Spending on prescription drugs has actually declined in recent years, but there are a number of other factors driving out-of-pocket costs higher. For starters, insurance companies are shifting a higher share of health-care costs to their patients. Since 2006, deductibles have skyrocketed by 300 percent, and the amount patients pay for coinsurance has nearly doubled. Insurers and pharmacy benefit managers also keep the bulk of the savings offered by drug makers in the form of rebates or other discounts. And hospitals markup prescription drugs by almost 500 percent.