Beyond the Midterms: Why Pharmacy Reform Must Remain a Priority

As the 2026 midterm elections approach, healthcare policy remains a significant topic of discussion. While political priorities may shift depending on the outcome, one issue deserves continued attention regardless of which party holds control of Congress: the rising cost and complexity of prescription medications. 

For years, prescription drug affordability has been a recurring theme in Washington. Administrations on both sides of the political aisle have acknowledged the challenges of the U.S. pharmaceutical system, from escalating costs to limited pricing transparency. Yet translating that recognition into meaningful, sustainable reform has proven difficult. 

Recent developments suggest that efforts to address these challenges are moving beyond discussion. The question now is whether that momentum can be sustained. 

From Conversation to Action 

The current administration has placed renewed emphasis on prescription drug pricing, pursuing initiatives designed to challenge longstanding pricing structures and increase transparency across the pharmaceutical supply chain. 

These efforts have included executive orders addressing drug pricing, proposals involving most-favored-nation pricing, and initiatives focused on government-funded healthcare programs such as Medicare and Medicaid. 

At the same time, Congress has taken steps toward pharmacy benefit manager (PBM) reform, including legislation intended to increase transparency and address certain compensation practices. 

These developments represent important movement in an area where change has historically been complicated and incremental. 

However, acknowledging progress does not mean the underlying challenges have been resolved. 

The pharmaceutical system involves manufacturers, wholesalers, PBMs, insurers, pharmacies, and other intermediaries. Each plays a role in how medications are priced, distributed, and ultimately paid for. Changing one part of that system can create consequences throughout the rest. 

Meaningful reform requires understanding those complexities rather than expecting any single policy or initiative to provide a complete solution. 

The Difference Between Policy Announcements and Lasting Reform 

Executive actions can establish priorities, direct federal agencies, and accelerate certain initiatives. But their authority has limits, and some policy changes may be revised or reversed by future administrations. 

Congressional legislation can establish more durable requirements and provide a broader foundation for structural reform. 

That distinction becomes particularly relevant as the midterm elections approach. 

A change in congressional leadership could influence which healthcare proposals receive attention, how existing initiatives are implemented, and what additional legislation moves forward. 

But regardless of the political landscape, the underlying issues remain. 

Opaque pricing arrangements, complicated rebate structures, administrative inefficiencies, and limited visibility into the true cost of medications continue to create challenges across the pharmacy system. 

Addressing these issues requires more than political agreement that prescription drugs are expensive. It requires continued examination of how the system operates, where financial incentives may be misaligned, and what changes can produce measurable results. 

The Conversation Must Extend Beyond Government Programs 

Much of the recent national discussion around prescription drug pricing has focused on Medicare, Medicaid, and other government-related initiatives. 

While these efforts are significant, they represent only part of the broader pharmacy landscape. 

Employers sponsoring self-funded health plans face their own challenges in managing prescription drug expenditures while supporting employee access to necessary medications. 

For these organizations, pharmacy spending can represent a substantial and unpredictable component of overall healthcare costs. 

And while changes to federal programs may eventually influence broader market dynamics, employers cannot assume that government pricing initiatives will automatically translate into lower costs for their health plans. 

This makes it especially important for employers, brokers, and benefits consultants to continue evaluating pharmacy arrangements, questioning traditional pricing models, and seeking greater visibility into where healthcare dollars are going. 

Pharmacy reform should not be viewed exclusively through the lens of government programs. Its implications extend to employers, families, and the broader healthcare system.

Progress Shouldn’t Depend on Election Results 

The upcoming elections will determine the composition of the next Congress, but they will not change the fundamental need for a more transparent, accountable, and sustainable pharmacy system. 

The challenges facing prescription drug spending are not new, nor are they exclusive to one administration or political party. 

Recent executive initiatives and legislative developments have helped keep pharmacy pricing and PBM practices in the national conversation. Maintaining that attention is essential. 

For policymakers, the next phase should focus on evaluating the effectiveness of existing initiatives, identifying remaining gaps, and pursuing practical solutions that address the structural drivers of prescription drug costs. 

For employers and their advisors, the work continues regardless of what happens in Washington. 

Understanding pharmacy expenditures, evaluating existing arrangements, and exploring alternative approaches remain critical components of responsible healthcare cost management. 

Keeping the Focus Where It Belongs 

Pharmacy reform is not a single policy, a campaign promise, or an issue that can be resolved within one election cycle. 

It is an ongoing effort to improve a complicated system that affects millions of Americans and the organizations responsible for supporting their healthcare needs. 

At SHARx, we believe greater transparency, accountability, and innovation are essential to creating a more sustainable approach to prescription medication access and spending. 

As the political landscape evolves, the focus should remain on what matters most: meaningful progress that improves medication access, reduces unnecessary expenditures, and creates lasting financial impact. 

Because regardless of who wins in November, the need for pharmacy reform isn’t going anywhere.