Patients pay too much for prescriptions. The government can’t fix it alone.

Patients are getting hit with prescription bills they can’t afford. When the surprise comes at the pharmacy counter, a third of Americans are walking away because of cost. A more affordable option may exist, but without knowing what their options are, patients can’t act on it.

Making it easier for patients to shop their prescriptions brings transparency and competition, but a list of cash prices only goes so far. Patients also need to know what the same drug costs through their insurance, across pharmacies, and today that number is the one they can’t get.

The federal government is working to give patients the right to access their prescription price and coverage information. Then, companies like Photon can turn it into choices patients can use. That’s why we went to Washington.

Photon Goes to Washington.

On Monday, October 5th, the administration dropped the final Transparency in Coverage rule, and we were invited to be in the room for it. The question of the day was how to make prices available and useful before patients decide where to receive care. That question is not new. In the near future, we want it to include price transparency for prescriptions.

Transparency 1.0 

Hospitals and insurers have been required to publish their prices for years. Many of them did, in the way my kids "clean" their room; everything from trash to treasure piled up in a heap and shoved into a hiding place where one is too horrified to dig through. The insurer files were enormous, duplicative, and full of ghost rates: negotiated prices for services the provider never actually performs, published anyway so the file looks complete. Just enough to pass inspection, not enough to be useful to a human. Until now.

What the Final Rule Changes

The new rule tightens the standard. Plans and insurers will have to attest to their data’s accuracy and completeness, reduce duplication, exclude unlikely provider-service combinations, and disclose more out-of-network data. If patients can’t find what they need, beginning January 1, 2027 they can ask their plan for a cost-sharing estimate by phone. An estimate tells them what they may owe; it isn’t a guaranteed final bill. CMS explains the changes and their timing here. 

These changes matter because the people building price-comparison tools need information they can reliably use to help patients understand their options before they choose care.

What the Data Showed

The most interesting part of the day was the stats shared from the stage:

• In one city, with one insurer, for one MRI, the price ranged from $350 to $3,000 (Dr. Oz).
• In 60% of cases, the rate insurers negotiated with hospitals was higher than the hospital’s own cash price (RFK Jr.).
• Denver employers paid twice as much for emergency care at one facility, with no difference in outcomes, and one of California's most expensive hospitals had its lowest quality scores (Elizabeth Mitchell, Purchaser Business Group on Health).

These examples concern hospital care, but they illustrate why seeing a price matters. Patients need a way to understand whether a more affordable option is available at the same level of quality care.

"The Tip of the Spear"

The moment of the morning belonged to FTC Chairman Andrew Ferguson. Speaking at the event, Ferguson said the agency has sent letters to major hospital systems across the country: demanding they publish truthful prices, or "we will find you and fine you." He called the FTC the tip of the spear and pointed to its lawsuits involving pharmacy benefit managers as one example of its price-transparency enforcement. 

Prescriptions, You're Next

We flew home thinking about the next step: a Prescription Drug File. Federal guidance says development of the file’s technical format begins in November 2026 with release expected around May 2027. Plans and insurers subject to the requirement are expected to begin publishing drug prices by December 2027. 

We like that timeline, because it rides on things this administration has already been loud about: PBM reform and TrumpRx. Drug prices are the one place patients already shop, already compare, and already get burned. A file that shows what the plan pays, what the pharmacy charges, and what you hand over at the counter is going to be very educational for everyone. Very.

We've been building for that world since day one. With Photon, patients receive a secure link to compare price, stock, and delivery options across pharmacies before the prescription is routed. The prescription never changes, but the prices and options certainly do. The number patients can’t always see is what their insurance would charge them, across different pharmacies, and that is the number the 2027 drug file finally puts on the table.

Why We Care

Transparency isn't a feature we bolted on. It's the heart of our business and the entire platform we built. Photon only wins when patients win, and patients win when the price is on the table before the decision, not after.

Government, health plans, PBMs, pharmacies, pharma and companies like Photon all have a role working toward the same goal: helping patients get the medication they need at a price they can afford. The time has come for the government to set and enforce meaningful transparency requirements. And for the rest of us to make that information useful for patients.

Prescription drugs, we'll see you in 2027. Patients are counting on us.