The following content is Americans who support limited government.
House Speaker Mike Johnson (R-Louisiana) said the spending bill to prepare for the incoming Trump administration and keep the U.S. government running is nearly complete. He expects the text of the bill to be released over the weekend. This could include a key part of President-elect Donald Trump's health care agenda: cracking down on pharmacy benefit manager (PBM) intermediaries that drive up drug prices for seniors.
One of the biggest reasons for high prescription prices is the PBMs of major insurance companies. Three giant PBM intermediaries, CVS Caremark, Express Scripts, and OptumRx, control approximately 80 percent of the total PBM market and administer drug benefits for more than 270 million Americans.
PBMs inflate profits by pushing out more expensive drugs when designing formularies and lists of drugs available to customers. By setting favorable prices and co-payments, PBMs essentially determine how much patients will pay out-of-pocket and what medicines are available to them. If a drug isn't on your prescription, your insurance company won't cover it. And in many cases, doctors won't prescribe it even if patients need it.
Kevin Duane, a pharmacist from Jacksonville, Florida, recently told the House Oversight and Accountability Committee: Because, for better or worse, PBMs can benefit more from it. ”
Essentially, PBMs are incentivized to prescribe more expensive drugs. This is a broken system that President Trump has long begun to repair. In 2020, President Trump introduced a policy that would allow seniors to directly benefit from rebates that drug companies pay to PBMs for preferential listing on insurers' drug formularies. These rebates were intended to reduce the cost of expensive medicines for seniors. President Trump laid out a detailed plan to extend these savings to seniors and potentially save billions of dollars.
“That means patients will benefit, not very wealthy people,” Trump said at the time. “Today's action ends this inequity and demands that these discounts go directly to the people who need them.”
Unfortunately, Joe Biden's so-called Inflation Control Act repealed President Trump's drug rebate rules, leaving the most at-risk seniors unable to get the savings they need.
President Trump and his medical team will no doubt reinstate the Trump rebate rule and huge savings for seniors. Meanwhile, House Speaker Johnson and Trump's allies in Congress could get a head start on Trump's health care policy.
More than 20 conservative groups recently encouraged Congress to pass the PBM Accountability Modernization and Securing Act (S. 2973). This bill would reset the money-making incentives that benefit patients by decoupling PBM fees from drug prices. Decoupling drug prices from fees charged by PBMs would help fix the incentives in the system that drive up drug costs for seniors and PBM profits.
Congress could add it to this year's final bill and pass it next week. Repair damaged systems. Providing savings to older Americans. That would be a great start for President Trump's health care policy.
