⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Making Medicines More Affordable: How Competition Can Lower Drug Prices”

Senate HELP Committee

March 16th, 2026 (recording linked here)

WITNESSES

• Brian J. Miller, MD, MPH, MBA: Associate Professor of Medicine, The Johns Hopkins University School of Medicine, Visiting Fellow, Hoover Institution

• Ryan Long, J.D.: Director of Congressional Relations and Senior Research Fellow, Paragon Health Institute Nonresident Senior Scholar, USC Schaeffer Institute

• Robert Weissman, J.D.: Co-President, Public Citizen

QUICK SUMMARY

• Prescription drug affordability remained a central concern, with consensus that high costs were limiting patient access and adherence to treatments.

• Witnesses and members debated the balance between fostering pharmaceutical innovation and increasing competition through generics and biosimilars.

• Pharmacy benefit manager (PBM) practices, rebate structures, and market distortions were identified as key drivers of higher drug prices and reduced uptake of lower-cost alternatives.

• Regulatory reforms at the FDA, including streamlined approval pathways and expanded over-the-counter or alternative access channels, were discussed as ways to lower costs and improve access.

• Broader structural issues—including patent practices, transparency gaps, international price disparities, and healthcare coverage—were highlighted as major factors influencing drug pricing and affordability.

🐘 Republicans

• Emphasized market-based solutions, including increasing competition through generics and biosimilars while preserving strong intellectual property protections to sustain innovation.

• Highlighted the role of PBM reform, regulatory streamlining, and alternative access channels (e.g., OTC, direct-to-consumer) in lowering costs.

• Expressed concern that aggressive government intervention, such as price controls or patent elimination, could reduce future drug development and U.S. competitiveness.

🫏 Democrats

• Emphasized that drug prices in the U.S. were excessively high due to pharmaceutical industry power, lack of negotiation, and systemic market failures.

• Supported stronger government action, including price negotiation, international reference pricing, and increased transparency requirements.

• Raised concerns about affordability, insurance coverage losses, and the health consequences of high drug costs, while criticizing industry practices and recent policy approaches as insufficient.

MEMBER OPENING STATEMENTS

• Chair Cassidy (R-LA) stated that Americans were struggling with the high cost of healthcare, particularly prescription drugs, which he identified as a major financial burden. He emphasized that while generics had successfully reduced costs, biologics were driving a disproportionate share of spending and required more competition through biosimilars. He argued that innovation, supported by intellectual property protections, is essential to developing life-saving treatments and should not be undermined by government overreach. He concluded that policymakers should pursue a free-market approach that expands access to lower-cost alternatives while preserving incentives for future medical advancements.

• Ranking Member Sanders (I-VT) stated that prescription drug prices in the United States were excessively high and unaffordable for many Americans, with significant consequences for public health. He criticized claims that drug prices had been reduced, arguing instead that prices had continued to rise and remained higher than in other countries. He proposed legislation to lower drug costs by aligning U.S. prices with those in other developed nations, which he said could save billions annually. He concluded that high drug prices were driven by pharmaceutical industry influence in politics and that stronger government action was necessary to address the issue.

WITNESS OPENING STATEMENTS

• Dr. Miller stated that high drug costs prevented many Americans from taking prescribed medications and that improving competition was key to affordability. He emphasized the need to expand biologics competition through streamlined biosimilar approval processes and regulatory reforms modeled after generics. He also argued for reducing anti-competitive practices in generic markets and increasing access through additional distribution channels. He concluded that modernizing FDA review processes and clinical trial systems could lower development costs while maintaining safety and efficacy standards.

• Mr. Long stated that medical innovation and competition were both essential to lowering drug prices and improving patient outcomes. He highlighted progress in generics and biosimilars, noting their significant cost savings, but argued that further reforms were needed to increase their adoption and address barriers like rebate structures. He emphasized policy solutions such as codifying FDA reforms, expanding over-the-counter drug access, and restructuring programs like 340B to reduce distortions in the market. He concluded that targeted reforms could reduce costs while preserving the innovation ecosystem that drives new treatments.

• Mr. Weissman stated that the pharmaceutical pricing system was fundamentally broken and disproportionately benefited drug companies at the expense of patients and taxpayers. He argued that high prices were driven by market failures, including patent monopolies, lack of price negotiation, and industry influence, and that Americans paid significantly more than other countries. He supported major reforms, including legislation to align U.S. drug prices with international benchmarks and to introduce competition when prices were too high. He concluded that meaningful change required bold political action to implement systemic reforms and rein in pharmaceutical industry power.

QUESTION AND ANSWER SUMMARY

• Chair Cassidy (R-LA) asked about streamlining biosimilar approvals, and Dr. Miller stated that requiring only pharmacokinetic studies could significantly reduce time and cost while maintaining safety and effectiveness.

  Chair Cassidy also explored substitution policies, and Dr. Miller supported allowing pharmacists to substitute biosimilars similarly to generics to enhance competition.

  Chair Cassidy asked about PBM rebate structures, and Mr. Long explained that recent reforms would reduce incentives to favor higher-priced drugs and increase transparency.

  Chair Cassidy raised concerns about weakening intellectual property protections, and witnesses warned that doing so could reduce future innovation.

• Ranking Member Sanders (I-VT) challenged claims about lower drug prices and confirmed with witnesses that U.S. prices remained among the highest globally. He emphasized international price comparisons and argued that other countries negotiated directly with manufacturers to achieve lower costs.

