Public awareness is rapidly growing about the harmful role that pharmacy benefit managers (PBMs) play in driving up prescription drug costs and denying consumers access to the medicines they desperately need. These powerful intermediaries have come under increasing scrutiny from policymakers and regulators, with the Federal Trade Commission (FTC) taking decisive action this year by filing a complaint against the largest PBMs for unfair and anticompetitive practices and issuing a groundbreaking interim report on their anticompetitive practices. These practices are not just unfair; they force consumers to pay unnecessarily high prices for the medicines they rely on. If some business executives are hoping that a second, business-friendly Trump administration will grant a reprieve to this small handful of giant companies that control 90% of the prescription drug market, they are sorely mistaken. The first Trump administration reversed its hands-off approach to PBMs. The recent appointments of the FTC’s chairman and commissioner are further indications of a continued commitment to addressing PBM monopolistic practices, creating more opportunities to hold these harmful intermediaries accountable. Trump 2.0 is likely to give PBMs some doses of regulatory drugs they certainly don’t want. In fact, on Monday, he told reporters, “We’re going to kick the middleman out.”
It’s not the administration and regulators that should worry PBMs. This week, congressional leaders have a crucial opportunity to enact a major overhaul of the PBM system. It aims to curb monopolistic practices by PBMs, including decoupling prices from profits. Numerous hearings have underscored the urgency of the matter, particularly revelations about cases in which PBM executives were caught lying to Congress. Immediate action is vital to address these deceptive behaviors and to ensure transparency and fairness in drug pricing.
