Delaware punches above its weight in a lot of ways, and the prescription drug cost debate is one where the state’s voice matters. The proposal getting the most traction in Washington right now, though, is one worth questioning before it goes further.
Most-favored-nation pricing would tie American drug prices to what other countries pay. But those reference prices were built into healthcare systems that operate on fundamentally different terms — governments that decided which treatments would be covered, at what pace patients could access them and how much of the cost burden would shift elsewhere. As a recent piece points out, that cost didn’t disappear. A significant share of global pharmaceutical research and development has been subsidized by what American patients pay. MFN would change that math without changing the underlying dynamic that drives what Delaware families owe at the counter.
That dynamic runs through pharmacy benefit managers. PBMs manage formularies, steer patients toward certain medications and collect rebates from drug companies that are meant to reduce patient costs. Those rebates don’t reach patients. Step therapy requirements pile on, sending people through a sequence of alternatives before insurance will cover what their physicians ordered. These are the mechanisms that most directly shape what Delawareans pay, and MFN wouldn’t touch them.
Congress has begun addressing PBM practices and should keep going. That’s where the real leverage is.
Monica Duffy
Middletown
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
