House Speaker Mike Johnson (R-LA) is preparing to unveil a government spending bill that could include key components of President-elect Donald Trump’s healthcare agenda. Among the priorities under consideration is reforming Pharmacy Benefit Manager (PBM) practices, a move aimed at lowering prescription drug costs for seniors by tackling middleman-driven price inflation.
PBMs like CVS Caremark, Express Scripts, and OptumRx dominate 80% of the U.S. market and manage drug benefits for over 270 million Americans. Critics argue that PBMs inflate prescription drug costs by prioritizing high-priced medicines for their own financial benefit, creating formularies that restrict access to affordable alternatives.
During a House Oversight Committee hearing, Florida pharmacist Kevin Duane described PBMs as gatekeepers controlling drug availability, often at the expense of patients. PBMs profit by negotiating rebates with manufacturers in exchange for placing drugs on formularies. However, these rebates rarely benefit patients directly, driving up out-of-pocket costs.
In 2020, President Trump introduced a policy requiring PBM rebates to go directly to seniors, potentially saving billions in prescription costs. This rule was reversed by President Joe Biden’s administration under the Inflation Reduction Act, halting the savings intended for those most in need.
Trump’s incoming administration plans to reinstate the rebate rule and expand reforms to benefit seniors. Meanwhile, Congress has the opportunity to act now. Over 20 conservative groups have urged lawmakers to pass the Modernizing and Ensuring PBM Accountability Act (S. 2973), which would decouple PBM fees from drug prices. This reform would realign PBM incentives with patient needs rather than profits.
Adding this provision to the end-of-year spending bill would deliver immediate relief to seniors and set the stage for broader healthcare reforms under Trump. Speaker Johnson’s efforts to address PBM accountability could mark a significant step in combating prescription drug inflation and restoring transparency to the system.
