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writing from the perspective of the pharmaceutical industry's trade organization, defend high prices of medications by pointing to savings from generic and biosimilar competition. However, the fact that generic drugs provide substantial savings after brand-name exclusivity ends does not justify exorbitant and increasingly unaffordable prices for new brand-name drugs.Our study focused solely on brand-name medications, which represent more than 80% of spending even though they are only 10% of prescriptions filled in the US. 2,3 Brand-name drugs are protected by government-granted market exclusivities, during which time manufacturers can freely set and raise prices. Eventual entry of generic competitors, which is often fought vigorously by brand-name drug makers, can dramatically lower prices and improve patient access, adherence, and outcomes. Use of generics has increased over the past several decades; when generics are available, they are used 97% of the time. 3 Brand-name drug manufacturers may demand higher prices for new medications to recoup revenue lost from competition on older products, but they do so regardless of whether these new drugs provide additional benefits to patients. The medical community rightly celebrates the development of transformative new medications such as the curative direct-acting antivirals for hepatitis C, which had their origins in substantial public funding. 4 But most new drugs represent incremental changes from older versions, lack evidence that they offer substantially greater benefits for patients over existing options, or both. 5 And while prices for the hepatitis C drugs eventually decreased, this occurred after these drugs caused the sharpest increase in US per-capita drug spending since the mid-2000s. 3 Because of a combination of rising prices for new brandname drugs and frequent price increases after these drugs are marketed, the average net price for brand-name drugs in Medicare Part D more than doubled from 2009 to 2018. 3 Rising brand-name drug prices are one of the reasons that percapita prescription drug spending increased 7-fold from 1980 to 2018. 3 In addition, drug prices are 2 to 3 times higher in the US than in other industrialized countries. 2 Ybarra and Weissman incorrectly assert that newer medicines merit higher prices because they are increasingly complex and target rare diseases. These trends do not fully explain the observed rise in prices. After adjusting for these characteristics, along with estimated manufacturer discounts, we found that average prices for new drugs outpaced inflation by 11% per year from 2008 to 2021. Prices increased even among drugs targeting common diseases, such as diabetes, heart disease, and attention-deficit/hyperactivity disorder.The substantial increase in prices for new brand-name drugs represents a stark reality, especially for patients unable to afford their prescriptions. Efforts to obscure this reality and distract policy makers from meaningful reforms ignore the enormous burden these high prices pose to pati...