RealClearHealth: Patients Before Profits May No Longer Be a Pipe Dream

By Kasia Mulligan, Patients Come First’s National Spokesperson

For too long, the American health care system has felt like a complex maze where the exit is blocked by layers of middlemen and opaque billing practices. As mothers, we are the primary healthcare CEOs of our households. We manage the appointments, track the symptoms, and strive to feed our families with nutritious, healthy food to ensure our children have what their need to thrive. We don’t expect the system to be perfect, but we do expect it to be honest.

Fortunately the tide is starting to turn.

With the recent enactment of long-awaited Pharmacy Benefit Manager (PBM) reforms via H.R. 7148, the Consolidated Appropriations Act, the era of shadow dealings in the drug supply chain is finally facing a sunset. are now being enacted into law.

These reforms bring much-needed transparency, requiring PBMs to report drug pricing data and--most importantly--ensuring that 100 percent of rebates and discounts are passed directly to patients at the pharmacy counter. This isn’t just a policy win; it’s a win for the family budgets that have been squeezed by middlemen we never asked for in the first place.

While we rightly ought to celebrate this victory; we cannot stop here.

There are other deep cracks in the healthcare system that are siphoning money away from the people that are hurting every day trying to pay for their medications and treatments while conglomerates pad their bottom lines.

The 340B Drug Pricing Program was created with a noble heart: to help lower-income patients and vulnerable communities access medications through participating hospitals. Rather than offering lower prescription drug prices, some hospitals have withheld discounts and diverted savings to fund unrelated projects without proper oversight. It’s incredibly disheartening to realize that the "safety net" promised to our most vulnerable patients is stretched thin—not by patient need—but by bad actors with institutional greed.

Instead of passing savings to the uninsured, some hospitals have been caught withholding doscounts and using the surplus as a slush fund for expansions and other unrelated projects. The numbers are staggering. In Minnesota alone, reports highlighted hospitals netting over $1 billion by charging full price for prescription drugs they acquired at steep discounts. When  a hospital gobbles up these savings, they aren’t just taking money from a government program; they are taking it from parents who are choosing between a prescription and a mortgage payment.

The Health Resources & Services Administration (HRSA) recently took a vital step by reintroducing the 340B Drug Rebate Pilot Program--an initiative to improve transparency within the hospital system. It’s about time someone asked these hospitals to show their receipts.

By prioritizing data collection and oversight, we can ensure  this program returns to its original intent: lowering costs for the people who need it most.

Finally, we must address the legislative bottleneck threatening the future of medicine. The 2022 Inflation Reduction Act (IRA) introduced price controls that treat medications differently based on their form. Currently, small-molecule medicines (the pills in your medicine cabinet) are subject to price negotiations after just seven years, while biologics get thirteen..

This disparity is a direct deterrent to innovation for the most accessible forms of medicine. When the government imposes arbitrary caps on investments, it’s the patients who lose out on the next breakthrough.

Read the full op-ed in RealClearHealth here.