| Driving up the Cost of Prescription Drugs for Seniors

| Chandra Char

| Imagine yourself or your 80-year-old grandmother, retired at home watching Days of Our Lives or The Price Is Right in the afternoon on a weekday. During the commercial break, As Seen on TV and pharmaceutical company ads spark your curiosity. You think, “Maybe I do need a Chia Pet,” or “That drug could really help me with my depression.” On average, American viewers watch approximately nine drug ads per day on TV, and that rate can be higher for seniors who are watching day-time programming.

These direct-to-consumer (DTC) drug ads are particularly predatory toward seniors. Ads can feel personally relevant for seniors when showcasing conditions such as arthritis, diabetes, and heart disease. These ads also pull on viewers’ heart strings, adding an emotional cost. When viewers see a relatable scene or experience, they are left to believe that a particular prescription drug can heal their condition and help them return to the pickleball court, not realizing that the commercial they watched was a complete fiction of marketing magic. The use of celebrity endorsements of drugs can enhance the likeability factor of certain brands and influence viewers to favor specific drugs.

What’s at Stake

DTC ads are a public health issue, and they influence the way we think about aging. DTC ads define aging by medical conditions that require prescription drug solutions to return to everyday activities. This perspective shapes the way older adults perceive their health and the way younger people perceive aging. The medicalization of aging sends a message that healthy aging is only possible through the support of prescription drugs. Deliberately targeting vulnerable populations who are not equipped to defend themselves and parse complex medical information raises serious ethical questions. A society that cares about healthy, dignified aging for everyone should be concerned about an industry that profits from medicalizing aging and age-related health conditions. 

American pharmaceutical companies spend approximately $14 billion a year on DTC drug advertising and write off billions of dollars in advertising expenses as standard business deductions. This further robs American taxpayers of roughly $1 billion in tax revenue each year. Currently, the United States and New Zealand are the only developed countries that allow DTC advertising. Most countries have banned or restricted DTC drug ads to protect consumers from misleading or exaggerated claims around their healthcare. 

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For example, the catchy tunes and bright colors in DTC ads can influence consumers, particularly seniors, to seek brand-name drugs rather than more affordable but lesser-known generics. Research shows that patients who request a specific medication at an appointment are more likely to receive it from their doctor. Requests for brand name, over generic prescriptions drugs cost the Medicare Program an additional $1.7 billion per year. Medicare Part D program. A study found that Medicare patients would have saved $109 million if patients had requested generic over brand name drug options; these dispensing behaviors result in higher costs for Medicare Part D as well as higher out of pocket costs for seniors. 

Americans pay roughly 4 times more for brand-named prescription drugs than people in other wealthy countries because aggressive marketing pushes cheaper, effective generics out of the picture. 

Furthermore, DTC ads frequently rely on misleading claims that undermine the advice and treatment plans of medical professionals. DTC ads capitalize on the credibility and authority of healthcare experts, clinical language, and medical office scenery to create the impression that products advertised as medicine must be safe. This type of misleading messaging can skew perception, making the catchy messaging more memorable than the laundry list of side effects. These tactics can be particularly harmful to seniors who may have limited social networks and rely on television as their primary source of information. Seniors experiencing reduced cognition and hearing challenges have lower information comprehension and recall. DTC ads play a specific role in creating challenges for seniors around understanding the risks of drugs and information when the voiceover speed increases when presenting information about drug side effects– which is correlated with decreased comprehension of information.  

Legislative Solutions

Americans are waking up to the dangers of DTC drug advertising and urging the government to act. 

• In 2024, Health and Human Services Secretary Robert F. Kennedy promised to end drug advertising on television. 
• Over the past five years, Congress has also introduced nearly 20 bipartisan bills to ban or reduce DTC drug advertising to support prescription cost transparency for seniors who are the primary consumers of prescription drugs. For example, the Drug-Price Transparency for Consumers Act of 2025 promised to compel advertisers to disclose the cost of a 30-day supply of the prescription. 
• State legislators are taking action too. In February, Maryland Senate introduced the Elimination of DTC Pharmaceutical Advertising Deduction bill to make it so that pharmaceutical companies can no longer deduct DTC drug ads, including TV, radio, print, social media and digital platforms, on their Maryland state tax returns. The tax revenue would be distributed to the Maryland Department of Health to reduce the cost of health insurance premiums and boost Medicaid eligibility. This bill is still under review.

Despite the fact that 88% of Americans support changes to DTC ad policies like requiring drug companies to include the list of medication prices in advertisements, experts are not confident in the success of these efforts.

Other Promising Approaches

Seniors need improved health and media literacy to process the information in the commercials they see. 

• Community-based education programs that teach seniors how to understand drug ads can increase comprehension, self-efficacy and reduce the chances of seniors being misled by DTC ads. 
• Seniors could also benefit from stronger, empowered patient-provider communication. Seniors need positive encounters with their doctors where they can ask questions about advertised drugs and where doctors are equipped to respond thoughtfully and educate patients rather than dismiss or comply. Helping seniors identify which DTC ad features are important can increase comprehension and empower patients. 
• Doctors can encourage shared decision-making to enhance patient-provider communication by improving prescription therapy that aligns with the patient’s values, medical needs, preference and health goals in order to empower the patient in their healthcare journey. 

Chandra Char PhD MPH is an expert in the field of public health and aging. She recently served as manager of a mid-sized NIH team of clinicians, researchers and others who advised on access and policy for disabled and elder care.