10 Questions Health Leaders are Asking about the Great Healthcare Plan — and What It Means for Cost and Coverage

Get clear, expert-backed answers to the biggest questions surrounding the Great Healthcare Plan, with insights from Emma Wager of KFF and industry experts including Jeffrey Casberg, Lindsay Bealor Greenleaf and Luke Greenwalt. This FAQ breaks down what proposed changes to drug pricing, PBMs, subsidies and insurance coverage could mean for your organization — and what to watch as policies take shape.

By Briana Contreras | Original Article

As policymakers continue to outline what has been described as a “Great Healthcare Plan,” health systems and payers are trying to understand what it could mean for coverage, drug pricing and overall costs. Prescription drug prices are still a major concern for many stakeholders, and federal efforts to reform pharmacy benefit managers (PBMs) and other middle players have gained support from both parties.

FAQ 1: What is the "Great Healthcare Plan"?

The Great Healthcare Plan is not a fully developed policy but rather a collection of goals and ideas aimed at lowering healthcare costs, according to Emma Wager, senior policy analyst for the Program on the Affordable Care Act (ACA) and Peterson-Kaiser Health System Tracker at KFF. Wager said many of the plan’s objectives, such as lowering drug prices and insurance premiums, include some policy proposals, though their effectiveness remains uncertain.

The White House has described the plan as a broad effort to reduce drug prices, lower insurance premiums and increase transparency across the healthcare system. Proposals include tying U.S. drug prices to those in other countries, shifting certain subsidy payments directly to consumers and expanding price disclosure requirements for insurers and providers, as well as reforms targeting pharmacy benefit managers.

FAQ 2: Which parts of the plan could move forward soon?

Some elements of the plan already exist in current policy or have been implemented in the past. According to Wager, the ACA already requires insurers to report claims denial data and provide clear coverage summaries. Previous administrations have also used existing authority to advance price transparency requirements.

Wager added that certain proposals, such as most favored nation (MFN) drug pricing, have already seen early action through negotiations with drug manufacturers. However, broader changes to existing law would require congressional approval.

FAQ 3: What is “most favored nation” drug pricing?

MFN drug pricing is a policy approach that aims to align U.S. prescription drug prices with those paid in other comparable countries, particularly in Europe, according to experts who spoke in a Managed Healthcare Executive (MHE) webinar focusing on the state of the pharmacy market held in January 2026.

Under this model, if a drug’s price in the U.S. is higher than an international reference price, manufacturers could be required to provide rebates or lower prices in programs such as Medicare or Medicaid. The goal is to reduce drug spending by benchmarking against lower global prices, though implementation details remain complex, the experts shared.

Jeffrey Casberg, RPh, M.S., senior vice president of clinical pharmacy at IPD Analytics and a member of the MHE editorial advisory board, was one of the experts participating in the webinar. Casberg said the real-world impact of MFN policies is still uncertain, noting that “the savings are kind of unclear with the MFN so far,” and it remains to be seen whether payers or consumers will see meaningful cost reductions.

FAQ 4: Why is it difficult to compare U.S. drug prices with other countries?

Comparing U.S. drug prices with those in other countries is difficult because the systems used to set prices are fundamentally different. In many countries, governments directly set or tightly control drug prices based on how they assess a drug’s value. In the U.S., prices are largely determined through negotiations among manufacturers, insurers and pharmacy benefit managers.

Another key challenge is that U.S. prices are often reported as list prices, which do not reflect the rebates and discounts that lower the actual, or net, price. Lindsay Bealor Greenleaf, head of Federal and State Policy at ADVI Health, said during an MHE and American Journal of Managed Care webinar in March 2026 that “comparisons are based off of list prices, not accounting for rebates and discounts most of the time,” making cross-country comparisons less accurate.

Countries also differ in how they balance price and access. Some accept lower prices by limiting access or delaying availability of certain drugs, while the U.S. often provides faster access to new therapies at higher upfront costs, according to a report from USC Schaeffer Center for Health Policy & Economics.

