American voters — and their elected leaders — are fed up with the cost of prescription drugs.
asserted
voters → elect → drugs
And they’re looking for someone to blame.
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they → look → someone
That blame ought to fall squarely on pharmacy benefit managers (PBMs) and insurers, which are siphoning off a growing share of total drug spending.
asserted
which → fall → spending
Inflation-adjusted net drug prices — the average sum retained by drug companies after accounting for the rebates and discounts they offer to PBMs, insurers, hospitals, and others in the drug supply chain — fell in 2025 for the eighth year in a row.
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they → adjust → row
But most patients and employers scarcely believe that statistic.
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patients → believe → statistic
To them, it often feels like prices just keep rising.
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prices → feel → them
That’s because PBMs and insurers keep taking advantage of an opaque, convoluted supply chain to shift costs onto patients and their employers.
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PBMs → ’ → patients
A recent House Oversight Committee investigation identified more than 1,000 instances in which PBMs pushed patients toward more expensive medicines — which come with larger secret rebates for the PBM — over cheaper alternatives.
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which → identify → alternatives
Simply put, many patients really are paying more.
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patients → put → more
But middlemen — not drug companies — are the ones pocketing that increase.
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middlemen → pocket → increase
Pharmacy benefit managers and insurers have engaged in a savvy public relations campaign to obscure this reality, absolve themselves of blame, and inaccurately shift blame onto drugmakers’ patenting practices instead.
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managers → engage → practices
Just last week, the heads of the PBM and employer-sponsored health plan lobbies argued in these pages that pharmaceutical patents are “driving up costs” for Americans.
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patents → sponsor → Americans
They wrongly asserted that the Hatch-Waxman Act — the four-decade-old law that guarantees new brand-name drugs a limited period of regulatory exclusivity, but also streamlines the approval of generic drugs — is “broken.”
asserted
that → assert → drugs
They inaccurately allege that brand-name drugmakers are patenting multiple components of their medicines to create “patent thickets” that unfairly prevent cheaper competitors from reaching the market.
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that → allege → market
These claims ignore the facts: America boasts the highest generic drug utilization rate in the developed world.
uncertain
America → ignore → world
Nine out of every 10 prescriptions in the United States are filled with generics.
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prescriptions → fill → generics
Savings from generics and biosimilars totaled almost $500 billion in 2025 alone.
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Savings → total → 2025
The mere fact that drug companies — like all other industries — often file numerous patents to protect their various discoveries from premature copycatting also doesn’t prove foul play.
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companies → file → play
The U.S. Patent and Trademark Office and the Food and Drug Administration have found no clear relationship between the number of patents associated with a brand-name medicine and the length of time it takes for generic competitors to arrive.
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competitors → find → time
Ignoring these key facts, the PBM and insurer lobbies are pushing Congress to pass the Eliminating Thickets to Increase Competition (ETHIC) Act.
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lobbies → ignore → Act
This bill would limit the number of patents that drug companies can assert during infringement lawsuits.
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companies → limit → lawsuits
In effect, it would block companies from protecting research discoveries that the U.S. Patent and Trademark Office has confirmed are novel, useful, and non-obvious.
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Office → block → discoveries
Developing a new medicine is a highly complex process where scientific and regulatory uncertainty mean that only 1 in 10 are ultimately approved by the FDA.
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10 → develop → FDA
The R&D process can take 10 to 15 years and cost billions of dollars.
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process → take → dollars
Patent protections give companies and investors an incentive to take those risks — by ensuring that rivals won’t be able to immediately copy the fruits of that research and sell it as their own.
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rivals → give → own
Making valid patents harder to enforce weakens R&D incentives, including the incentive to continue to research medicines after FDA approval, which often leads to new indications in completely different diseases or stages of disease, as well as easier-to-administer forms and longer-acting versions of medicines.
asserted
which → make → medicines
Patients and policymakers have every right to be angry about the often unaffordable cost of medicines.
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Patients → have → medicines
But they shouldn’t fall for PBMs’ and insurers‘ blame game.
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they → fall → game
Weakening the patent system would do little to make medicines cheaper — but it would deter lifesaving research, while letting middlemen off the hook for driving up patients’ costs.
asserted
it → weaken → costs
The Aporia
