There’s a lot about prescription drugs that Americans find hard to swallow.

U.S. drug companies, despite developing miracle cures, have adopted an international pricing strategy that appears to give foreigners bargains at Americans’ expense.

Congress has provided the first prescription-drug benefit in Medicare history but at a cost of more than $500 billion and with no way for the government to bargain with insurance companies for lower prices.

Workers are seeing their own health costs rise as employers ask them to pay more for their prescriptions. That has left many employees angry without appearing to ease employers’ lot: drug spending is still cited by employers as the leading factor in rising overall health costs.

Clearly, anyone claiming to have a remedy for prescription drug problems should check his hands for scissors before patting himself on the back.

Drug spending in the U.S. has grown by double digits for much of the past decade and is forecast to continue growing in the 9 to 12 percent range through 2010. The factors driving up drug spending are powerful:

• Doctors are writing more prescriptions. One study says this accounts for half of the increase in U.S. spending on drugs. An aging population and the substitution of drugs for other therapies such as surgery play a role here.
• The unit cost of drugs is going up, in part because billions of dollars have been spent on advertising since the government’s 1997 decision to allow more drug promotion. Higher unit costs may account for one-quarter of increased drug spending.
• More new drugs, with higher price tags, are reaching the market, aided by a faster government approval process.

Still, there are causes for optimism about drug-cost control.

First, although drug spending is growing rapidly, it constitutes only about 11 percent of overall spending on health care.

Next, employers aren’t giving up on cost-control measures. A study by the Kaiser Family Foundation indicates that companies big and small plan to increase the amount employees have to pay for prescriptions this year. That should create more consumer pressure on drug companies to bring down prices.

Cynthia Chilton, a health and group benefits consultant in Portland for Mercer Human Resources Consulting, says employers can accelerate this process by switching from drug plans that require employees to pay a set dollar amount for each prescription to plans that require them to pay a percentage of each prescription’s cost. Such changes can make consumers “a lot more motivated” to look for cheaper alternative drugs, Chilton says.

There also are signs of increasing government activism on drug costs. Maine has implemented and Hawaii is implementing plans that use state buying power to make drugs available at as much as a 60 percent discount to low-income residents.

And at the federal level, pressure is building to study reimportation of lower-priced drugs from countries such as Canada and to revise the new Medicare law to allow government negotiation for price discounts from drug makers.