Californians Deserve Greater Drug Transparency

Prescription drugs are a crucial part of California's healthcare system, costing commercial health plans and Medi-Cal billions of dollars each year. As that spending continues to rise, patients need greater clarity about how medicines are promoted and priced, and about the commercial relationships that support the information they receive.

California has taken steps to improve transparency, but patients still struggle to see the full picture. In 2024, California's commercial health plans spent $14.9 billion on prescription drugs, while Medi-Cal spent $19.4 billion in the 2024-25 fiscal year. Californians should, therefore, be able to understand how medicines are promoted, how their prices are determined and what financial relationships may sit behind the information they receive.

The Golden State has already recognized this problem. It has introduced drug-price reporting requirements and, more recently, strengthened oversight of pharmacy benefit managers (PBMs). There is, however, a strong case for going further, particularly where commercial relationships or complex pricing structures can leave patients with an incomplete picture. After all, it is their health and their lives at stake.

One of the most pervasive issues is misleading pharmaceutical marketing, which can shape how patients understand treatments and make decisions about their health, especially when dealing with serious or unfamiliar conditions. Such marketing does not necessarily involve an outright falsehood. Information can be factually accurate while still creating a misleading overall impression if benefits are prominent but risks, limitations or other material information are harder to find.

In September 2025, the FDA announced a renewed enforcement drive, sending thousands of warning letters and approximately 100 cease-and-desist letters to pharmaceutical companies over deceptive advertising.

This enforcement is particularly important for Californians, and indeed Americans across the country, who may depend heavily on information supplied by manufacturers and patient organizations when navigating serious or rare conditions.

Pfizer $PFE's Vyndamax highlights advocacy and funding transparency in ATTR-CM

Patients dealing with unfamiliar, serious conditions may depend heavily on materials supplied by manufacturers. Pfizer's marketing of Vyndamax (tafamidis) for ATTR-CM, a serious and rare heart disease, offers one useful example of the wider transparency question.

Pfizer's Vyndamax materials direct patients toward advocacy organizations, including Amyloidosis Support Groups (ASG), which stresses that, with rare diseases, "knowledge is truly power". Patient advocacy groups have questioned whether some promotional claims fully reflect the treatment options now available to patients. In particular, concerns have focused on language presenting Vyndamax as the "only" once-daily capsule for ATTR-CM, which advocates argue may make patients think they have fewer treatment options than they do. Separately, Pfizer's historic disclosures show that it provided $50,000 in support to Amyloidosis Support Groups, Inc. in 2016.

That funding was disclosed by Pfizer, however, the point is that patients should be able to see such relationships clearly and in context, without having to search through old corporate records while seeking guidance about a rare and serious disease.

The same transparency problem appears in a different form when it comes to drug pricing.

California's insulin pricing case against PBMs, $LLY, $NVO and $SNY

In 2023, California Attorney General Rob Bonta sued insulin manufacturers Eli Lilly, Novo Nordisk and Sanofi, alongside PBMs CVS Caremark, Express Scripts and OptumRx. The state alleged that the companies used unlawful, unfair and deceptive practices that contributed to artificially high insulin prices. More than three million California adults have been diagnosed with diabetes, making the consequences particularly significant for the state.

California's complaint alleged that manufacturers raised insulin list prices while PBMs negotiated large rebates in exchange for giving those products favorable placement on lists of covered medicines. According to the state, this meant the list price visible to patients could be much higher than the amount ultimately paid after rebates.

This gap matters most for patients who have to pay all or part of the list price themselves. Uninsured and underinsured Californians, along with people on high-deductible health plans or with gaps in coverage, can therefore face particularly high out-of-pocket costs.

California has made progress, but there is still more to do

Despite all of this, California has not been passive. Its Prescription Drug Cost Transparency Program requires manufacturers to report information on new drugs and qualifying list-price increases. In 2025, AB 116 expanded the state's transparency efforts by requiring HCAI to collect cost information from PBMs. Governor Gavin Newsom also signed SB 41, prohibiting PBM spread pricing and requiring manufacturer rebates to be passed through to health plans, among other reforms.

California can build further on the progress it has made. Although prescription-drug advertising is mainly regulated at federal level, the state can act when commercial conduct misleads consumers. The stated should also enforce its existing false-advertising and consumer-protection laws when patients are given misleading information.

In very simple terms, Californians should be able to see who is funding the information they receive, what a medicine can and cannot do, and how its price was reached. Transparency is not an argument against innovation, it is a basic part of protecting patients.