Big changes are on the horizon for healthcare, and they might just help seniors save big on prescription drugs. President-elect Donald Trump has vowed to take on Pharmacy Benefit Managers (PBMs)—those middlemen responsible for inflating drug prices—calling them out as “the horrible middleman that makes more money… than the drug companies.”
Here’s what’s happening:
The Issue with PBMs
PBMs like CVS Caremark, Express Scripts, and OptumRx control 80% of the PBM market and dictate the cost of prescription drugs for over 270 million Americans. Their influence on formularies (the list of covered drugs) pushes expensive medications onto patients—not because they’re better, but because they’re more profitable for PBMs.
Kevin Duane, a Jacksonville pharmacist, told Congress, “Patients and their doctors have virtually no say in what drugs are used, since the PBM essentially forces which drugs can be used—not because a drug is better or worse, but because the PBM can make more money from it.”
Trump’s Solution
Trump, along with House Speaker Mike Johnson and healthcare nominees Robert F. Kennedy, Jr., and Dr. Mehmet Oz, is determined to “knock out the middleman” and slash prescription costs.
In 2020, Trump introduced a policy to allow seniors to benefit directly from drug manufacturer rebates—savings that PBMs currently pocket. While President Biden repealed this rule, Trump plans to bring it back, giving seniors access to billions in savings.
What’s Next?
This week, Speaker Johnson is expected to include reforms targeting PBMs in the end-of-year spending package. Congress is also considering The Modernizing and Ensuring PBM Accountability Act (S. 2973), a bill designed to realign PBM incentives to prioritize patients over profits. By breaking the link between drug prices and PBM fees, this legislation could lower costs for seniors and fix a broken system.
Why It Matters
With over 20 conservative groups backing the reforms and momentum building in Congress, this could be a pivotal moment in healthcare reform. If passed, these changes would mark a huge win for seniors and a strong start to Trump’s healthcare agenda.
What do you think about tackling the PBM system? Should Congress prioritize this reform before the holidays? Let me know your thoughts!
