In a recent podcast, Robert F. Kennedy Jr. made the following observation:
“At CMS, the Trump Administration recently published the Transparency and Coverage 2.0 proposed rule. It requires health insurers to show patients the actual cost of care upfront, so you can see the cost before you receive it.”
It is worth watching (2:41 minutes, link). I consider this a genuine turning point. Price transparency in medical care is a good start.
The move toward price transparency in healthcare—allowing patients to know costs upfront and compare options—is genuinely good news. It is long overdue and clearly points in the right direction. I have been thinking about this issue for years, particularly with respect to drug pricing, but often hesitated to raise it because it exposes uncomfortable truths and invites predictable resistance.
Still, the logic cannot be ignored.
If a drug has been approved as “safe and effective,” and a physician writes a valid prescription, a simple question must be asked: why is a pharmacy effectively the only place a patient is allowed to buy it? Why must a packaged chemical substance be handed to the patient exclusively through a government-approved intermediary, operating from a specific facility, with massive markups that add no intrinsic value to the product?
At its core, this arrangement runs directly against free-market principles, which promote freedom of choice and competitive pricing. Pharmaceutical products are not sold under these principles. Instead, access is tightly controlled, competition is suppressed, and prices are inflated by design.
At its core, a medicine is a chemical substance—a molecule, a compound, or a defined combination thereof. If we are serious about understanding, controlling, and assuring the quality of such substances, the relevant discipline is chemistry. Pharmacies and pharmacists dispense medicines; they do not define chemical identity, purity, stability, degradation pathways, or manufacturing specifications. Dispensing is not a science. Chemistry is.
To illustrate the problem, consider an analogy. When you buy fuel for your car, the person at the pump is not a chemist or chemical engineer—and does not need to be. They are not responsible for refining gasoline, determining its octane rating, or controlling its molecular composition. Those responsibilities belong to chemists and manufacturers operating under defined specifications. The attendant simply transfers the product. No one argues that fuel must be sold only through licensed “fuel engineers” at protected prices to ensure safety. Yet in medicine, we accept precisely this logic.
In practice, a physician—who typically lacks in-depth training in drug development, chemical synthesis, formulation, stability, and quality control—writes a prescription, and the patient is then forced into a tightly controlled retail channel. The patient is not free to obtain that medicine from any qualified supplier capable of meeting clearly defined chemical specifications. Information is withheld under the guise of “scientific jargon,” much of which neither pharmacists nor medical practitioners are trained to fully understand, as it is rooted in chemistry.
Competition is restricted, access is limited, and prices explode—without any corresponding improvement in safety or quality.
Ironically, one could argue that quality standards enforced by centralized authorities and retail distribution chains—often relying on pharmacopeial shortcuts—are weaker than those achievable through direct chemical manufacturing under rigorous specification control. I have discussed extensively on my blog the serious limitations of pharmacopeial testing frameworks such as USP (link). The claim that the current system primarily exists to protect quality, and by extension, safety, does not withstand scrutiny.
This arrangement would be considered absurd in almost any other domain. When people buy food—arguably genuine health products—they are free to choose suppliers, compare prices, and assess quality. No mandatory middleman controls access or enforces price markups. Yet in medicine, the distortion is treated as normal—and even necessary.
The result is a market warped by regulatory protection and artificial scarcity, where drug prices rise not because of science, chemistry, manufacturing costs, or intrinsic value, but because distribution is bureaucratically controlled.
Price transparency in healthcare services is a good beginning. True reform means opening the door to real competition, including direct-to-consumer access from qualified manufacturers. If a product meets well-defined chemical and quality standards, patients should not be forced to pay excessive premiums to intermediaries that add no scientific rigor or improvement in quality—and should be free to choose their supplier.
My message to policymakers is straightforward: if transparency is the goal, apply it fully. Remove unnecessary barriers. Allow genuine competition. Let science—chemistry—define safety and quality, not protected distribution networks.
The impact would be immediate: relief for patients, improved efficiency, stronger quality control, and a sharp, natural decline in drug prices. True reform does not end with transparency.
It begins there—and then challenges the structures that inflate costs without justification.