Polling by the Value of Care Coalition shows that when it comes to decisions about their health care, patients trust doctors (82%) — not government boards and panels (1%). If an option were included for “government officials in foreign countries,” it’s not hard to imagine they would fare worse. Unfortunately, legislators at the Florida Capitol are debating whether to allow foreign drug pricing decisions to influence American health care.
Senate Bill 1158 and House Bill 697 propose a radical shift in how Floridians access medicine, attempting to institute what’s known as international reference pricing, or “most favored nation,” for prescription drugs.
The concept seems simple: legislators would direct Florida to benchmark the cost of medicines to prices paid in a set of foreign countries. In reality, this is incredibly concerning as this move would import foreign price controls directly into the Sunshine State without regard for how those countries handle patient access or clinical value.
Shortcuts, Not Patient Solutions
International reference pricing assumes that a drug’s value is the same in Tallahassee as it is in a health care system thousands of miles away. But we know that other countries have very different health care systems than in the United States, with different goals. While we value access to innovative treatments, they focus on low-cost treatments that may be dated. While we value individualized treatment, many of the countries Florida would reference use a one-size-fits-all approach. Finally, many foreign countries use metrics like “Quality-Adjusted Life Years” (QALYs) — controversial benchmarks that discriminate against people with disabilities and the elderly by assigning a lower “value” to their treatments. By tying Florida’s drug reimbursement to such benchmarks, the state risks adopting the same delays or denials that patients in other countries often face.
As we’ve seen with state-based Prescription Drug Affordability Boards (PDABs) and federal government price negotiations, government-led health care decisions often prioritize top-line budgets over patient outcomes. Concerns have been raised by stakeholders throughout the health care supply chain:
- One-fifth of community pharmacies reported that they would not stock drugs subject to upper payment limits in Medicare due to reimbursement concerns, and another two-thirds said they might not participate, raising the risk of pharmacy access deserts.
- Health plans say they will increase premiums and out-of-pocket costs for patients and that access to impacted drugs may be restricted if upper payment limits are implemented.
- Doctors warn of greater administrative burdens that cut into time spent treating patients, and of patients being switched off their treatments when insurers adjust coverage to comply with upper payment limits — disruptions that can result in worse health outcomes.
- According to a 2025 study, Medicare patients saw their out-of-pocket costs rise by an average of 32% for drugs subjected to federal price caps, known as Medicare’s maximum fair price. Early reviews of 2026 plans suggest this trend is continuing.
Accountability Matters
Accountability gaps arise when unelected boards or bureaucrats get between patients and their doctors.
Recent survey research shows 93% of specialist physicians are concerned about people unaffiliated with a state medical board making decisions that may hinder patient access to needed medications. The Florida legislation goes a step further, offshoring accountability to foreign value assessments, governments with centralized price controls, and health systems that accept the policy tradeoffs resulting in delayed or no access to new treatments and less access to existing treatments. Unfortunately, that leaves little recourse for a Florida patient desperate for a treatment that manages their condition.
Focus on Patient-Centered Health Care Policy
Real affordability for patients comes from relief at the pharmacy counter, the hospital, and the doctor’s office, not from apples-to-oranges comparisons that jeopardize medical innovation and patient choice. Government officials in foreign countries should not dictate patient care in Florida. Rather, policymakers should consider patient-centered public policy that prioritizes individual needs and the value of care right here at home.