OPINION: WE HAVE TO ACCELERATE PHARMACY BENEFIT MANAGER REFORM RIGHT NOW. HERE’S WHY

As someone who has worked across business, finance, and healthcare, I have seen firsthand how rising drug costs spread far beyond the pharmacy counter. Too many policymakers are celebrating domestic pharmaceutical expansion while ignoring the pricing structures keeping many treatments financially out of reach for ordinary Americans.

When manufacturers dramatically raise prices, everyone pays — including people who never took the drug themselves. Businesses face higher healthcare costs, and insurance premiums rise. Medicare and Medicaid spending surges while hospitals and providers come under growing financial strain. And ultimately, taxpayers absorb the burden through their taxes and miss out on public spending in other areas. 

Many Americans feel powerless and trapped inside a system designed to maximize profit rather than promote their health and well-being. To comprehend the situation at hand, regular people have to become systems thinkers and de facto analysts, which is a tall order when simply wondering about the cost of medicine. 

That harsh reality hits even harder when you realize that the United States remains the global leader in biotechnology and medical research, pioneering breakthrough treatments that have changed lives around the world. One would think that all of this progress and technology would be reflected in the American domestic market, but reality tells a different story. 

Americans support innovation. They understand that successful pharmaceutical companies should profit from meaningful breakthroughs. But there is a difference between rewarding innovation and allowing effectively unlimited pricing power disconnected from affordability, access, and public trust.

When life-saving treatments launch at prices ordinary Americans cannot realistically absorb, the healthcare system begins to lose legitimacy. Inside a system already strained by rising costs and administrative complexity, attempts at reform often drift toward calls for far more centralized or socialized models of healthcare. Whether those models are desirable or not, the political pressure behind them grows as large portions of the public begin to view the existing system as economically and morally unsustainable. Exhausted by the endless maze of contradictions, many Americans have simply lost confidence that the system is working in their interest at all.

Fixing this problem is difficult because healthcare markets do not function like normal markets. Many Americans recently saw the story about an Australian tech entrepreneur who used artificial intelligence to help create a custom cancer vaccine for his rescue dog, ultimately shrinking the animal’s tumors and extending her life. Stories like that generate real hope about what medicine and technology may soon be capable of achieving.

Still, the example also highlights another uncomfortable issue: competency and access. Are ordinary Americans realistically supposed to build private biotechnology solutions to save a family member? That is not a functioning healthcare system. It suggests that navigating serious illness increasingly requires extraordinary financial resources, technical knowledge, institutional access, or sheer luck.

Families confronting those realities are not negotiating from a position of leverage or mutual advantage. They are trying to save a loved one. That creates a level of vulnerability unlike almost any other sector of the economy, and it is one reason healthcare pricing remains politically and emotionally explosive.

The public anger surrounding healthcare has become so intense that even horrific acts of violence are now being interpreted through that lens. After the 2024 killing of the UnitedHealthcare CEO in Midtown Manhattan, some radicals openly justified or celebrated the act of violence by rationalizing the executive’s death as a permissible action due to the broader failures inside the healthcare system. That reaction was — and still is — morally grotesque, but it has also been used as a political grievance tool to tap into the substantial public rage. 

Washington should take note of that. The goal should not be performative outrage or ideological warfare over healthcare models. It should be delivering measurable value to the American public through meaningful reform, stronger competition, better oversight, lower structural costs, and genuine improvements in long-term health and wellness outcomes.

A clear example of political misdirection in American healthcare is the way pharmaceutical companies spend enormous sums attacking insurers, pharmacy benefit managers, hospitals, and nearly every other part of the system while avoiding meaningful scrutiny of the role drug pricing itself plays in driving costs higher.

That constant cycle of blame-shifting may create political leverage and public confusion, but it does little to address the underlying affordability crisis confronting ordinary Americans.

If policymakers genuinely want to reduce healthcare costs, they cannot ignore the role manufacturers play in setting and escalating prices throughout the system.

That does not require hostility toward markets or opposition to innovation. America can support medical research and domestic manufacturing while also demanding greater transparency, stronger competition, and tougher scrutiny of anti-competitive behavior.

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The goal should not be to punish success or discourage investment. It should be to restore balance between innovation and affordability, so the healthcare system remains economically and politically sustainable.

America absolutely should manufacture more medicines at home. But a healthcare system cannot call itself “America First” if ordinary Americans still cannot afford the treatments being produced.

Chadwick Hagan is an American investor, entrepreneur, author, and executive producer.