ABSTRACT In the United States, drug costs account for approximately 10% of health care expenditures and are expected to grow over the next decade1. Due to a combination of rising drug prices, increased out-of-pocket costs, and increased use of specialty drugs, a growing number of Americans cannot afford their medications. This issue is particularly relevant for the treatment of skin diseases, where retail prices of selected brand name dermatologic medications increased an average of 363% in real terms between 2009 and 2015, while the general and average pharmaceutical inflation rose only 11% and 23%, respectively2,3. In this article – part of a health policy series reviewing a wide-range of policy topics impacting clinical dermatology4– we provide an overview of how drug prices are set, with an emphasis on microeconomic factors that drive their complexity in the US, as well as discuss trends in drug pricing that are relevant to both the present and future delivery of dermatologic care.