Drug costs can vary widely. Anyone on prescription medications knows this unfortunate truth. What can be done about this?

Like many Americans over the age of 50, I take a statin for high cholesterol. These drugs have proliferated greatly in the last ten years as research has shown that lowering your cholesterol levels can slow, and even reverse, cholesterol deposits in your coronary arteries.

My doctor prescribes two medications for me, simvastatin and ezetimibe, to get the best results. Simvastatin is an inexpensive medication that can be purchased for as little as $3, (sometimes nothing!) for a 90-day supply with my drug insurance plan. Ezetimibe, however, will cost me $500 for the same 90-day supply unless I find a discount.

This wide disparity in the cost of medications has led many Americans to order their medications from other countries like Canada and India. To counter these rising drug prices, several online companies have been created including GoodRx, HomePage and BlinkHealth.

These companies have made significant progress in lowering the cost of drugs by working with pharmacies to bring more transparency and competition into the marketplace. What else can be done to lower drug prices?

Robert Laszewski, insurance industry analyst, offers some suggestions on his blog, Health Care Policy and Marketplace Review. He has looked at drug pricing in other countries and discusses a system called reference-based pricing. This system uses the market to set a reference price for each prescription drug that also takes clinical results into consideration. This varies somewhat from country to country:

• Italy – the lowest price from a range of alternative drugs in a class
• Germany – an average of all of the drugs in a class
• Spain – an average of a group of the lowest priced players

The health care system then pays no more than the reference price for a drug in the class, no matter which pharmaceutical company the consumer and their physician uses.

He says such a competitive bidding process lowers prices and drug outcome results are competitive and transparent. If a patient and their doctor wants to pay more for an alternative drug, they know all of the prices and comparative clinical outcomes upfront. If a drug company is truly able to innovate for an existing class of drug, that drug could be placed in a new class – innovation is still rewarded.

There is no doubt that the status quo benefits the pharmaceutical industry at the expense of the consumer. Yes, there is a high cost of investing in research and development that is necessary to find new and better drugs. But competition and transparency will always produce better products at lower costs in a free marketplace.

It’s time the American consumer stopped subsidizing the cost of new drugs for the rest of the world. By allowing drug companies to compete based on both price and clinical outcomes, we can lower drug prices for Americans and achieve that goal.

(For more on ways to lower drug prices, see Lowering Drug Prices.)

ObamaCare is still a problem. It’s been off the front-page headlines lately but that will change soon unless the Trump administration moves to make needed changes.

Insurance companies are submitting their 2019 rates now for approval and the early signs are frightening. Rate hikes as high as 91% will hit many consumers just before the November elections unless something happens soon.

Michael Cannon, director of health policy studies at the Cato Institute, writing in The Wall Street Journal, says President Trump has asked HHS to expand health insurance protections in a way that could make coverage more affordable and improve the outlook for ObamaCare’s risk pools. The decision rests with new HHS secretary Alex Azar.

Maryland insurance commissioner Al Redmer warns that ObamaCare is in “a death spiral.” That refers to the situation that occurs when diminishing enrollees requires raising premium prices to cover costs but further increases the decline in enrollees.

Since the Republicans have failed to repeal ObamaCare, the only near-term solution is short-term health plans that are exempt from ObamaCare’s extensive regulations. Such plans often cost 70% less, offer a broader choice of providers, and free consumers to enroll anytime and purchase only the coverage they need.

In 2016, during the Obama administration, HHS limited these short-term plans to three months in an effort to force more people onto ObamaCare plans. The National Association of Insurance Commissioners complained this reduced consumer protections and exposed the sick to even greater risk, including the risk of having no coverage. Enrollment in short-term plans fell below 100,000 in 2017, from about 150,000 in 2015.

Trump asked HHS to reverse this Obama rule last October, encouraging longer-term plans. HHS responded by proposing 12-month terms and renewal guarantees last February. A final rule was expected by June 1.

How would these new short-term plans improve the situation?

HHS’s nonpartisan chief actuary estimates 12-month terms would provide year-round coverage for an average $342 per month vs. $619 per month for ObamaCare plans. This would reduce the number of uninsured Americans by 200,000.

Cannon believes even greater benefits would come from allowing renewal guarantees. He believes consumers could purchase health insurance coverage for 90% less than the cost of the average ObamaCare plan if Azar follows through on the Trump plan. He says allowing renewal guarantees could reduce the average cost of insurance protection to a mere $86 per month – keeping more expensive patients, including those who lose employer-sponsored plans, out of ObamaCare’s risk pools.

Look for Democratic candidates to blame all our healthcare problems on the Republicans who didn’t fix the current system – though they refused to help – and promise the solution is single-payer healthcare. This is the greatest canard the American people could ever swallow. But the Trump administration could go a long way toward dampening the issue by following through with these needed short-term plan reforms.