Americans are spending more on prescription drugs than anyone else in the world.

Why? Part of it is because the United States drug pricing system is set up differently than everyone else. While other countries, like the United Kingdom, have regulatory agencies that determine whether a drug should come to market and can then negotiate a price consumers will pay, the US market doesn’t. So pharmaceutical companies can charge whatever they want.

But each system has its trade-offs: A regulated system keeps prices low but can restrict access to some drugs. The US system allows full access to drugs, but often they’re too expensive to even afford. Americans without insurance are the most likely to skip medication because of the cost. Americans who have insurance are the second most likely.

Check out the video above or Sarah Kliff’s reporting for more.

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