James Carville, a longtime adviser to former President Bill Clinton, coined the phrase, “It’s the economy, stupid,” to capture voters’ anxiety about their personal finances, jobs, and the cost of living. That same anxiety exists today, and employers, employees, and patients are looking for relief.
Right now, far too many Americans are being priced out of the medications they need. After years of rampant healthcare inflation, employers, workers, and patients are feeling the strain. In the private employer marketplace, where more than 160 million people receive their healthcare benefits, Mercer projects that the average total health benefit cost per employee will rise around 6.5% in 2026. That’s the largest increase in more than a decade. Those costs will come in the form of higher premiums, steeper deductibles, and rising out-of-pocket burdens for workers and families, with drug prices being a prominent feature of that increase. Today, more than 24 cents of every premium dollar goes toward prescription drugs.
The good news is that Congress does not need to start from scratch when addressing drug prices. Concrete, bipartisan solutions are already on the table to reduce patent abuse, encourage more rapid development and approval of lower-cost generics and biosimilars, and spur greater accountability from pharmacy benefit managers. And with stakeholders across the spectrum all demanding change, lawmakers have the opportunity to act now to make a real difference.
IS CHEAPER BETTER IF IT KILLS CANCER CURES?
Enacting patent reform that puts patients ahead of profits
America’s drug research and development system is the envy of the world and has made possible treatments that save and improve lives. But for some brand-name drug companies, that “risk and reward” approach is becoming all reward — leaving consumers to foot the bill. Over the past two decades, drug manufacturers have exploited patent processes to extend monopolies far beyond what Congress envisioned. Under patent law, companies get a period of exclusivity to recover the costs of bringing drugs to market. Originally, biologics were granted 12 years of exclusivity while brand-name drugs were provided 20 years.
Using and abusing patent law, drug companies have deliberately gamed the patent system to reset the clock and extend the market exclusivity of patented drugs. This has also allowed brand-name manufacturers to profit again and again while blocking more affordable competition. Data show that between 2005 and 2015, 74% of drug patents issued were for drugs already on the market. And in another study, of the roughly 100 bestselling drugs, nearly 80% obtained additional patents to extend their monopolies.
In an era where soaring prices are plaguing constituents at the gas pump, the deli counter, and the pharmacy, lawmakers are looking to ease the pain. One solution being advanced is the Eliminating Thickets to Increase Competition Act or the ETHIC Act (H.R. 3269). The legislation, which has bipartisan support in the House and Senate, limits the number of patents or patent claims a drug company can make. This requires them to make the best case, rather than flooding the courts with multiple lawsuits — a practice often employed to drown generic manufacturers in costly litigation that keeps affordable options from coming to market. The bill ensures that the brand-name manufacturer has their “day” in court, as opposed to “endless days” in court.
Beating back high prices with biosimilars
Patent reform is one step, but lawmakers should pursue solutions across the drug system to boost competition and lower costs. That includes taking steps to ensure continued investment in the market for affordable biosimilars.
Data suggests that biosimilars — the lower-cost alternatives to brand-name biologic drugs — are among the most immediate opportunities to make drugs more affordable. A 2025 federal report found that biosimilars generated $12.4 billion in savings in 2023 alone, with total savings since 2015 totaling nearly $36 billion.
ERIC was an early leader in recognizing the potential of biosimilars to increase affordability. In 2020, ERIC launched a groundbreaking initiative with Johns Hopkins University to better understand the role biosimilars could play in reducing healthcare costs. Similarly, according to ERIC’s most recent PBM fiduciary report, if Humira has a list price of $84,000 per year, an 85% discounted biosimilar alternative would cost around $12,600. That would save a patient roughly $14,200 in annual copay.
Although biosimilars offer proven savings, overly complex interchangeability, or “switching study” requirements, have slowed their widespread adoption. The Biosimilar Red Tape Elimination Act (H.R. 5526) aims to end delays. The bipartisan legislation would immediately deem FDA-approved biosimilars as interchangeable with their brand-name counterparts and eliminate redundant “switching study” requirements. The change will streamline approval, boost competition, and reduce drug prices. The changes would also empower pharmacists to substitute lower-cost biosimilars at the pharmacy counter, potentially saving patients hundreds while upholding safety standards.
Advancing “FAIR” PBM fiduciary reform
Patent reform and biosimilar legislation can improve the marketplace, but employers and patients still need access to affordable options. While employers and employees alike cheered the inclusion of PBM reform in the final Consolidated Appropriations Act of 2026, employers still lack a complete picture of affordable drug options for their employees and families. That is because, despite enormous influence over plan spending, PBMs are not held to the same fiduciary standards as other plan service providers. The PBM Fiduciary Accountability, Integrity, and Reform (FAIR) Act (H.R. 6837) would change that by clarifying that the Employee Retirement Income Security Act’s fiduciary standards apply fully to PBMs acting on behalf of employer health benefit plans.
To put that in plain terms: PBMs would be legally required to act in the best interest of plan sponsors and the workers they serve. This is a common-sense reform with growing bipartisan support that would hold PBMs to the same standards as employers.
It’s time to act on these worthwhile reforms. A 2025 national survey conducted by Fabrizio Ward found that more than three in four voters say it is very important for Congress to act to reduce prescription drug prices. This represents a striking level of national support across party and demographic lines.
HOW CONGRESS CAN DELIVER HEALTHCARE AFFORDABILITY AND MITIGATE INFLATION REDUCTION ACT DISASTER
If Congress does not act, costs will continue to rise, eroding employer-sponsored coverage. It’s time to seize on this growing political momentum and advance patent reforms, accelerate generics and biosimilars approvals, and enact PBM fiduciary requirements.
James Carville’s 1992 assessment of the American voter wasn’t wrong. And it holds true today. Time changes, but pocketbook concerns do not. What was “the economy” then is “affordability” now. The 2026 midterm elections are approaching fast. Lawmakers still have urgent work to do to turn affordability and access from promises into reality.
James Gelfand is the President and CEO of The ERISA Industry Committee.