Staff ReportsPresident-elect Donald Trump is once again stepping up to tackle the Big Pharma gang, and this time he’s zeroing in on the notorious Pharmacy Benefit Managers (PBMs). At a press conference at Mar-a-Lago, Trump characterized these middlemen as “the horrible middleman” that seems to rake in more dough than the actual drug manufacturers. He made it clear that the time has come to give these money-hungry middlemen the boot, promising to take drug costs down to unprecedented levels.
For the uninitiated, PBMs are the puppet masters behind the curtains of prescription drug pricing. With the trio of CVS Caremark, Express Scripts, and OptumRx capturing around 80 percent of the market, they are essentially running the show for over 270 million Americans. These groups inflate profits by pushing pricier medications while controlling which drugs make it onto their sought-after formularies. If your preferred medication isn’t on the list, good luck trying to get it covered by insurance or even prescribed by your doctor. Essentially, the PBMs dictate who pays what, and it’s often the patients who foot the bill for these ill-gotten gains.
You don't have to be Milt Friedman to understand that #PBMs are not using their economies of scale to bring down drug prices. In fact, it's the opposite, thanks to vertical integration and self-dealing. #BigMiddleManager #HowPBMsWork pic.twitter.com/f8CcR2NEvX
— HealthCareDenied (@CareDenied) December 17, 2024
Enter Kevin Duane, a pharmacist from Jacksonville, Florida, who recently took a stand before the House Committee on Oversight and Accountability to shed light on this convoluted system. He lamented that patients and doctors find themselves in a tight spot, as PBMs wield their power to influence medication choice, not based on healthcare needs but rather on profit margins. The system is clearly rigged, favoring the PBMs over the actual care of patients.
This isn’t a new battle for Trump. Back in 2020, he took a bold step toward dismantling this corrupt regime by introducing a policy that would allow seniors to reap the benefits directly from the drug rebates given to PBMs. He articulated a vision where these savings would end up in the hands of those who need it most—seniors. Unfortunately, President Joe Biden saw fit to revoke this policy through the so-called Inflation Reduction Act, leaving vulnerable seniors out in the cold when they were counting on significant savings on their prescriptions.
With a robust healthcare team behind him, Trump is poised to revive the much-needed Rebate Rule, setting the stage for seniors to enjoy real savings once again. Conservative groups are already putting the wheels in motion, urging Congress to hasten the passage of bills like The Modernizing and Ensuring PBM Accountability Act and the Mental Health, Lower-Cost Drug and Extenders Package. These initiatives aim to revamp the PBM payment structure, thereby severing the dubious connection between drug prices and PBM profits, ultimately benefiting patients.
The mission is clear: knock out the PBM middlemen, restore accountability to the healthcare system, and usher in significant savings for America’s seniors. If Trump’s healthcare agenda kicks off on this note, it’s bound to be a game-changer for those who have been unfairly burdened by high drug costs for far too long.
