
07/08/2025
In the United States, medicines are increasingly treated not as essential tools for survival but as luxury commodities, available primarily to those who can afford them. A deeper analysis from the National Institutes of Health reveals why:
“Medicines are expensive because, as a society, we have chosen to rely on a for-profit business model for medical innovation that prioritizes profit maximization for the benefit of shareholders and investors over health purpose. The few medical breakthroughs are overly expensive, precluding access except for the wealthiest.”
This reality reflects a healthcare system that has drifted from its public health mission, where the value of medicine is measured not by lives saved but by profit margins.
Pharmacy Benefit Managers (PBMs) play a significant role in the complex dynamics of prescription drug pricing in the United States. These intermediaries operate on behalf of insurance companies, employers, and government programs to negotiate drug prices, determine formulary inclusion, and influence patients’ out-of-pocket costs.
While PBMs were originally established to reduce healthcare spending, they have increasingly come under scrutiny for practices that appear to drive prices upward. As highlighted in Harvard Health Publishing, “Pharmacy benefit managers… often receive a share of total spending on medicines, which might encourage approval of higher-priced drugs.”
This indicates that PBMs might not be looking for cost-effective healthcare solutions but instead are motivated to promote higher-priced medications, even when they may not have a superior health benefit. Their complex rebate structures, lack of pricing transparency, and increasingly consolidated relationships with major insurers have contributed to a highly opaque and distorted pharmaceutical pricing system.
In response to rising public frustration over drug prices, former President Donald Trump signed a 2020 executive order introducing the “Most Favored Nation” model, which aimed to tie U.S. drug prices to those paid in other high-income countries.
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