I spent over two decades watching this system get built from the inside, so to many of us, the recent class action lawsuit against Express Scripts isn't a surprise, it's a reckoning that's been a long time coming.

If we actually want to lower what people pay at the pharmacy counter, we need transparency, accountability, and real guardrails on the gatekeepers who control access to medicines. I negotiated inside this system for years. The math doesn’t lie — and until we fix how the money flows, patients will keep paying the price.

Here is why there will be little impact, even if many more manufacturers agree to negotiate. Most patients will not see an impact from the price concessions since these agreements are for Medicaid patients and patients without insurance. Medicaid patients comprise around 24% of the US population and the uninsured comprise around 9%. These two deals do not impact the two largest healthcare populations in the US: insured and Medicare patients.