Why do Americans continue to pay the highest prices for medicine in the world? Lawmakers have sculpted specific policies, often not found in many other nations, that boost pharmaceutical industry profits. Meanwhile, the drug industry has spent $61 million on state elections and nearly $67 million on federal elections since 2010. Both parties have made pivotal decisions ... that have kept drug prices high. Insurance companies and pharmacy benefit managers, or PBMs, across the U.S., face at least nine class-action lawsuits alleging they attached arbitrary premiums to the prices of often less-expensive, generic prescription drugs. The plaintiffs also accuse the PBMs and insurers of imposing so-called "gag clauses" on pharmacies to keep pharmacists from telling consumers that they could save money by paying out of pocket. The system could be denying customers $120 billion in discounts and rebates. Should drugs developed at taxpayer expense be sold to Americans at sky high prices? In the past, the federal government passed a rule saying no - but that rule was rescinded in 1995. If Americans were allowed to import lower-priced drugs from places like Canada, it would save government agencies alone $6 billion. But ... Americans are still prohibited from engaging in such importation. The federal government could [also] save billions of dollars a year by having Medicare use its huge market power to negotiate - or require - lower drug prices for the program's beneficiaries.