AAFA Calls for Comprehensive Reform to Make Medicines Accessible and Affordable for All

Washington, DC, May 15, 2025 (GLOBE NEWSWIRE) — The Asthma and Allergy Foundation of America (AAFA) appreciates the President’s Executive Order calling attention to America’s persistent problem of unaffordable prescription medicines. Our research tells us that high cost remains a primary barrier to treatment for people with asthma. However, we are deeply concerned that the proposed Most-Favored-Nation (MFN) pricing framework—while well-intentioned—fails to address the underlying complexities of the U.S. drug pricing ecosystem and risks creating unintended consequences that could restrict access for patients who rely on life-saving medications.  

“Comparing the U.S. pharmaceutical system to those of other nations oversimplifies the reality of how drugs are developed, priced, and distributed in this country,” said AAFA President and CEO Kenneth Mendez. “The U.S. has a unique health care infrastructure with many more stakeholders—including insurers, pharmacy benefit managers (PBMs), employers, and government programs—each influencing the cost patients ultimately pay. Applying international pricing models without reshaping this entire ecosystem ignores critical inefficiencies and misaligned incentives that continue to drive high costs.”  

Asthma medications are often used to illustrate the drug cost problem in the United States. Despite being developed decades ago, many inhalers remain costly in the U.S., often priced multiple times higher than in other high-income countries. These inflated prices are not only the result of manufacturer pricing, they reflect a complicated network of patent protections, limited competition, and opaque rebate structures that benefit stakeholders other than patients. Pegging U.S. prices to international benchmarks won’t fix all the access issues.  

President Trump issued an Executive Order on May 12, 2025 that aims to reduce drug pricing by requiring drug manufacturers to offer American consumers “the most-favored-nation lowest price”.  

The good: 

Similar to the 2024 price caps on several inhalers in the U.S., the proposed MFN pricing framework focuses policy attention on drug pricing. There is broad, bipartisan agreement that people should have access to life-saving drugs and they should be affordable. The MFN approach intends to address the unfair pricing of drugs in the U.S. compared to other high-income nations.  

The bad: 

The U.S. health care system is complex, and pushing on one lever to reduce costs may unintentionally increase costs to patients by other mechanisms. Without addressing all of the root causes, policies like MFN risk reducing availability or shifting costs elsewhere in the system, which could delay access or limit options for patients. The pharmaceutical industry has indicated that MFN drug pricing may lead drug manufacturers to reduce investment in the United States. 

The ugly: 

The MFN framework does not address other factors that influence drug pricing. And unfortunately, the Trump Administration’s own policies – including cutting key programs for people with asthma and other chronic diseases at the Department of Health and Human Services – raise serious concerns about the Administration’s approach to improving health for patients. To meet the objectives of the President’s budget, House Republicans are proposing massive cuts to Medicaid which threaten to reduce or eliminate access to care for millions of Americans. Medicaid doesn’t just cover prescriptions; it also supports proven, cost-effective interventions such as home-based asthma care that can reduce environmental triggers and improve health outcomes. These services can help people with asthma rely less on medications in the first place. Undermining that support while promising savings on drugs reflects a fragmented approach that ultimately fails patients. 

To truly lower drug prices while preserving innovation, we need structural reform. That means bringing all stakeholders to the table—manufacturers, payers (government, commercial, and private), providers, patient groups, employers, and policymakers—to develop a comprehensive strategy that addresses systemic barriers to affordable prescription drugs. We must hold each party accountable while also ensuring that new policies do not delay or limit access to essential treatments for people with chronic and life-threatening conditions like asthma and allergies.  

Other factors that influence drug pricing in the United States:  

PBM formularies, incentives and rebates: PBMs determine which drugs are covered and at what cost to patients, often prioritizing higher-cost medications due to rebate structures that benefit PBMs and employers rather than patients. AAFA supports reforms that decouple PBMs from pharmacy operations, as seen in Arkansas, to reduce conflicts of interest and increase transparency. AAFA also supports ensuring that rebate savings are passed directly to patients, prioritizing their access to more affordable medications rather than increasing profits for intermediaries. 

Medicare Drug Price Negotiation: Medicare gained limited authority to negotiate drug prices in 2022 under the Inflation Reduction Act. The program allows the Centers for Medicare & Medicaid Services (CMS) to negotiate prices for select high-cost medications under Medicare Part D and Medicare Part B (starting in 2028). The program has negotiated 10 drugs to date with 15 drug negotiations underway. AAFA is supportive of the initiative’s aim to lower costs for beneficiaries but concerned that formulary changes or stricter utilization management could unintentionally restrict patient access to essential medications, including asthma treatments. We urge CMS to implement strong oversight to prevent such unintended consequences and to ensure that negotiated prices do not inadvertently lead to reduced coverage or higher out-of-pocket costs for patients. 

Generic Drug Access: While generic drugs offer lower-cost alternatives, barriers to access persist due to restrictive PBM formularies, patent extensions, and market exclusivity tactics that delay competition. For instance, generic Flovent, a common asthma inhaler, is not consistently covered despite being more affordable, leaving patients to navigate complex and costly formularies. Additionally, ‘pay-for-delay’ agreements can prevent lower-cost options from entering the market. AAFA urges reforms that mandate formulary transparency, enforce patent reform to prevent anti-competitive practices, and streamline regulatory pathways to accelerate generic approvals. 

Drug Price Caps: Price caps, such as those on inhalers and epinephrine, provide relief on patients’ out-of-pocket costs, but fail to address underlying cost drivers. While AAFA supports efforts to lower patient costs through price caps, not all patients can benefit from them as they vary by state, by product, and often exclude individuals on public insurance programs like Medicaid or Medicare. AAFA supports comprehensive reforms that address the entire supply chain, from manufacturers to PBMs, to ensure sustained affordability and broader access. 
 
High-Deductible Health Care plans: High-deductible health plans (HDHPs) are increasingly common, but they often leave patients with substantial out-of-pocket costs for essential medications. For people with asthma and allergies, limited pharmacy benefits can mean paying the full price for life-saving treatments until deductibles are met. AAFA supports covering the cost of prescription drugs outside a plan deductible, allowing preventive medications, including asthma and allergy treatments, to be accessible without financial barriers. 

AAFA’s focus is on making treatments for asthma and allergies affordable and accessible to all. We urge the Trump Administration and Congress to take comprehensive, collaborative steps to deliver sustainable relief for patients.

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About AAFA  
Founded in 1953, AAFA is the oldest and largest non-profit patient organization dedicated to saving lives and reducing the burden of disease for people with asthma, allergies, and related conditions through research, education, advocacy, and support. AAFA offers extensive support for individuals and families affected by asthma and allergic diseases, such as food allergies and atopic dermatitis (eczema). Through its online patient support communities, network of regional chapters, and collaborations with community-based groups, AAFA empowers patients and their families by providing practical, evidence-based information and community programs and services. AAFA is the only asthma and allergy patient advocacy group that is certified to meet the standards of excellence set by the National Health Council. For more information, visit: aafa.org and kidswithfoodallergies.org 

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