Lower Drug Costs and the Horizon of Well-being for NHOPI Communities

To understand the potential impact of this policy, we must first examine the health challenges facing NHOPI/NHPI — Native Hawaiian and (Other) Pacific Islanders. Here are some key figures.
- Diabetes: In 2018, Pacific Islanders were 2.5 times more likely to be diagnosed with diabetes and 2.5 times more likely to die from it compared to non-Hispanic whites, for example.
- Cardiovascular Health: In 2014, NHOPI individuals were 10% more likely to be diagnosed with coronary heart disease than non-Hispanic whites.
- Stroke: NHPI adults were nearly four times more likely to experience a stroke and 30% more likely to die from such events.

These health disparities exist within a complex socioeconomic context. In 2022, 13.5% of non-Hispanic NHOPI families lived in poverty (compared to 5.9% of non-Hispanic white families). Health insurance coverage also differs significantly: 11.5% of non-Hispanic Pacific Islanders lacked health insurance (versus 5.3% of non-Hispanic whites). While slightly more NHOPI individuals (38.4%) were covered by Medicaid or public health insurance than non-Hispanic whites (36.1%), fewer had private health insurance (60.3% versus 74.1%).

An additional challenge is how health data is collected. Information specific to NHOPI communities is often limited, with federal agencies frequently aggregating data for Asian American, Native Hawaiian, and other Pacific Islander populations. In fact, more disaggregated data is needed to understand the particular health needs across the dozens of distinct island groups within the NHOPI designation: Communities that collectively speak over one hundred different languages and dialects, incuding Hawaiian, Hawaiian Pidgin, Samoan, Marshallese, CHamorro, Chuukese, Pohnpeian, Kosraean, Yapese, Carolinian and Palauan.

The new federal initiative introduces a "Most-Favored-Nation" (MFN) approach to address prescription drug costs. The policy aims to correct an imbalance where the United States, representing a small fraction of the global population, bears approximately three-quarters of worldwide pharmaceutical profits.
The policy narrative suggests pharmaceutical manufacturers offer substantial discounts in foreign markets while maintaining higher prices in the U.S., effectively making American consumers subsidize lower costs elsewhere. This executive order seeks to give Americans access to the MFN price: The lowest price a manufacturer charges for a given drug in comparable developed nations.

The Secretary of Health and Human Services is responsible for communicating these MFN price targets to manufacturers and developing enforcement plans if substantial progress isn't made.

An MFN pricing model could alleviate some of the economic pressures associated with managing chronic health conditions prevalent in NHOPI communities. For those living with diabetes, heart disease, or recovering from stroke, the cost of lifelong medications often constitutes a sizable portion of household budgets. Reducing these costs might improve adherence to prescribed treatments, thus leading to better management of these conditions and mitigating their long-term severity.

Consider diabetes: with NHOPI individuals facing a 2.5-fold higher likelihood of diagnosis, the collective cost of insulin, oral medications, and supplies imposes a considerable burden. A policy that successfully reduces these expenses could mean fewer difficult choices between vital medicines and other necessities.
Similarly, for conditions like asthma, where Native Hawaiians/Pacific Islanders were 30% more likely to experience the condition than non-Hispanic whites in 2014, more affordable pricing for inhalers and treatments could enhance daily well-being and potentially reduce emergency healthcare episodes.

The path from policy announcement to health equity is rarely straightforward. The success of this drug pricing initiative for NHOPI communities depends on factors beyond pharmacy prices. For, medicine access remains a complex issue. Even with lower medication costs, persistent obstacles related to healthcare availability — such as transportation challenges, geographic distribution of healthcare facilities (particularly in U.S. territories like Guam, American Sāmoa, where stroke mortality rates are double the national average), and culturally appropriate care — require ongoing attention and proper communication methods.

In 2022, approximately 40.3% of non-Hispanic Native Pacific Islanders aged five and older spoke a language other than English at home, and 11.8% described their English proficiency as less than "very well". Therefore, ensuring information about adjusted drug prices, available treatments, and support programs is communicated in linguistically clear and culturally meaningful ways is essential. Dedicated language services transform from a convenience into a cornerstone of effective healthcare delivery.

The policy execution details — how MFN prices are calculated and maintained, and how these savings flow through insurers and pharmacy benefit managers to benefit patients — will be crucial to its success, as the executive order mentions facilitating direct-to-consumer purchasing programs for manufacturers who adopt MFN pricing, an avenue worth exploring further.

The effort to lower prescription drug expenses through an MFN strategy holds potential for easing the financial burden of healthcare for NHOPI populations. Given the higher incidence of certain chronic conditions within these communities, more affordable access to medications could contribute to improved health management and outcomes.

However, realizing this potential requires a broader support ecosystem. It demands continued efforts to dismantle healthcare barriers, refine and update data collection methods — such as surveys in native languages — for clearer understanding of specific community needs, and champion health services that become accessible, culturally appropriate.

The journey ahead involves recalibrating pharmaceutical economics and sustained dedication to health justice, while ensuring policies conceived nationally can meaningfully impact the diversity that make up the US nation. The conversation about how these new pricing paradigms will genuinely touch the lives and well-being of NHOPI individuals is just beginning, hopefully steering us toward a future where health equity becomes reality rather than aspiration.