Working in public health has given me a front-row seat to how hard it has become for Iowa families to simply stay healthy. I’ve spent years volunteering with mobile clinics and nonprofit groups, meeting people who are blocked at every turn by pharmacy benefit managers. These PBMs sit between patients and their prescriptions with zero transparency.

It’s heartbreaking to stand in a mobile clinic and watch a patient walk away without the medication their doctor prescribed because a PBM denied it or pushed a different, higher-priced drug. I’ve seen patients end up in the ER over issues that could have been prevented with the right medication at the right time.

That’s why proposals like the Most Favored Nation pricing idea worry me. MFN doesn’t address the daily barriers created by PBMs here at home, and it won’t stop them from pocketing rebates that should help patients.

If Congress wants to make progress, real reform has to start with PBMs. The PBM Reform Act could finally rein in practices that hurt patients. For the families I meet in clinics across Iowa, that would mean a chance at getting healthy again.