 89.07%
Eliquis 5mg $1.09 $10.35 89.47%
Sildenafil 20mg $1.62 $4.19 61.19%
Xarelto 20mg $1.22 $19.95 93.89%
Apoquel 16mg $2.77 $2.53 No significant savings
Apixaban 2.5mg $0.70 N/A Generic not available in the U.S.
Jardiance 10mg $2.29 $21.13 89.15%
Rifaximin 550mg $1.50 N/A Generic not available in the U.S.
Rybelsus 7mg $8.78 $35.39 75.18%
Januvia 100mg $0.80 $21.30 96.27%
Ozempic N/A $1,021.97 Refrigerated products not shipped by PharmacyChecker-accredited Pharmacies
Vardenafil 20mg $2.35 $38.77 93.95%
Trelegy Ellipta $96.48 $734.84 86.87%
Budesonide 3mg $0.96 $14.61 93.41%
Symbicort 160mcg/4.5mcg* $55.99 $308.99 81.88%
Ivermectin 6mg $1.03 $9.35 88.99%
Pimobendan 1.25mg** $0.78 $1.05 25.94%
Paracetamol 500mg^ $0.13 $0.19 31.57%
Dextroamphetamine 10mg N/A $3.55 Controlled Substances Not Shipped by PharmacyChecker-accredited Pharmacies
Domperidone 10mg $0.25 N/A Generic not available in the U.S.
      Average: 78.35%

PHARMACYCHECKER RESEARCH JANUARY 2023. Average International Price calculated based on data published on Average U.S. Retail Price calculated using data published on or

*We compared Symbicort (budesonide/formoterol) 160mcg/4.5mcg with the therapeutically equivalent, internationally marketed versions of budesonide/formoterol Vannair Aerosol (budesonide/formoterol) 200mcg/6mcg. Patients are advised to consult their prescriber to confirm therapeutic equivalence. 

**Pimobendan is available for purchase from international online pharmacies. We compared its price with the brand Vetmedin (pimobendan) available for purchase in the U.S. from the popular pet medication website, Chewy.

*Paracetamol and acetaminophen are the same medication: C8H9NO2. The drug is called acetaminophen in the United States, Canada and Japan, and paracetamol in the UK, Europe, and most of the world in accordance with the International Nonproprietary Names system, coordinated by the World Health Organization.

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U.S.-sold Medication Manufacturing Origin, 2023

Drug Name Manufacturing Origin
Tadalafil India
Eliquis Switzerland
Sildenafil India
Xarelto Germany
Apoquel Switzerland
Apixaban Generic not available in the U.S.
Jardiance Italy
Rifaximin Generic not available in the U.S.
Rybelsus Denmark
Januvia Italy; UK
Ozempic Denmark
Vardenafil India
Trelegy Ellipta USA
Budesonide India
Symbicort France
Ivermectin USA
Pimobendan Generic not available in the U.S.
Acetaminophen* UAE
Dextroamphetamine USA
Domperidone Generic not available in the U.S.

PharmacyChecker Research January 2023. Sources: Country of manufacture determined through the National Library of Medicine and FDA Labeling Package Insert drug information. Generic medication typically has multiple sources. Drug sample is based on the top 20 most-searched medications on in 2022.

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