Allyssa Thompson
BY ALLYSA THOMPSON
For nearly a decade, patient advocates across New Hampshire and the country have worked toward one goal: bringing fairness, transparency and accountability to the prescription drug system.
This year, that work paid off.
Congress recently passed meaningful reforms targeting pharmacy benefit managers (PBMs), the middlemen who largely determine which medications patients receive and how much they pay. For years, PBMs operated with little oversight, often benefiting when drug prices rose or when patients were steered toward certain pharmacies or medications.
That is now beginning to change.
The legislation breaks the link between PBM profits and drug prices. Instead of earning more when prices rise, PBMs will now be paid through flat, fair-market service fees. This removes harmful incentives and restores balance to a system that too often worked against patients.
For those of us who have advocated for this reform for years, this moment is deeply meaningful. It represents real progress after countless discussions, briefings and education efforts.
Transparency is another critical breakthrough. PBMs will now be required to provide detailed reporting on how money flows through the system at the drug and pharmacy levels and across their affiliated businesses. This includes rebates, pricing practices and how patients are directed to certain pharmacies.
Over time, many PBMs have become part of larger, vertically integrated health care companies, owning or affiliating with insurers, pharmacies and other parts of the supply chain. While integration can offer efficiencies, it also raises concerns about conflicts of interest when patient care decisions are tied to internal business relationships.
You can’t fix what you can’t see. By shining a light on pricing practices and the operations of vertically integrated entities, policymakers, health plans and patients will finally have tools to hold the system accountable.
The reforms also ensure savings reach patients. PBMs must pass through 100% of rebates and drug-related payments in Medicare Part D and employer-sponsored plans. For too long, hidden pricing practices drove up costs for patients and taxpayers. These changes make clear that savings should benefit patients, not middlemen.
For New Hampshire, these reforms are especially important. Many communities, particularly in rural areas, rely on local pharmacies and independent providers. The legislation strengthens protections that allow patients to use the pharmacy of their choice and helps prevent steering away from trusted local care. Community health providers and independent pharmacies, many of which serve as lifelines, now have a fairer chance to compete and continue serving patients.
This issue has never been about party or politics. It’s always been about what’s best for Granite State patients. We want to acknowledge New Hampshire’s federal delegation for their continued support of PBM reform over the years. Their commitment to patients has helped make this progress possible.
Still, this is just a first step. As policymakers and stakeholders examine the role of vertically integrated health care entities and the broader prescription drug supply chain, there’s an opportunity to build on this progress and ensure incentives remain aligned with patients at every level.
Just over a month since its passage, there is reason to be optimistic. There is still more work to ensure every patient can afford medications and access high-quality care, but this moment matters.
For patients, families and advocates who have worked tirelessly, this is a long-overdue win and an important step toward a fairer, more transparent and more accountable health care system.
Allyssa Thompson is co-president and CEO of Breathe New Hampshire, a nonprofit dedicated to protecting and improving respiratory health through education, advocacy and research to prevent and eliminate lung disease in the Granite State.
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