Affordability is shaping up to be the defining issue of the 2026 midterm elections. In swing states and battleground districts, voters consistently rank the cost of living, and prescription drug prices in particular, among their top concerns. Both Republicans and Democrats are racing to claim the mantle on reducing costs, but few issues will matter more than what happens to the price of the medications Americans depend on every day.
Without a doubt, Americans are struggling with skyrocketing costs across the board, and few costs have hit family budgets harder than prescription drugs. Many working Americans have watched the cost of routine medications climb higher and higher, forcing them to improvise to stay on the medications they need.
One policy solution is importing life-saving medications from Canada and other Tier 1 countries at a fraction of the U.S. price through consultancies, alternative funding programs, or employer- sponsored benefits. As more small businesses, municipalities, school systems, and individuals turn to these programs, especially across America's heartland, Big Pharma has pushed back in courts across the country, and its tactics are escalating.
Large pharmaceutical companies have sued dozens of telehealth providers, compounding pharmacies, and import consultancies, with mixed judicial outcomes and a long string of dismissals.
Legal experts call it a "kitchen sink" approach: throwing every claim available to see what a judge will hear and driving up litigation costs for defendants. In doing so, manufacturers risk cannibalizing their own product lines abroad to protect market share and price controls in the U.S. – all at the expense of American patients.
Big Pharma's newest tactic is intellectual property claims under the 1946 Lanham Act, the federal trademark law meant to protect Americans from fraud and counterfeiting. Part of the Act targets vendors "passing off" products as something more valuable – the kind of provision meant to stop street vendors selling fake Louis Vuitton handbags on Canal Street, not to price a grandmother out of her diabetes medication.
A recent Big Pharma win at the Fourth Circuit targeted importers who helped a Maryland resident obtain Gilead's BIKTARVY from Turkey. Gilead didn't argue the drugs were chemically different – it could not – and instead called them "materially different" because the packaging was in Turkish, framing its own medication as dangerous to Americans.
That precedent does more than shut down importers. Under this legal theory and the statutory language, patients themselves could be on the hook for Big Pharma's claimed damages and "lost" U.S. revenue for filling a prescription overseas. That's a city sanitation worker buying his insulin from a licensed pharmacy in Ontario because the American price tripled, and he is suddenly liable for a drug company's lost profits. It's a school bus driver ordering her son's asthma inhaler from a licensed pharmacy abroad, and a county road-crew foreman filling his own heart prescription overseas, both at a fraction of the domestic price. These aren't hypothetical outliers – they are the exact Americans this strategy is designed to intimidate into paying full U.S. price.
And there's a deeper unfairness baked in: Americans already pay more for the same drugs than anyone else, and now risk liability for trying to pay what every other country pays. It's a uniquely American penalty – punished for seeking the same medicine, from the same manufacturer, at the price charged everywhere else on earth.
This precedent also puts the courts at odds with growing state-level efforts to let individuals import medication from countries with comparable safety standards as the US. Big Pharma won't let up, because success here means maintaining control of U.S. markets at the expense of patients' freedom to buy their own medicine – and in some cases, their lives.
The industry's legal strategy reveals a telling contradiction: to argue independent importers are disrupting their "control of the stream of commerce," manufacturers must first admit their own failures – gaps in supply chain stability, tracing, and distribution. That's a remarkable concession from an industry that claims to have it all under control, especially since these pharmacies secured the drugs through legitimate partnerships with the very manufacturers now suing them.
Rather than compete, Big Pharma litigates – and increasingly, it litigates against the patients themselves. This isn't about patient safety or national security. Its monopoly preservation dressed up as consumer protection, with ordinary Americans as collateral damage in a fight the industry picked not because it was wronged, but because it was outmaneuvered.
Heading into the midterms, candidates who ignore this reality do so at their own peril: a free market doesn't shield the biggest player from competition; it lets better solutions win – and it doesn't punish Americans for paying a fair price for their own medicine.
