When Drug Policy Headlines Overpromise: What Sounds Like Reform but Isn’t

Every year, a few drug policy headlines make the rounds that sound like big wins. And every year, we see stakeholders scramble to respond, only to find that the impact is… a little less transformative than promised. 

When Headlines Overpromise 

Here are a few: 

“List prices are going down.” Sounds great, but unless net prices and benefit designs change too, patients might not feel a difference. We’ve seen benefit plans with lower WACs but higher cost sharing due to design misalignment. 

“Step therapy is being limited.” Often true in narrow regulatory contexts, but operational workarounds remain. Plans may simply shift requirements or redefine first-line agents to preserve utilization controls. 

“Transparency legislation passed.” Useful in theory, but data availability doesn’t always translate to usable insight. Much of the transparency data is messy, lagged, or so high-level that it’s hard to act on. 

“PBM reform is happening.” Yes—but what counts as reform varies wildly, and not all of it fixes root problems. Narrow definitions may focus on disclosure without touching rebate pass-throughs or network spread. 

Why These Gaps Matter 

Policy wins aren’t bad. But they’re often partial. And the work of drug policy strategy is understanding where real change is happening, where it isn’t, and how to plan accordingly. 

Sometimes, a policy win shifts the narrative without shifting the incentives. Sometimes, it changes the paperwork without changing patient experience. And sometimes, it really does matter, but requires a lot more follow-up work than the headline suggests. 

Helping Organization See What Comes Next 

We help clients pressure test their assumptions about what a policy change will do in their context for their formularies, their vendor partners, and their patient populations. Because responding to the headline is easy. Responding to what comes next is the real work. And often, that’s where the value is won or lost. 

Stop reacting to headlines. Start shaping your response before they land. Let’s talk about how we can help your organization move from policy noise to operational clarity.