Costs for prescription drugs have risen dramatically over the past decade in Georgia while people struggling to pay for medications have little idea as to why.

In recent years, Georgia residents and their insurers have spent more on prescription drugs and for out-of-pocket medication costs not covered by health plans than most states in the U.S., according to several studies. Georgia joined every other state in the country in witnessing a trend of both more people filling prescriptions under Medicare and steep cost increases for those drugs between 2013 and 2019, rounding out to an 89% hike in Georgia’s drug costs during that time, according to federal data.

Medicare and other health plans cover most prescription-drug costs to keep them affordable, but many low-income Georgia residents and seniors on fixed incomes still struggle to make up the difference for what’s not covered – leaving many people to choose between paying for medications or buying groceries.

Meanwhile, the root causes for why drug prices have soared in recent years remains largely unknown, shielded behind certain carve-outs in state law and a complex system of behind-the-scenes price negotiations that many patient advocates blame for the rising costs. The intricate causes for Georgia’s rising medication costs have left many people in the lurch like Nicola Jackson, whose monthly battle to pay for her medications poses a constant challenge for her family’s budget.

In this five-part story, State Affairs tells the stories of several Georgia residents like Jackson who struggle to afford their medications, as well as the forces at play that make tracking the rise in costs – and who exactly is to blame – a difficult task.

Costs for prescription drugs under Medicare in Georgia shot up between 2013 and 2019. (Credit: Brittney Phan for State Affairs)

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OUR STORY

Part I: The Search for Answers

Georgia is among the highest spending states in the U.S. when it comes prescription drugs and out-of-pocket costs, according to national researchers.

Part II: A Window into Drug Costs

Seeing her monthly bills for prescription drugs on paper is bad enough for Nicola Jackson. Having to tell her husband about it makes the stress even worse. 

Part III: Choosing Drugs over Groceries

While Medicare data hint at rising medication costs across the board in Georgia, research by NiceRx shows prices for many high-demand prescription drugs have also ballooned – including for several drugs that Jackson needs.

Part IV: Prescription-Drug Blame Game

Critics trace rising drug costs largely to intermediary companies called pharmacy benefit managers that have pointed the finger right back at drugmakers, pharmacies and other key players.

Part V: Lawmakers Push for Transparency

State regulations and a law firm’s investigation into prescription drugs under Georgia’s Medicaid programs have kept the focus on pharmacy benefit managers in recent years.