Bioengineers can embedded soft, stretchable electronics into the tiny clusters to create “cyborg” islet organoids. These can mimic the pancreas, sensing glucose levels and releasing hormones. This could help building replacement cells for people with type 1 diabetes.

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To be sure, neither tool is costless. Formulary exclusions can inconvenience some patients, and encouraging patients to use lower-cost pharmacies can mean switching where they fill their prescriptions. But every healthcare system faces a choice: tolerate some limits or accept higher prices across the board. Negotiation requires leverage, and leverage requires the ability to say no—and to reward lower-cost drugs and providers with more business.

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