After the Midterms: Healthcare Affordability Is Pharma's Story for the Next Two Years
Congress is set for the next two years. You can read the politics anywhere. This is not that piece.
Aaron Uydess
Impact Partner & Founder
Key takeaways
Affordability won the midterms, and it will be the healthcare debate for the next two years. 58% of voters were very concerned about healthcare costs. Whether or not a bill passes, the hearings and headlines will shape what patients, caregivers and HCPs ask about your brand.
Price is becoming a public number, and the question is being answered in search and AI. Medicare negotiation, MFN deals, PBM pass-through and TrumpRx each put a findable dollar figure next to a brand name. 40 million Americans a day already ask ChatGPT about healthcare. If your brand doesn’t answer the cost question, someone else does.
Three moves before Q1 closes. Build an affordability layer that machines can read and run it through every channel. Make the DTP decision on your terms, owned by marketing. Arm the field to answer “I saw it costs X online” with the next step.
The midterms are over. Congress is set for the next two years, and the Associated Press has called both chambers for the Democrats. You can read the politics anywhere. This is not that piece.
This piece is about one thing the exit polls made impossible to ignore: healthcare affordability decided votes, and it will decide what pharma marketing, sales and DTP teams are asked to answer next. That is the issue Washington will spend the next two years debating, loudly, whether or not any of it becomes law. For commercial leaders, the debate itself is the event. It changes what patients search for, what caregivers ask AI assistants, and what HCPs get asked in the exam room.
Here is what we know, three predictions on where it goes, and three things to do about it now.
What we know
Affordability was the vote. In the NBC News national exit poll, 58% of voters said they were very concerned about the cost of healthcare, and 54% said current policy had made their costs worse. KFF's October tracking poll had health costs tied with gas as the top economic worry, with voters trusting Democrats nearly two to one to handle it. That is a mandate, and it will be spent.
The starting line matters, because the next two years build on what already happened in 2026:
Coverage. The enhanced ACA subsidies expired December 31, 2025. KFF estimated subsidized enrollees would see their premiums more than double. The House passed a three-year restoration in January; it died in the Senate.
Drug pricing. Two tracks now run at once. The IRA's third negotiation cycle is the first to include Part B drugs and to revisit previously negotiated prices, with 2028 prices due from CMS by November 30, 2026. In parallel, most-favored-nation deals have produced pricing concessions from 16 manufacturers.
The middle. PBM reform is already law. The February 2026 appropriations act mandates full rebate pass-through and flat service fees in place of price-linked compensation. And TrumpRx launched in February as a government-run front door that routes cash-pay patients to manufacturers' own direct-to-patient sites.
Read those three together and the pattern is clear. Price is becoming visible, the middle is being squeezed, and direct-to-patient is now federal infrastructure.
Three predictions for 2027 and 2028
These are predictions about what gets debated and surfaced, not what gets signed. A divided government stalls bills. It does not stall headlines, hearings, or the questions patients bring to their phones.
1. Affordability legislation moves first, and fast. Subsidy restoration is the obvious opening bill because the House already passed it once. Expect it to be followed by proposals to widen Medicare negotiation to more drugs on shorter timelines, and by hearings on the PBM vertical-integration question that February's law left open. Some of this gets vetoed. All of it gets covered, and coverage is what shapes patient expectations.
2. Price becomes a public number. Negotiated Medicare prices, MFN prices, TrumpRx cash prices, and rebate pass-through each put a published dollar figure next to a brand name. For the first time, many brands will have a findable price. When a price is findable, it gets found, compared, and quoted back to the HCP.
3. DTP stops being a pilot. The federal government now operates a direct-to-patient storefront at TrumpRx.gov, and a patient who clicks on Zepbound there lands on LillyDirect. That sets the expectation. Any brand with a cash-pay, underinsured, or high-deductible population will be asked by patients, by HCPs, and eventually by payers why it does not have a direct path. The question shifts from should we to why haven't we.
Where the affordability question actually gets answered
The Washington debate matters because of where it lands: in a search box. Patients, caregivers and HCPs are asking "how much does this cost" and "is there a cheaper way to get it" before they ask anyone in a white coat.
The numbers are not subtle. Rock Health found that 32% of U.S. consumers used AI for health information in 2025, double the prior year, and 74% of them used general-purpose tools like ChatGPT rather than anything a provider or payer built. OpenAI reports more than 40 million Americans ask it healthcare questions daily, with 1.6 to 1.9 million messages a week on insurance, billing and cost-sharing. A SingleCare survey put it at 46% of adults who have asked an AI tool about a medication.
So what. Every one of those sessions is a brand conversation the brand is not in. If your affordability answer is buried in a PDF, locked behind a co-pay enrollment form, or simply absent, the model answers with GoodRx, Cost Plus Drugs, a Reddit thread, or a competitor's direct program. The HCP then hears that answer secondhand, from a patient holding a phone.
That is the real shift of the next two years. The price conversation is leaving the exam room and the hub, and moving to search and AI. Brands that publish a clear, structured, honest answer to "what will this cost me" will be the ones the models cite. The rest will be explained by someone else.
Three moves to make before Q1 closes
First, build an affordability layer that machines can read, and run it through every channel. One page per brand that states the list price, the cash price, the co-pay program terms, and the patient assistance path in plain language with structured data behind it. Not a disclaimer. An answer. This is an omnichannel job, not a web job. The same answer has to show up in DTC media, in the rep's iPad, in the hub script, in HCP eMail, and in the DTP storefront, in the same words. For most brands that means modifying the existing content strategy, because today the price story lives in three places and matches in none of them. Then test it the way a patient would: ask three AI assistants what your drug costs and see who they cite.
Second, make the DTP decision in Q1, on your terms. Decide whether your brand needs a direct path, what it would cost, and what it would carry. Treat it as a commercial strategy decision that belongs to marketing, with market access and patient services at the table, not a market access project that marketing hears about later. The companies that wait will make this decision in reaction to a competitor's launch or a payer's question, which is the worst possible moment to design a channel. If you already have a program, pressure-test whether it can absorb the volume a public price will send it.
Third, arm the field to answer the price question in the room. Reps and MSLs are about to hear "I saw it costs X online" far more often. They need a sanctioned, consistent, honest answer that connects the published number to the path the patient should take. A field team that deflects the cost question loses the visit. One that answers it with the next step keeps it.
None of these require Congress to pass anything. They require a decision to prepare for the conversation that is already happening.
Let's talk about your brand
The next two years will reward the teams that treated affordability as a strategy instead of a compliance line. If you want to know how these three moves apply to your portfolio, let's spend 25 minutes on it. It is not a pitch. It is a conversation about the question keeping you up at night and what to do about it before the first hearing.
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About Kairos Meridian
Kairos Meridian provides pharma strategy, marketing, and analytics in service of impact… with a dose of innovation. We serve as the senior, independent partner for pharma brands, for vendors that sell into them, and for the private equity firms making decisions about pharma-related assets.
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Forbes: Midterm election results, Democrats sweep House and Senate (Nov 4, 2026)
Healthcare Dive: ACA premiums could rise 114% if enhanced subsidies lapse (KFF analysis)
Fierce Pharma: Trump administration rolls out 15 more drugs for IRA price negotiations
Sidley: Congress passes significant federal PBM reform (Apr 9, 2026)
FOX 32 Chicago: TrumpRx list expanded again and tops 800 drugs
Remap Consulting: TrumpRx in focus, implications for pharma manufacturers (Mar 30, 2026)
Becker's Hospital Review: 40 million Americans use ChatGPT for healthcare (OpenAI report)
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