Improve Access and Innovation to Achieve MAHA
By Salvatore J. (Sal) Giorgianni

The Trump administration has promised to "Make America Healthy Again," and we applaud that goal. Pharmaceutical innovation has saved countless lives, but developing new drugs is risky, costly and time-consuming. In fact, only about 46% of new drugs approved in the United States recoup all development and standard business costs after 10 years on the market. Companies that create these therapies need incentives to keep researching. Yet some policy approaches risk damaging that progress by distorting the free-market system. Policymakers should instead focus on making the market more transparent and efficient.

One such approach under consideration is a "Most Favored Nation" pricing scheme, which would link U.S. drug prices to those in other developed nations, many of which impose price caps through government-run health systems. While well-meaning, an MFN policy in the United States would likely have serious unintended negative effects and do little to control actual out-of-pocket costs.

Countries with strict price controls often restrict access to the newest, most innovative medicines. Patients there frequently face delays or denials for lifesaving treatments. Such policies reduce medicine to a commodity, where cost overrides quality and innovation -- contrary to America's spirit of free enterprise. Adopting those models risks shortchanging American patients and slowing the development of new therapies.

There is also a national security dimension. MFN policies could inadvertently empower countries like China, which has invested heavily in biotech and pharmaceuticals. Over the past decade, China has increased its biotech patents by nearly 380%, aiming to become a global leader. If U.S. innovation is stifled through artificial price controls, it would strengthen competitors and reduce America's dominance in biotech and health care. This is not just an economic issue -- it's a security issue.

Fortunately, there are better ways to lower drug costs without harming innovation.

A critical step is to eliminate the middlemen -- pharmacy benefit managers -- that control much of what patients pay at the pharmacy counter. These companies negotiate discounts but often keep the savings rather than passing them to consumers. They also steer patients toward higher-priced drugs because larger rebates mean bigger profits. 

President Donald Trump has recognized this problem -- and he has taken steps to restrict the middlemen who inflate drug prices.

Last year, he promised to "knock out" the middlemen and supported direct-to-consumer sales models that let patients bypass PBMs altogether. Some pharmaceutical companies -- including Pfizer, Bristol Myers Squibb and Novo Nordisk -- are already adopting these approaches, offering greater transparency and lowering costs. AstraZeneca and Eli Lilly have announced major investments in U.S. manufacturing and R&D, while others are raising prices abroad to help bring down costs at home.

This momentum is promising. Instead of stifling it with policies that suppress innovation, the focus should be on expanding direct-to-consumer models and ensuring transparent, fair pricing. Safeguards such as clear safety information and accurate pricing can strengthen the system while protecting innovation and America's competitive edge.

Patients should not have to choose between affordability and access to breakthrough treatments -- or between low prices and a strong U.S. supply chain.

Addressing the real drivers of high drug costs, particularly PBM abuses, offers a smarter, more sustainable path. By pursuing these reforms, the Trump administration can truly advance its goal: helping Americans stay healthy without sacrificing the medical breakthroughs of tomorrow.

Salvatore J. (Sal) Giorgianni, Jr, PharmD, CMHE, is vice president and co-founder of Healthy Men, a nonprofit dedicated to advancing the health of boys, men and their families. He is chair-emeritus and co-founder of the American Public Health Association Caucus on Men's Health. This was originally published in Well News.

Editor’s Note: Dr. Salvatore J. Giorgianni Jr. and the nonprofit Healthy Men are verified sources. Some statistics, including the “46 percent of new drugs” figure, couldn’t be independently confirmed, and a few policy points reflect the author’s own perspective in an ongoing national debate.