America’s seniors deserve real relief from sky-high prescription drug costs—not political quick fixes that threaten their health and well-being. As an advocate for senior healthcare, I urge policymakers to focus on Pharmacy Benefit Manager (PBM) reform, rather than the so-called “Most Favored Nation” (MFN) drug pricing policy. While both seek to address the burden of expensive medications on older Americans, only PBM reform can deliver sustainable, fair, and safe savings—without sacrificing access to lifesaving therapies.
The Problem: Drug Prices Are Too High, and Seniors Suffer Most
It’s no secret: more than 9 in 10 seniors take at least one prescription drug, and out-of-pocket costs keep rising. Stories abound of older adults choosing between food and medications, splitting pills, or skipping refills altogether. But the roots of this crisis are deeper than just what drug companies charge.
Hidden away in the shadows of America’s prescription drug supply chain are the Pharmacy Benefit Managers—the giant corporate middlemen who control which drugs seniors can get, how much they pay at the pharmacy, and how “savings” from manufacturer rebates are distributed. Three PBMs now process nearly 80% of all U.S. prescriptions, wielding outsized power over patients, pharmacies, and health plans.
MFN Price Controls: A Risky and Ineffective Shortcut
The Most Favored Nation executive order sounds appealing at first glance: it would cap Medicare drug prices at the lowest level paid by other wealthy countries, such as Germany or Canada. Proponents argue this would stop “foreign freeloading” on American innovation. But the reality is far more troubling—for seniors most of all.
1. Access Delays and Rationing
Countries whose prices the MFN rule mimics routinely deny advanced therapies to older adults. In Canada and the UK, senior cancer patients often wait months—or are outright denied—new treatments available in the U.S. If we import their price controls, we import their access problems, too. Academic studies and real-world evidence confirm this: countries with tightest price caps offer fewer new drugs and have longer wait times for approvals.
2. Threats to U.S. Medical Innovation
The MFN approach would undermine America’s biopharmaceutical leadership. The Congressional Budget Office and independent analysts estimate it could shrink U.S. investment in new drug research by hundreds of billions—if not trillions—of dollars over two decades. That means fewer new cures, fewer clinical trials, and less hope for seniors battling cancer, Alzheimer’s, and other diseases disproportionately affecting older Americans.
3. Unintended Harms for Vulnerable Patients
The MFN order aims to cut Medicare’s drug bill by reducing what it pays doctors and hospitals for specialty injectables and infusions—therapies like chemotherapy or advanced diabetes medications. But many clinics, especially in rural or underserved communities, already operate on thin margins. They cannot absorb big reimbursement cuts and may be forced to stop offering these critical drugs, leaving seniors with fewer places to turn for lifesaving care.
PBM Reform: The Market-Based, Patient-Centered Solution
Rather than cap prices from above, PBM reform targets the hidden games and incentives that distort the drug market from within. Seniors would benefit directly from a transparent system—with negotiated savings flowing to them, not middlemen.
1. End “Spread Pricing” and Ensure Pass-Through Savings
PBMs currently profit by keeping the difference between what they reimburse pharmacies and what health plans pay, often inflating patient costs. Requiring PBMs to pass negotiated discounts—especially rebates on brand-name drugs—directly to seniors at the pharmacy counter would lower out-of-pocket costs overnight.
2. Transparency in Rebates and Formularies
PBMs should be required to disclose how much they receive in rebates and administrative fees, and how these influence which drugs seniors have access to. Clear and honest reporting will expose any practices that hurt patient choice and affordability.
3. Ban Anti-Competitive Contracting
Prohibit PBMs from stifling competition, such as tying up pharmacies and manufacturers in exclusive contracts that limit access to generics or biosimilars. More competition means lower costs for everyone, especially for seniors on fixed incomes.
4. Protect Independent Community Pharmacies
Seniors often rely on neighborhood pharmacies. PBM “DIR fees” and arbitrary reimbursement cuts have driven hundreds out of business, especially in rural or underserved areas. Reform should include protections so that seniors can access needed drugs close to home.
The Bottom Line: Empower Seniors, Don’t Endanger Them
The MFN rule is a blunt instrument: it risks slashing access, chilling innovation, and shifting costs in unpredictable ways, all while failing to address the real drivers of price spikes. In contrast, PBM reform strikes at the heart of the system’s opacity and skewed incentives. By demanding transparency, accountability, and true competition among PBMs, lawmakers can deliver immediate relief for America’s seniors—encouraging lower prices, greater access, and continued biomedical progress.
For older Americans, medicine is not a luxury. It’s a lifeline. Reforming the PBM system is the surest, safest, and most senior-friendly way to make prescription drugs affordable—without gambling with their access or their future health.
About the author: Pam McAloon–Retired Registered Nurse specializing in Critical Care and Oncology. Currently serving as Pinellas County Republican State Committeewoman
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