Patients nationwide are paying for a broken system — delayed treatments, unaffordable medications and needless suffering driven by profit-first policies.
Instead of addressing the sources of high drug costs, one area of concern for people with chronic conditions is that lawmakers are turning to a deeply flawed concept known as Most Favored Nation (MFN) pricing policy. Unfortunately, implementing MFN pricing policy won’t resolve the problems in our health system that drive up costs for patients and could restrict patient access to medications.
Rather than adding further complications, Congress and the administration should champion pharmacy benefit manager (PBM) reforms that will reduce waste in the system and lower costs for patients. Congress has the tools to act, but it has repeatedly failed to deliver on PBM reform.
PBMs were originally intended to lower drug prices, but today they have established a system that frequently serves corporate profits over patient care. PBMs now increase costs by promoting higher-priced medications and pocketing rebates that patients never see.
For years, we’ve seen the toll of this model. For those managing chronic or life-threatening conditions, this translates into higher-than-necessary medication costs. For many patients, price hikes mean missed doses, worsened health and hospitalization, outcomes no one should face in the name of profit.
Americans overwhelmingly agree that it’s time to rein in PBMs. A recent poll by the National Association of Chain Drug Stores shows how vital PBM reform is to voters. The survey found that 69 percent of registered voters believe Congress should make PBM reform “must-pass legislation” before concluding its work. The same percentage of voters agrees that their representatives “should do whatever it takes” to enact reform. This level of voter urgency sends a strong message: Americans are watching, and they demand meaningful action to protect their health and reduce the skyrocketing cost of prescription drugs.
I hear from patients and families daily who are doing everything right, following their doctor’s advice, taking medications as prescribed, and still ending up at the pharmacy counter being told they need to “fail first” on a cheaper drug before the one their doctor prescribed will be covered. This is called step therapy, and it’s just one of many tools PBMs use that can lead to worsened health outcomes. Others include copay accumulator programs, which block financial assistance from counting toward a patient’s deductible, forcing many to pay full price even when help is available.
These practices don’t just cost patients more money but they also hurt their health. For people with chronic conditions, missing a dose or being forced to switch to an ineffective treatment isn’t just inconvenient; it can lead to complications, hospitalizations or worse. And while PBMs report record profits, patients are left wondering why they’re paying more and getting less.
A recent House Oversight Committee report confirmed what patients have known for years: PBMs inflate drug prices, restrict patient choice, and ultimately compromise the health of those with chronic conditions. Each time a patient is forced to skip or ration medication due to cost, our healthcare system fails. And when patients can’t access or afford the treatments they need, the entire system pays — more emergency room visits, preventable hospital stays, and greater strain on providers and the system as a whole.
This has to change. Congress must take meaningful action to rein in PBM abuses and put patients first.
To start, we need transparency. PBMs should be required to disclose their rebate deals and pricing tactics, so patients, providers and employers can see whether these deals are saving money or enriching middlemen. In addition, Congress must ensure that negotiated rebates and discounts are shared with patients. Finally, we must reject foreign reference pricing or most favored nation policies, which would import a flawed drug pricing model from other countries with fewer treatment options and longer wait times.
Artificially lowered prices promise good headlines, but come with unacceptable risks of restricted access to lifesaving medicines, slowed innovation, and less effective treatments.
Despite Centers for Medicare & Medicaid Services’ intention to lower drug costs, stakeholders (and multiple lawsuits) raised alarms that the MFN model could result in delayed or forgone treatment. We do not need MFN to achieve lower prices; we already have the right solution: meaningful PBM reform.
Americans are watching. They have made it clear they want action to lower drug costs and hold PBMs accountable. Congress doesn’t need another study or delay — it needs the will to act. The time for comprehensive PBM reform is now. Patients can’t afford to wait.