  Ranking Member Sanders questioned the role of pharmaceutical profits and lobbying, and Mr. Weissman stated that industry influence and monopoly power were key drivers of high prices.

  Ranking Member Sanders concluded by highlighting the health consequences of high costs, with witnesses agreeing that unaffordable drugs led to worse outcomes and higher system-wide costs.

• Sen. Collins (R-ME) focused on insulin affordability and biosimilar pathways, and Dr. Miller stated that current approval timelines were too long and costly, emphasizing the need for expedited pathways.

  Sen. Collins raised concerns about abuse of the FDA citizen petition process, and Dr. Miller explained that it was sometimes used to delay competition and should be more tightly regulated.

  Sen. Collins also asked about PBM practices, and Mr. Long noted that formulary incentives still favored higher-priced drugs, suggesting further reforms to ensure lower-cost options were accessible.

• Sen. Baldwin (D-WI) emphasized transparency and affordability, and Mr. Weissman stated that greater transparency would expose pricing practices and reduce industry manipulation.

  Sen. Baldwin raised concerns about insurance coverage losses and rising premiums, and Mr. Weissman warned that these trends would lead to increased financial strain, reduced access to medications, and worsening health outcomes.

• Sen. Marshall (R-KS) focused on PBM practices and FDA efficiency, and Mr. Long supported increased transparency, including potential audits of PBM-related contracts.

  Sen. Marshall asked about FDA performance, and Dr. Miller stated that while improvements had been made, further structural reforms were needed to streamline reviews.

  Sen. Marshall also emphasized broader healthcare costs and chronic disease, while Mr. Long explained that PBM rebate systems incentivized higher-priced drugs and distorted biosimilar adoption.

• Sen. Hassan (D-NH) addressed patent abuses and market exclusivity, and Mr. Long acknowledged the need to balance innovation incentives with timely competition, supporting reforms to improve patent transparency.

  Sen. Hassan highlighted specific industry practices, and Mr. Weissman confirmed that tactics like authorized generics were used to delay competition and maintain high prices.

  Sen. Hassan also explored cost-reduction strategies, and Dr. Miller suggested that alternative distribution channels like “behind-the-counter” drugs could lower costs by bypassing intermediaries.

• Sen. Husted (R-OH) focused on over-the-counter (OTC) transitions, and Mr. Long explained that regulatory uncertainty was a key barrier, with reforms helping clarify approval requirements. Dr. Miller added that earlier FDA engagement and clearer guidance could significantly reduce development time and costs.

  Sen. Husted emphasized that expanding OTC availability could generate substantial savings and improve access for patients.

• Sen. Hickenlooper (D-CO) examined litigation barriers to generic entry, and Mr. Long supported policies like “skinny label” reforms to reduce legal uncertainty and promote competition.

  Sen. Hickenlooper compared legislative action to executive actions, and Mr. Weissman argued that statutory reforms like Medicare price negotiation would have more durable and meaningful impacts.

  Sen. Hickenlooper also raised transparency concerns, and Mr. Weissman noted that limited visibility into pricing deals reduced accountability and likely limited consumer benefits.

• Sen. Armstrong (R-OK) focused on regulatory efficiency and future innovation. Dr. Miller advocated for reducing FDA “red tape,” modernizing clinical trials, and using automation to lower development costs. Mr. Long emphasized that improving success rates and consistency in approvals could reduce costs and speed access to drugs.

  Sen. Armstrong also questioned whether faster development would reduce prices, prompting debate, with Mr. Weissman arguing that monopoly pricing would persist, while Mr. Long highlighted that increased competition could still drive prices down.

• Sen. Alsobrooks (D-MD) criticized the Trump RX platform, and Mr. Weissman agreed that it could mislead consumers toward higher-cost brand drugs instead of cheaper generics.

  Sen. Alsobrooks argued that such programs could increase out-of-pocket costs and lead patients to ration medications. Mr. Weissman said that the program’s limited scope and design did not meaningfully address systemic affordability issues.

• Sen. Moody (R-FL) defended alternative approaches like Trump RX, emphasizing transparency and direct-to-consumer access. Dr. Miller agreed that expanding access channels, including OTC and cash-pay options, could increase competition and reduce costs.

  Sen. Moody also argued that new market-based approaches were necessary given past policy failures.

• Sen. Markey (D-MA) focused on broader cost pressures, including tariffs and insurance cuts, and Mr. Weissman stated that tariffs on drugs would likely increase costs for patients. He warned that reduced coverage and higher costs would worsen access to medications and lead to negative health outcomes.

  Sen. Markey concluded by emphasizing the cumulative impact of policy changes on affordability and public health.

• Sen. Banks (R-IN) discussed transparency and global competition, and Mr. Long argued that direct-to-consumer platforms could simplify pricing and reduce inefficiencies.

  Sen. Banks raised concerns about China’s growing role in pharmaceuticals, and Dr. Miller warned that regulatory inefficiencies in the U.S. could weaken domestic competitiveness and national security.

  Sen. Banks concluded that modernizing FDA processes was critical to maintaining leadership in drug development.

• Sen. Kim (D-NJ) focused on insurance coverage and access, and Mr. Weissman confirmed that programs like Trump RX still required prescriptions and did not address underlying affordability issues.

  Sen. Kim emphasized the importance of expanding insurance coverage, and Weissman warned that recent policy changes could reduce access and strain healthcare infrastructure.

  Sen. Kim concluded by supporting expanded Medicare negotiation authority as a key tool for achieving significant cost savings.