Breaking the System That Broke Us – Inside Solving the US Drug Conundrum

In Solving the US Drug Conundrum, authors André Wencker and Pascal Orliac take on a herculean task: explaining the U.S.’s wildly overpriced pharmaceutical system and outlining a credible path to fixing it. With clarity, passion, and a firm grasp of global healthcare policy, they succeed in delivering one of the most vital and timely books on healthcare reform today.

At the center of their message is a powerful indictment of Big Pharma and PBMs (Pharmacy Benefit Managers). Using extensive research from U.S. congressional reports and global health economics studies, the book exposes how these entities have systematically gamed the patent system to delay competition. According to the authors, top-selling drugs in the U.S. have been blanketed with patent thickets—an average of 74 active patents and 140 applications per drug. This tactic blocks generics and biosimilars, keeping prices sky-high for years beyond the original patent’s expiration.

Equally damning is their analysis of the PBMs, intermediaries that supposedly lower costs but instead profit from opaque rebate systems and formularies that prioritize revenue over patient care. The book discusses how even life-saving biosimilars are denied access to formularies due to rebate deals with original manufacturers. These are not accidental inefficiencies; they are deliberate strategies, and the human cost is immeasurable.

But Wencker and Orliac are not content with outrage alone. They present two core solutions: a constitutional right to healthcare and Reference-Based Pricing (RBP) based on international drug pricing. Together, these reforms could end reliance on PBMs altogether and realign U.S. drug pricing with global norms. Drawing inspiration from Oregon’s progressive policies, the authors make a convincing case that meaningful change is both necessary and within reach.

The timing of the book’s release is poignant. Coming just days after the killing of UHC CEO Mike Thompson—whose company owns one of the three PBMs scrutinized in the book—the event became a flashpoint for public anger. The lack of sympathy for the victim revealed the depth of resentment toward a system widely viewed as exploitative. This book taps into that moment, explaining why the outrage exists and where it can lead.

All in all, Andre Wencker and Pascal Orliac have delivered more than criticism through the pages of their book—they give readers a plan. It is their rigorous analysis that has provided grounded in hard data; their comparisons with Europe are illuminating, and their solutions are achievable. For policymakers, healthcare professionals, and citizens alike, this is essential reading. It’s time we stop treating high drug prices as a mystery and start solving the conundrum once and for all.