Ray Seigfried is a Democrat representing Arden in the Delaware Senate.
There can be no greater moral responsibility than a parent caring for his or her child, no more fundamental moral obligation than couples caring for each other, no higher calling for a religious leader than caring for a congregation and, indeed, no more fundamental purpose for a representative, senator, governor or president than caring for the people he or she serves. Caring is what makes us human. This is why these words are inscribed on the wall of the U.S. Department of Health and Human Services building in Washington, D.C.:
“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped” — Sen. Hubert H. Humphrey
The moral test of government is once again challenged.
On July 4, Donald Trump and the Republican Congress delivered and signed legislation that does not meet the test of moral courage. The bill contains around $4.5 trillion in tax reductions and substantial cuts to Medicaid and food assistance for people below the poverty line. In Delaware, over 300,000 people are currently on Medicaid, and many throughout our state need food assistance programs. Two-thirds of Delaware’s Medicaid program is funded by the federal government.
Hidden in this 900-page legislation is yet another expense to the people of Delaware: medication costs. In 2022, President Joe Biden and the Democratic Congress passed legislation enabling Medicare to negotiate certain drugs to reduce costs. Several drugs were negotiated this year and will be offered at a lower price to Medicare beneficiaries during 2026. A second-year negotiation is underway, scheduled to be released in 2027. However, Trump’s new “Big Beautiful Bill” will exempt more medications from Medicare negotiations. The Congressional Budget Office estimates that this exemption will eliminate $5 billion in savings over 10 years. One can only conclude that the pharmaceutical industry has a very powerful lobby.
As a state senator with a health care background, I am keenly aware of the high medication costs. The state’s medication program for both its employees and retirees is also affected by high-cost drugs. In 2024, the cost for medications exceeded $500 million. The State Employee Benefits Committee has the legal challenge of deciding how the state will request pharmaceutical proposals and who will administer such a program. Drug programs are administered by pharmacy benefit managers, like CVS or Express Scripts. A PBM will process claims, negotiate drug prices and secure rebates, refunds, discounts and coupons with manufacturers. They can also create lists of drugs for their customers to purchase, called “formularies.”
PBMs have significant control over the cost of drugs directly because they are the intermediaries between the drug manufacturers and the customer. Organizations must optimize their PBM engagement by selecting only the services that best align with their strategies and goals. Clarity and rigor in contract terms are critical to protecting stakeholders’ interests and achieving meaningful outcomes. This is especially important because pharmacy benefit managers are not known for their transparency. Customers who request information about their agreements with the pharmaceutical industry are often denied; they are told they are trade secrets or confidential information that will not be shared. This lack of transparency leaves customers with the experience of paying higher prices without knowing why. Allowing them to earn a profit to make the world healthier is a noble quest. Abusing this right for the greed of money is not.
When Congress created the Food and Drug Administration to review and approve pharmaceuticals, it set as its criteria two factors:
Congress did not add a third factor, which many countries have, called “cost effectiveness.” Perhaps Congress left cost effectiveness out because it trusted companies to work toward the common good of society.
This is why, in my second month as a state senator, I submitted Senate Joint Resolution 7, advising the State Employee Benefits Committee on nine strategies and policies when negotiating for pharmaceuticals, to achieve better outcomes. This resolution was passed by both the Senate and the House of Representatives, and now awaits the governor’s signature. State governments must always find ways to promote value, especially with federal cuts on the way, and lowering pharmaceutical costs is certainly one of them. We must have the courage to pass the moral test and promote the common good.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
