April 16, 2026
The Honorable Bill Cassidy
Chairman
U.S. Senate Committee on Health, Education, Labor and Pensions
Washington, DC 20510
The Honorable Bernie Sanders
Ranking Member
U.S. Senate Committee on Health, Education, Labor and Pensions
Washington, DC 20510
Dear Chairman Cassidy, Ranking Member Sanders, and Members of the Committee,
On behalf of National Taxpayers Union (NTU), the nation’s oldest taxpayer advocacy organization, we commend the committee for holding a hearing entitled “Making Medicines More Affordable: How Competition Can Lower Drug Prices.” Ensuring prescription drugs remain affordable is essential to controlling the growth of U.S. health care spending and limiting the burden federal health programs impose on taxpayers. We urge the Committee to focus on solutions that allow competitive markets to expand access to affordable medicines, rather than bureaucratic interventions that distort price signals and risk limiting innovation.
It’s important for policymakers to recognize that the U.S. already benefits from a strong pharmaceutical ecosystem. Nearly 90% of all blockbuster drugs are available to patients, and more than 90% of prescriptions are filled via generics, both of which serve taxpayers well. This balance of access and affordability means that government health care programs benefit over the long term from drug breakthroughs that reduce costly hospital stays and other treatments, and benefit over the nearer term from the price competition that generics provide. Lawmakers should tread carefully before enacting shortsighted reforms that risk jeopardizing this delicate balance.
There is ample evidence that prices decline as more competitors enter the market for a given drug. Public policy should, therefore, focus on removing regulatory barriers to entry that keep manufacturers from bringing their drugs to market. To this end, NTU is part of a coalition that has announced support for the Biosimilar Red Tape Elimination Act. This practical reform to the Food and Drug Administration would eliminate a costly and duplicative regulatory hurdle for biosimilar manufacturers and ensure more therapies reach the patients who need them.
More often than not, government intervention in the pharmaceutical space ends up raising prices or causing shortages for patients. Nowhere is this more apparent than in trade policy. Tariffs on pharmaceuticals and their associated ingredients, such as those announced earlier this month using the Section 232 national security tariff authority, would ironically imperil national security by raising production costs for domestic drug manufacturers. As NTU has noted, U.S. drug developers benefit tremendously from resilient supply chains. The prospect of extending these import taxes to generics at a later point would do little more than limit choice for patients. More recent hearings in other committees have also sounded the alarm about impurities in foreign Active Pharmaceutical Ingredients, which many U.S.-based generic manufacturers utilize in their products. While policing these substances is a legitimate concern, overreaction through heavy import taxes or bans will only harm the development of generic competition.
The biggest risk to affordability comes when lawmakers attempt to ignore market signals and manipulate prices themselves. Setting drug prices below the cost of research and development doesn’t lead to increased efficiency, it simply discourages private investment in medical innovation. It’s no coincidence that pharmaceutical firms have already discontinued 26 drugs and 56 research programs since the enactment of the Inflation Reduction Act’s drug price negotiation program, which effectively functions as a government-mandated price control. And, because some drugs falling under coercive negotiation have generic equivalents under development but not yet marketed, there can be a strong deterrent effect on private investment in generics as well.
Most-Favored-Nation (MFN) drug pricing initiatives will similarly result in shortages that harm patients and taxpayers alike. By tying Medicare and Medicaid’s drug reimbursement to prices set in European health systems that rely heavily on government mandates instead of market competition, MFN effectively imports foreign price controls that result in delayed patient access to new therapies. This would only further exacerbate the burden federal health programs impose on taxpayers by increasing reliance on expensive hospital stays and other treatments that could be avoided with access to effective drugs.
Making prescription drugs more affordable doesn’t require importing the failed policies of countries that ration care and limit treatment options for patients. It simply requires getting government out of the way and establishing a clear and predictable policy framework. The Working Families Tax Cuts enacted last summer offers a clear illustration of this dynamic: by permanently codifying tax rules that incentivize manufacturers to make capital investments, the U.S. is now witnessing a pharmaceutical manufacturing boom, one which hopefully won’t be cut short by other counterproductive policies toward generics, biosimilars, or branded drugs.
We encourage the Committee to focus its attention on the structural drivers of high drug costs. Singling out drug manufacturers with price controls while leaving other actors such as pharmacy benefit managers, insurers, and hospitals out of comprehensive, balanced policy solutions will not produce the outcomes that patients and taxpayers need going forward.
Sincerely,
Alex Ciccone
Policy and Government Affairs Manager
National Taxpayers Union