Why PBM Reform, not MFN, is a Viable Path to Affordable Drug Access

More than half of American adults manage multiple chronic conditions. The prevalence is enough to strain the U.S. healthcare system and challenge patient access to new treatments. To compound the issue, pharmacy benefit managers (PBMs) and others siphon nearly half of every dollar spent on brand-name drugs, driving up costs for patients.

Reform for how Americans access drugs is a primary topic in Washington.

Of the two trending options on the table, only one puts patients first.

PBM reform and most favored nation (MFN) pricing have gained significant recent traction. One key distinction is the former directly confronts the issue at hand by mitigating the influence of middlemen, whereas MFN imports drug prices set by foreign governments with a riskier range of potential outcomes.

Any solution must prioritize patient access.

Today, PBMs wield enormous influence over which medicines patients receive and what they pay. Their rebate-driven models, formulary barriers, and use of affiliated group purchasing organizations (GPOs) often prioritize financial return over clinical need.

For people managing chronic disease, these practices can delay effective therapy and inflate out-of-pocket costs.

PBM reform seeks to restore patient-centered access by curbing opaque pricing practices and ensuring negotiated savings reach patients. By reducing pricing distortions created by PBMs and increasing transparency, reform targets the systemic barriers that most consistently raise costs for patients.

In the interim, direct-to-patient (DTP) programs can offer short-term relief.

They allow patients to bypass intermediaries altogether and buy medications directly from manufacturers at a transparent, often significantly discounted, price. For some, especially those with high deductibles, limited coverage or no insurance, DTP would address unpredictability at the pharmacy counter and minimize surprise costs. In time, there could be an opportunity to expand DTP, integrating insurance coverage and enabling broader participation.

MFN moves the U.S. in another direction.

By tying drug prices to those set in foreign markets, MFN would introduce volatility that would limit patient access to new medicines. By undermining the conditions that support steady development, testing, and rollout of new therapies, MFN would jeopardize access for patients who rely on new therapies to manage complex or rare conditions.

The pursuit of parity with other nations can come at the expense of timely care for Americans who need it most.

Across Europe and Canada, patients routinely face delayed and constrained access to medicines due to government price-setting practices. In Canada, a 2021 Fraser Institute analysis found newly approved therapies often arrive over a year later than their U.S. equivalents, shrinking treatment windows for people with chronic disease. In the U.K., rare disease patients are frequently denied access to transformative treatments when the National Institute for Health and Care Excellence deems them not to be “cost-effective”.

It would be precarious to address affordability in the U.S. by treating countries with major access concerns as the rubric. It’s also clear from those experiences that we cannot simply adopt foreign prices and still enjoy U.S.-level access to medicines or have the same pace of innovation.

PBM reform provides a clearer path forward. While no single solution can fully address the challenges that Americans with chronic disease face, any solution should strengthen the connection between patients and their prescribed therapies, ensuring affordability and consistent access.