The pharmaceutical industry's multi-year legal campaign to block Medicare from negotiating lower drug prices hit a dead end last week when the Supreme Court refused to hear appeals from six major manufacturers. But the fight is far from over—it has simply moved to Capitol Hill.
Drugmakers including AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Novartis, and Novo Nordisk had asked the justices to strike down the 2022 law that ended a two-decade ban on government price talks for Medicare. The court's denial leaves intact a series of lower court rulings that found no constitutional right for companies to charge the federal government—the world's largest buyer of prescription drugs—whatever they want.
For years, Medicare was uniquely barred from negotiating prices, a prohibition written into law by industry lobbyists. No other sector of the economy enjoyed such protection. As a result, American patients paid far more for brand-name drugs than patients in other wealthy countries where governments routinely bargain for lower costs.
When Congress finally ended that sweetheart deal, drugmakers filed more than a dozen lawsuits. Judges appointed by both Republican and Democratic presidents consistently rejected their arguments. The Supreme Court's decision not to intervene signals that the industry's legal theory never gained traction.
But the policy battle is just getting started. The Pharmaceutical Research and Manufacturers of America spent nearly $38 million on lobbying in 2025, a 22% increase from the prior year. A top priority is the EPIC Act, which would extend the exemption for small-molecule drugs—about 90% of prescriptions—from nine to thirteen years, delaying their eligibility for negotiation.
The industry has already scored one legislative win: last year, Congress exempted multi-use orphan drugs from negotiation, a move costing taxpayers an estimated $8.8 billion. That giveaway shows pharma can still buy influence on the Hill even when it loses in court.
For patients like Judy Aiken, a 72-year-old retired nurse from Portland, Maine, the Supreme Court's decision means the lower price she now pays for Enbrel will continue. Before negotiation, her monthly cost exceeded $7,000; now it's about $2,300—a 67% reduction. She had rationed her medication and postponed home repairs. Now, she says, she has hope.
Aiken is one of 9 million Medicare beneficiaries benefiting from negotiated prices this year. Prices for the first ten drugs fell by an average of 62%, putting $1.5 billion back in patients' pockets and saving taxpayers $6 billion. A second round covering 15 more drugs will help another 5.3 million Americans in 2027, and a third round is already underway. By the end of the decade, up to 60 high-cost drugs will be subject to negotiation.
The courts have refused to give pharmaceutical companies a permanent carve-out. Congress should follow suit. As Merith Basey, CEO of Patients For Affordable Drugs, argues, patients in every other wealthy country already get the medications they need at negotiated prices. Americans deserve the same—and the law that delivers it must be protected and expanded.
