Living with a heart condition means staying on top of my health every single day. I rely on daily medications to manage my condition and reduce my risk of serious complications. What I shouldn’t have to rely on—but am forced to deal with constantly—is a prescription drug system that creates uncertainty at every turn because of pharmacy benefit managers (PBMs).

PBMs decide which medications are covered, when patients can access them, and how much they’ll cost at the pharmacy counter. Too often, those decisions change without warning. Discounts that should lower costs are withheld, coverage rules shift, and patients are left paying more out of pocket. For someone with a cardiac condition, these delays and cost spikes can be dangerous, forcing patients to postpone care or ration medications they need to stay healthy.

Some policymakers argue that importing foreign drug prices through Most Favored Nation pricing is the answer. But that approach doesn’t confront the real problem. Importing prices from other countries leaves PBM power untouched, offers no guarantee that patients will see savings, and distracts from reforms that could help immediately.

Real relief for patients starts with PBM reform. Congress should crack down on the middlemen driving costs up behind closed doors and ensure that negotiated savings actually reach patients. For those of us managing serious heart conditions, fixing PBMs is a huge victory. 

Stephen Brown
Feasterville, PA