Why Drug Pricing Reform Must Start with PBMs– Not Price Controls

By: Tom Kowalski, Co-Chair, We Work For Health

Recent efforts to revive the so-called “Most Favored Nation” (MFN) drug pricing policy have reignited debate over how best to lower prescription drug costs in the U.S.

Proponents claim it’s a simple fix: tie what Medicare pays for drugs to the lowest prices in other wealthy nations.

But beneath the surface, MFN represents a deeply flawed policy that fails to address the real drivers of high costs and threatens major consequences for innovation, jobs, and patients– especially in states like Texas.

The MFN model would impose foreign-style government price controls on the U.S. system by pegging Medicare drug prices to the lowest rates paid by other nations. This approach ignores the actual structure of drug pricing in America, where pharmacy benefit managers (PBMs)– not manufacturers– control the prices patients pay at the counter. These powerful middlemen negotiate behind closed doors, collecting significant fees and rebates that inflate costs for consumers while adding nothing of value. And they do this without transparency or accountability.

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