LIGHTCAP: Healthcare Middlemen Are Driving Up Prices

Coming off the heels of National Women’s Health Week, it’s a good time to reflect not only on how far we’ve come in advancing the health and well-being of women and girls but also on the policies that will determine where we go from here. As someone who cares deeply about the strength and resilience of my community, I believe we have a responsibility to speak up when misguided decisions in Washington threaten to undermine innovation and access.
One of the most pressing concerns I see on the horizon is the proposed “Most Favored Nation” (MFN) pricing model for prescription drugs. At first glance, the idea might sound reasonable, but when you look more closely, it becomes clear that this is a deeply flawed and potentially harmful policy that doesn’t address the real drivers of high drug prices and could do lasting damage to patients and innovation.
Much like the pricing provisions in the Inflation Reduction Act, MFN policy takes aim at the researchers and developers who bring new treatments to market, rather than tackling the actual middlemen in our healthcare system who drive up prices. These middlemen, known as pharmacy benefit managers (PBMs), play a major role in determining what drugs are covered by insurance, how much patients pay out of pocket, and how much pharmacies are reimbursed. They negotiate significant rebates and discounts with drug manufacturers, but those savings rarely make it to the patient.
PBMs operate with little transparency or accountability. While they claim to help control costs, their incentives are often misaligned with the needs of patients. Instead of prioritizing access, they focus on maximizing their own profits. That’s why patients continue to struggle with high out-of-pocket costs, restricted formularies, and surprise denials, even when their medications are supposed to be covered.
The MFN model does nothing to address this. Instead, it risks discouraging investment in the very research and development efforts that lead to new cures and treatments. This is particularly troubling for women, who are more likely to suffer from chronic illnesses, more likely to be caregivers, and more likely to delay or forgo care due to cost. If the MFN model were to take effect, it could make it harder for patients to access the medications they need, not just now, but in the future, as fewer new treatments come to market.
Women and girls deserve a healthcare system that works for them, one that supports innovation and ensures access to life-changing therapies. Women face unique and complex medical needs that require continued investment in cutting-edge science. We should be doing everything we can to support the next breakthrough, not creating barriers that slow it down or stop it altogether.
Price-setting policies might save the government money on paper, but at what cost? We risk losing the momentum we’ve built in medical innovation, especially for rare diseases and conditions that primarily affect women and underserved populations. Slashing reimbursements or tying prices to other countries’ health systems doesn’t just jeopardize innovation; it puts patient access and outcomes at risk.
There is a better way forward. If policymakers are serious about lowering costs for patients, they should focus on meaningful PBM reform. There is growing bipartisan support in Congress to address PBMs and bring more transparency to the medical market. Reforming this system would do far more to reduce out-of-pocket costs for patients than sweeping price control policies that could lead to delays or shortages.
We can’t afford to make the same mistakes again. The MFN model is a distraction from the real issues and a step in the wrong direction. Let’s focus our energy on reforms that actually help patients by ensuring they can access the care they need, when they need it.