FAQ 5: What role do pharmacy benefit managers play in drug pricing?

PBMs act as middlemen between insurers, drug manufacturers and pharmacies, according to KFF. They negotiate rebates and price discounts with manufacturers, design formularies and manage utilization and payment rules.

These activities have drawn growing attention from policymakers and sparked calls for

reform. PBMs can also directly affect what patients pay and overall drug costs, making them a key part of discussions about affordability and transparency.

FAQ 6: Could direct-to-consumer drug purchasing become more common?

Some experts have said drug makers may sell medicines directly to patients in certain cases, a model that could expand as the Trump administration promotes efforts like Trump RX to offer more direct access to lower-cost drugs. KFF noted that giving patients more ways to obtain medications aligns with federal goals to increase competition and transparency, though the long-term impact on costs and access remains unclear, especially for high-cost or specialty drugs.

However, adoption could be limited. Luke Greenwalt, MBA, vice president and lead U.S. thought leadership at IQVIA and member of the MHE editorial advisory board, said during the January webinar that these programs depend on whether manufacturers can offer prices patients are willing to pay out of pocket.

Experts in the webinar also suggested direct-to-consumer models could work best for high-demand or lower-cost drugs, such as GLP-1s, but are less practical for specialty or oncology treatments.

Greenleaf also noted that these models may improve transparency but are unlikely to replace the broader system.

FAQ 7: Could the Great Healthcare Plan affect insurance coverage and affordability?

It’s still unclear how the plan would affect coverage and affordability, particularly for people enrolled in ACA marketplaces.

“There are very few details about many of the policies listed in the Great Healthcare Plan, making it difficult to evaluate how each would work in practice,” Wager said, adding that proposals related to redirecting subsidies lack key information, including who would qualify and how payments would be structured.

FAQ 8: What challenges could affect how the plan is implemented?

A major challenge is the lack of detailed policy design. According to Wager, without clear information about eligibility, funding levels and program structure, it is difficult for stakeholders to assess feasibility or prepare for implementation.

A KFF analysis published in January 2026 reinforces this uncertainty, noting that key details of the proposal remain unclear, including how subsidies would be distributed and whether funds could be used for non-ACA-compliant coverage. Analysts warned that some approaches could raise premiums or destabilize ACA markets, particularly if healthier individuals move to alternative plans, potentially leaving people with pre-existing conditions with fewer coverage options.

FAQ 9: Could drug pricing reforms affect innovation?

Drug pricing reforms could have an impact on innovation, especially as multiple policies are layered together. Green mentioned that efforts such as most-favored-nation pricing and Medicare drug price negotiation may add financial pressure on manufacturers, particularly when combined with other policies like the Inflation Reduction Act.

She said these changes could create a “concerning tipping point” for investment in future treatments, including cancer, rare disease and Alzheimer’s therapies. While the full effects are still unclear, experts in the webinar suggest stakeholders are watching closely to see whether these policies slow the pace of new drug development over time.

FAQ 10: What should health systems and payers watch next?

Health systems and payers should watch for areas where there is growing alignment between the Great Healthcare Plan and proposals already under discussion in Congress, according to Wager.

“Several provisions have emerged in both the Great Healthcare Plan and in the variety of plans proposed in Congress in the debate over enhanced premium tax credits, which indicate broad interest across both branches of government,” she said. “These include proposals that could shift funding directly to individuals, an approach that may resemble Health Savings Accounts (HSAs) or similar models aimed at using consumer choice to reduce overall spending.”

She also suggested that changes to ACA subsidies that could shift toward more direct financial support for folks should be monitored, as key details remain unclear. In addition, Wager noted that PBM reform and price transparency efforts continue to draw bipartisan support, signaling a higher likelihood that these policies could move forward.

This FAQ was approved for accuracy by Wager.