In 2021 the United States spent $4.3 trillion, or $12,914 per person, on health care, including physician services, prescription drugs, hospital care, insurance, Medicare, Medicaid, and out-of-pocket costs. Prescription drug spending increased 7.8 percent to $378.0 billion in 2021, faster than the 3.7 percent growth of 2020.These expenditures accounted for 18.3 percent of gross domestic product (GDP), and economists expect this share to expand to 19.6 percent in 2031.1 In 2021 the world’s ten largest pharmaceutical companies took in $734.8 billion in revenues.2

Yet even though the United States is the richest country in the world, millions of Americans lack health insurance and access to adequate health care and are deep in medical debt, especially in the South.3 Cancer physicians and patients are finding it difficult to obtain older, cheaper generic chemotherapy drugs because pharmaceutical companies are in the business of making money for themselves and their...

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