Recent industry data highlight a growing disconnect in US health care costs. Insurers frequently point to drug prices as a key driver of rising premiums, yet the data show drug prices moving in the opposite direction.

According to Drug Channels recent analysis, net prices for brand-name drugs have declined over the past two years, even as list prices often remain flat or rise modestly. The analysis shows that manufacturer price concessions, including rebates and discounts, are growing faster than list prices. They are expected to reduce manufacturer revenue by an estimated $35–$40 billion in 2026.

At the same time, the Kaiser Family Foundation reports that employer-sponsored family premiums rose again in 2025, nearing $27,000 annually, with workers paying roughly $6,850 out of pocket, continuing a multiyear trend of rising premiums and cost sharing. Kaiser also reported State Medicaid spending growth was 12.2% in FY 2025.

Meanwhile, Fortune Global 500 rankings show that major insurers have made significant gains over the past five years. Centene, a predominantly government-payer insurer that barely appeared on the Fortune 500 prior to the passage of the Affordable Care Act, has climbed from the 40s into the low-20s over the past five years, reflecting rapid growth in Medicaid and ACA marketplace enrollment. Elevance Health (formerly Anthem) has similarly risen from the high-30s into roughly the top 20, while CVS Health, which includes Aetna, has moved from the back half of the top 10 into the top 5, cementing its position among the nation’s largest companies.

UnitedHealth Group has been consistently dominant, remaining near the top of the Fortune 500 for years, and today ranks among the top three US companies by revenue, a position it has largely held through scale, vertical integration, and sustained growth.

Taken together, the data suggest that even as drug prices fall, the savings are not reaching patients. Premiums and out-of-pocket costs continue to rise, while insurers grow larger and more financially powerful, raising a fundamental question for policymakers and consumers alike: If drug costs are coming down, where is the money going?