Pharmacy benefit managers (PBMs) and pharmaceutical companies have been locked in a battle over the cost of prescription drugs for years. PBMs, third-party companies that administer prescription drug benefits for health insurers, argue that they are working to reduce drug costs for patients. Pharmaceutical companies, conversely, say that PBMs are using their market power to extract excessive rebates from drugmakers, which are passed on to patients through higher prices.

When patients go to the pharmacy to fill a prescription, they are often told that their insurance company won’t pay for the medication unless a physician obtains approval.  Patients may even wait days, weeks, or months for a necessary test or medical procedure to be scheduled because physicians must obtain similar authorization from an insurer. This tactic, used by insurance companies to control costs, is called prior authorization.

Patient advocates on Tuesday blasted the Biden administration’s refusal to compel the manufacturer of a lifesaving prostate cancer drug developed entirely with public funds to lower its nearly $190,000 annual price tag. The drug’s development was 100% taxpayer-funded. Yet a one-year supply of Xtandi currently costs $189,800 in the United States.

Since the 1930s, the National Institutes of Health has invested nearly $900 billion in the basic and applied research that formed the pharma and biotech sectors. 75% of so-called new molecular entities with priority ratings (the most innovative drugs) trace their existence to NIH funding, while companies spend more on “me too” drugs.

Fewer than half of Americans rate the quality of U.S. health care as excellent or good. Only 12% say it is handled extremely or very well. Americans have similar views about health care for older adults. The public gives even lower marks for how prescription drug costs, the quality of care at nursing homes, and mental health care are handled, with just 6% or less saying those health services are done very well in the country. Can it ever be improved?