Dr. Jerome Adams (Purdue University photo/John Underwood)
As a physician, former U.S. Surgeon General, and former Indiana State Health Commissioner, my career has been guided by a simple belief: health care should work for everyone, not just those with the best insurance, the closest specialists, or the ability to pay for concierge care.
In an ideal world, every American would have affordable medications, easy access to on-call doctors, and seamless, high-quality care close to home. But we do not live in that world. And until we do, we should be careful about shutting down responsible alternatives that help fill real gaps in care, especially for rural and underserved communities.
That is why I am paying close attention to legislation moving through the Indiana Statehouse. Senate Bill 282 is motivated by a legitimate and important goal: protecting patient safety. Lawmakers are right to want guardrails that ensure medications are prepared, prescribed, and dispensed appropriately. Patient safety must always come first.
At the same time, as originally written, the bill risks going too far. It could restrict access to individualized treatments that many Hoosiers rely on today, including compounded therapies that are legally prescribed by licensed physicians and dispensed by regulated pharmacies operating under existing state and federal oversight.
For many patients, this issue is not theoretical. It impacts their ability to access many medications- including GLP-1-based therapies for weight management and metabolic disease. These medications have been life changing for many people and are now being studied for broader benefits across a range of chronic conditions. Yet access remains uneven. Cost, insurance coverage gaps, supply issues, and geography all matter. For some patients, responsibly compounded alternatives are not a preference. They are the only realistic current option to get therapies they need and deserve.
This conversation should not be framed as patients versus pharmaceutical manufacturers, or innovation versus safety. We need all of it. Breakthrough drugs developed by pharmaceutical companies save lives and advance medicine, and we must be cognizant of the need to reasonably protect intellectual property rights and incentives for future innovation. At the same time, personalized care exists — and is rapidly expanding — for a reason. Patients are different. Their medical histories, tolerability, comorbidities, geography, and financial realities vary. A system that works only for those who can afford the most expensive or most convenient option is not a system that serves the public’s health.
I have felt the frustrations of our health care system personally. In 2024, I received a nearly $5,000 bill for an emergency room visit, despite having insurance. That experience reinforced what millions of Americans already know. Care is often too expensive, too difficult to access, and too disconnected from patients’ daily realities. When people feel boxed out of the system, they look for alternatives. Our goal should be to make more options safer and transparent, not to eliminate them altogether, while pretending the status quo is fine.
To be clear, there are bad actors in every corner of health care, including in the telehealth and compounding space. They should be identified, regulated, and removed. Strong enforcement of existing laws matters. Patient safety matters. But safety and access are not mutually exclusive. We can do both.
Indiana has an opportunity to lead with balance. Strengthening oversight, improving transparency, and reinforcing the physician-patient-pharmacist relationship can raise standards without reducing access. Model approaches, such as the ALEC Safe Compounding Act, show that it is possible to protect patients while preserving individualized care and state-based regulatory authority.
At its core, this debate is about trust and choice. Hoosiers value the freedom to make medical decisions in consultation with licensed professionals they know and trust. They also understand the realities of living far from major medical centers or facing financial barriers that limit options.
We should aim for legislation that reflects those realities. Laws should protect patients, encourage innovation, and expand access, not narrow it. They must recognize our health care system is imperfect, and that responsible alternatives sometimes matter most for those with the fewest choices.
Indiana lawmakers do not have to choose between safety and access. With thoughtful policymaking, we can and should do both.
Dr. Jerome Adams, MD, MPH, is a former U.S. Surgeon General and former Indiana State Health Commissioner. He currently serves as a Presidential Fellow and the Executive Director of the Center for Community Health Enhancement and Learning at Purdue University. Send comments to editorial@therepublic.com.
