In a moment that may redefine the future of medicine pricing and access, Roche CEO Thomas Schinecker recently made a statement that reverberated across the healthcare industry: it would be “very easy” to cut US medicines prices by 50%, if only it could eliminate the middlemen.
Roche plans to bypass the powerful but controversial pharmacy benefit managers (PBMs) entirely, going direct-to-patient backed by a staggering $50bn investment. This is not just an economic shake-up. It is a healthcare revolution, one that holds vital lessons for global medicines access, particularly in Africa.
PBMs were once meant to streamline healthcare by negotiating lower medicines prices and managing formularies for insurers and employers. But over time they evolved into bloated middlemen, extracting nearly half of the total medicines spend while offering zero therapeutic value.
They invest nothing in research, bear no manufacturing risk, and profit from complex rebate systems that obscure real prices. The result is a system where patients — especially those with chronic or rare diseases — often face medication prices that are arbitrarily inflated and painfully out of reach.
While the names are different, the dynamics in many African countries are alarmingly similar. Instead of PBMs, a web of importers, wholesalers and distributors mark up medicine prices at every step, often adding 100%-500% to the base cost before the medicine ever reaches a patient.
In regions already struggling with limited healthcare infrastructure, these markups can be deadly. Patients unable to afford basic antibiotics or hypertension treatments are pushed towards informal markets, where counterfeit and substandard medicines are rampant.
This isn’t just a pricing issue; it’s a public health crisis and patient safety issue. Across Africa fake medicines contribute to the deaths of about 500,000 people each year, a likely underestimation.
SA has taken meaningful steps to combat this problem, having introduced a single exit price (SEP) policy and a centralised procurement model that eliminated excessive price variability. This approach established a system where medicine prices are fixed at the point of sale from the manufacturer or importer.
The SEP is the maximum price at which a manufacturer or importer may sell a medicine to all private sector buyers, whether pharmacies, hospitals or doctors. It was introduced as a regulatory mechanism designed to control medicine prices and ensure greater transparency, consistency and fairness in the pharmaceutical market.
It applies to all prescription medicines sold in the private sector and has become a key component of SA’s strategy to improve access to affordable, quality-assured medicines. Ultimately the SEP removes the ability for intermediaries to inflate prices arbitrarily, while giving the government greater leverage to negotiate better deals directly with pharmaceutical companies.
The result has been a significant improvement in the affordability and availability of essential medicines in both the public and private sectors.
What Roche and other pharma giants are now doing in the US mirrors this logic. The only difference being that it is driven by the private sector. Eli Lilly has already started selling Zepbound directly to consumers. Pfizer has launched PfizerDirect. Novo Nordisk is also moving towards a consumer-facing model.
Roche’s $50bn commitment is more than just a corporate play. It is an investment in owning the supply chain, controlling logistics, gathering outcome data and reclaiming pricing autonomy. These companies are betting that removing middlemen isn’t just profitable; it is essential to surviving the next phase of pharmaceutical commerce.
This shift could not be more urgent. Whether you’re in Johannesburg, Dakar or Detroit, the access problem is more than about only science. It is also about supply chains. Medicine affordability is not just a matter of innovation; it is also a matter of distribution.
Layers of non-value-adding intermediaries have turned life-saving medications into luxury items for millions. Eliminating these layers and replacing them with regulated, transparent and efficient systems could be the most important action governments and companies can take to ensure health equity.
SA’s reforms show what’s possible when public policy confronts the markup economy head-on. The proposed US pharma pivot highlights that even market-driven solutions can align with access goals when incentives are structured around value and transparency. Together, they offer a playbook for how other African nations and countries worldwide can rethink medicine pricing from the ground up.
While not perfect, SA has become a reference model for other countries, especially in Africa, that are seeking to improve medicine affordability by cutting out price-inflating intermediaries.
What Roche is planning to do is not just a business strategy. It is a direct challenge to a system built on opacity and rent-seeking. This move can be considered a first shot in a war against unjustified markups, inflated prices and a model that has for too long prioritised profit over patients.
In Africa, that results in a large number of patients accessing medicines through cheaper informal markets. Access to unsafe medicines is no access at all. African nations should pay attention and follow suit.
• Hwenda is founder and CEO of Medicines for Africa.
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