Midterm Elections Impact on Drug Pricing and Insurance Practices

As the U.S. midterm elections approach, the spotlight is on drug pricing policies that affect pharmacies, with implications for reimbursement practices and patient accessibility shaping the industry.

According to Adino “A.J.” Barbarito, Esq., a senior associate at Frier Levitt’s Life Sciences Litigation practice group, the focus on drug pricing, pharmacy benefit managers (PBMs), and healthcare affordability will continue to be a significant issue, regardless of which political party assumes congressional control. This ongoing emphasis highlights potential industry changes that insurance professionals should closely monitor.

The Political Landscape and Industry Impact

Both political parties acknowledge the importance of drug pricing and PBM reform, evidenced by bipartisan backing. The Centers for Medicare & Medicaid Services (CMS) is actively collecting feedback, with a deadline set for November. This aligns with the White House's Most-Favored-Nation (MFN) pricing policies, which aim to benchmark drug prices against those in other developed countries. These discussions intersect crucially with Medicare price negotiations and the potential expiration of enhanced Affordable Care Act (ACA) subsidies.

Potential Legislative Developments

Legislative momentum is evident, with the "PBM Kickback Prohibition Act" awaiting a vote. Additionally, changes introduced via the Consolidated Appropriations Act of 2026 could significantly alter PBM practices, particularly in Medicare Part D. Democratic control might prioritize expanded Medicare drug price negotiations and further scrutiny of MFN agreements, while Republican influence could spur PBM and 340B program reforms, possibly entangling FDA user-fee reauthorization talks in 2027.

Pharmacy Strategies and Adaptations

The MFN pricing model offers notable U.S. marketplace price reductions. However, its complexity arises from voluntary participation and fluctuating drug pricing dynamics. The Inflation Reduction Act’s Medicare Drug Price Negotiation Program targets high-cost drugs for discounts, impacting procurement and reimbursement for pharmacists, necessitating strategic adjustments in response.

Insurance and Consumer Dynamics

The expiration of previously enhanced ACA subsidies is causing premium increases, driving some patients to select high-deductible plans or exit the insurance exchanges. The Kaiser Family Foundation anticipates substantial shifts in enrollment and consumer costs, urging pharmacists to adjust their cost-sharing strategies as patient purchasing behaviors evolve. Legislative outcomes post-election will substantially influence whether these subsidies are restored or replaced by new mechanisms.

For insurance professionals, these developments necessitate proactive monitoring and strategic planning. Industry dynamics depend significantly on the election's outcome, and the chosen paths will dictate legislative and procedural changes affecting drug pricing, insurance enrollments, and consumer behavior.