Massachusetts is a national leader in healthcare, home to cutting-edge hospitals and life sciences research. But for all our medical breakthroughs, families across the Commonwealth are being crushed under the burden of prescription drug prices. Despite industry marketing that paints Big Pharma as benevolent innovators, the truth is that Massachusetts residents are paying too much for the medications they need to survive, and the status quo is unsustainable.
According to the Kaiser Family Foundation, nearly one in four Americans struggle to afford their prescription drugs. A 2023 Healthcare Cost Institute study found that the average annual cost for common specialty and chronic condition medications exceeded $18,000 per patient in Massachusetts—higher than almost anywhere in the nation. It’s no surprise that some Bay Staters report skipping refills, splitting pills, or delaying care, jeopardizing their health and wellbeing. For small businesses, soaring drug prices make it harder to offer competitive health benefits to workers, straining our innovation economy at its core.
Too often, pharmaceutical companies try to shift the blame, targeting pharmacy benefit managers (PBMs) with slick ad campaigns and lobbying dollars. Yes, PBMs are “middlemen.” But acting as if they are responsible for high drug prices ignores the elephant in the room: the pharmaceutical industry itself, which has raised brand-name drug prices by an average of 31% over the past five years, far outpacing inflation and wage growth. Just last year, the 10 largest drug companies collectively reported over $110 billion in profits, even as patients rationed insulin and cancer therapies.
Over-regulating the negotiating power of PBMs would hand that power to drug manufacturers—who face little-to-no competition on many life-saving medications. PBMs currently save Massachusetts employers, unions, and public programs billions each year by pushing back on pharmaceutical price hikes and leveraging rebates. PBM-negotiated discounts lowered prescription-related medical costs by as much as 50% and saved the average insured consumer $1,154 per year. Without them, patients and payers would absorb the full impact of unchecked pharma pricing.
PBMs must be more transparent and accountable in their practices. The concern isn’t theoretical. Ask any diabetic in Springfield who spends hours each week fighting to untangle formularies, or the cancer patient in Worcester forced into mail-order plans or suddenly denied a preferred pharmacy.
Integrated care models, many pioneered here, show what’s possible. When insurers, doctors, and PBMs collaborate, patients get better coordination, fewer errors, smoother refills, and healthier lives. But none of this works if sky-high drug prices, dictated by monopoly power, undermine access at every point.
Lawmakers must stand up to Big Pharma’s misinformation and reject false choices. We can both regulate PBMs and protect their ability to negotiate. We can strengthen independent pharmacies and leverage market competition to keep costs down. Most critically, we can break the myth that high prices are just the cost of innovation, when the evidence shows drug companies spend more on marketing and stock buybacks than on research and development.
When the General Court next debates prescription affordability, our test should be simple. Will the policy put patients first, or preserve profits? Massachusetts families are counting on leadership that demands more—transparency, accountability, and affordable medicines for all.
It’s time to build a smarter, fairer system. Massachusetts can, and must, show the nation how.
Anne Brensley is CEO of FX WiseRisk.
