While governments across the world have been negotiating drug prices for quite some time, this approach is pretty groundbreaking for the U.S. As one would expect, this change has sparked a huge debate — will the creation of this taxpayer-funded drug negotiation infrastructure be a failed experiment, or will it become the standard for the future of drug pricing in this country?

One CEO of a pharmacy benefit manager says it’s the latter.

“I think that once that infrastructure gets created, it’s going to get very difficult to undo it,” said Jason Borschow, president and CEO of Abarca Health. 

“Even the biggest PBMs have no solution for these drugs that have no competition. And so who’s going to make the determination? We should find that balance where the government negotiation is limited to drugs that have no competition, and we allow the private markets to have more flexibility around determining what’s best for their area and for their region. That’s my hope,” Borschow said.

Borschow also declared that the U.S. healthcare system is designed to push high list prices for drugs. Rebates give pharmaceutical supply chain participants more opportunities to create margin, and that gives way to price disparities.

“And so the question everybody’s asking is: where are the differences in those dollars going? Are they going to people’s pockets, or are they benefiting the right people?” Borschow asked.

His PBM, along with other upstarts like EmsanaRx and CapitalRx, are trying to bring more transparency to the drug pricing process by showing clients the net cost of prescriptions. Borschow and other founders of PBMs looking to disrupt the space think that clearly showing pharmacies and patients each step of the pricing process — from the list price to the price a patient pays — will be of critical importance as drug pricing strategy evolves over the next few years.