How 2024 GOP candidates can effectively talk about drug prices

Prescription drug prices, like so many other expenses most households face every month, have been too high for too long. We’ve been asked to believe big-government solutions would work to bring prices down. Yet all the “best intentions” of federal bureaucrats have failed to produce results. In fact, asking the federal government to run any significant part of our lives is usually the pathway to disappointment and regret. But that doesn’t mean we don’t have other, better options.

In the 2024 presidential elections, it would be a mistake for any candidate, regardless of their ideology, to concede ground on this issue. Drug prices should be a focal point of next year’s campaigns for at least three reasons. One, the American people need relief. Two, we know that the Inflation Reduction Act isn’t actually going to make medications more affordable for the average Iowan. Three, some individual states have identified solutions that lower out-of-pocket costs without relying on heavy-handed big government solutions.

Governors Ron DeSantis and Sarah Huckabee Sanders are among the state leaders who have provided a template for how to attack drug costs effectively. And it may not be how you think.

DeSantis and Huckabee Sanders identified a little-known bad actor in the drug pricing system and worked to rein in the anti-consumer, anti-small business practices of these middlemen known as pharmacy benefit managers, or PBMs. PBMs sit between the producer of prescription drugs and the pharmacist who dispenses those drugs to you and your family. They don’t create new cures, manufacture new drugs, or work with patients and families to ensure their prescriptions are filled accurately and safely. Yet they take up to 51% of the price of your prescription drugs by adding complexity and opacity to the drug pricing system in America.

DeSantis-driven Florida legislation will demand greater transparency from these Fortune 25 corporations that have operated without scrutiny and accountability for far too long and would ban much of the drug pricing gamesmanship that boost PBM profits but hurt patients and local community pharmacies. Arkansas Gov. Sarah Huckabee Sanders signed a law that saves patients money by requiring PBM-negotiated rebates be shared with consumers.

These leaders are effectively protecting their constituents from being ripped off by PBMs, and this must also be done at the federal level.

When the PBMs came into existence, they were designed to use their purchasing power as leverage to force lower prices from pharmaceutical manufacturers. Over time — and multiple mergers and acquisitions — these businesses changed. Now, three giant corporations control 80 percent of the market, creating an oligopoly and generating massive revenues that place them among the world’s most profitable companies. Their profiteering has affected virtually every American. Families struggle to pay for needed medicines and still put food on the table, small businesses struggle to afford health benefits for their employees, and county governments are squeezed by unnecessarily high pharmaceutical costs that take resources away from law enforcement, infrastructure improvements and other public needs.

The reason drug prices remain on the table as an issue in the 2024 elections is that the Inflation Reduction Act didn’t fix any of this. Selecting certain drugs in the Medicare program to be subject to government-imposed price controls may affect Medicare spending in the future, but it will do nothing to help Iowans who are being hit with high copay and cost-sharing charges at the pharmacy counter today. Candidates who can successfully address real world drug affordability in the here and now will win voter hearts and minds — achieving that goal through PBM reform has the added benefit of not discouraging biopharmaceutical innovation the way government price controls do. A recent poll in our state shows that a majority of likely Iowa voters overwhelmingly support policies to rein in PBM abuses and lower costs. And it’s safe to say Iowans often influence the national issue agenda during presidential elections.

DeSantis and Huckabee Sanders are among a still relatively small group that understand there are wins to be had on the prescription drug cost issue for policymakers who set their sights on where the profiteering at consumer expense is taking place.

Politicians in Washington, D.C. have talked a big game on drug prices for years, but they have always gravitated toward proposals that sound good in stump speeches but don’t address the root causes of rising drug costs. Iowans know better. What DeSantis, Huckabee Sanders, and a few others are doing in their states represents a fresh, practical approach to a long-standing problem. All aspirants for the White House and Congress next year would be wise to follow their lead.

Gentry Collins is CEO of the American Free Enterprise Chamber of Commerce.