As President Trump enters his second month in office, he does so with clear momentum delivering on a mandate from the American people. The American people overwhelmingly voted to return him to the White House, and with that, they endorsed his promises to prioritize government efficiency and reduce taxpayer spending. This sounds very promising, but while President Trump’s goals are ambitious and necessary, it must be recognized that Congress will play a pivotal role in enacting those policies, and they need to do so swiftly.
One area that demands immediate attention is the affordability challenge for prescription drugs. Unfortunately, some of the PBM proposals currently under consideration in Congress miss the mark. Instead of reducing costs, these policies – likely considered in a Continuing Resolution or reconciliation package – would create unnecessary regulations that expand the role of the federal government into the private sector while doing little to address the root causes of high drug prices – a result of big pharma setting exorbitant prices. This would not just a policy misstep: it’s a blatant disregard for the mandate President Trump received from voters to limit government and cut spending.
Let me be clear: PBM-related proposals would do nothing to decrease taxpayer spending, but actually increase government spending, hike health care costs, and move savings that would otherwise flow to patients toward big drug companies’ bottom line. For example, proposals have been floated to ban market-based incentives.
One proposal under consideration represents an unprecedented government intrusion into the commercial market. Government mandates in the private market would completely eliminate employers’ choice in contracting decisions with PBMs as well as strip away the choice and flexibility they value in designing pharmacy benefits that best fit their patient populations. This proposal alone would increase health care premiums by more than $26 billion annually for those relying on employer-sponsored health insurance, according to a 2023 analysis from Matrix Global Advisors’ Alex Brill, former chief economist for the U.S. House Ways and Means Committee.
Another challenge of these PBM proposals is their complexity. Reconciliation bills are notoriously long and complex, making them difficult to easily navigate.
Voters, like those I represented in Pennsylvania, want simple solutions that make their lives easier and their health care more affordable. Let’s make sure that Congress does not do the oppose. We don’t need unnecessary regulations that make the government more involved in our healthcare decisions and do nothing to lower prices at the pharmacy counter.
President Trump has a track record of making the right call on similar misguided policies. In 2019, the U.S. Department of Health and Human Services (HHS) introduced a rule that would have banned PBMs from negotiating rebates in the Medicare Part D program. Both the Centers for Medicare and Medicaid Services (CMS) and the nonpartisan Congressional Budget Office (CBO) reviewed the so-called Rebate Rule. In separate reports, both concluded the policy would have increased costs for taxpayers by nearly $200 billion and hiked health care premiums on seniors by 25 percent.
According to a 2019 article in POLITICO, “Concerns about 2020 premium hikes and doubts about the rule’s true impact on drug costs weighted the discussion … Trump, already incensed over reports of massive drug price hikes and pharma’s successful legal bid to kill the administration’s drug price advertising mandate, sided with the rule’s opponents and ordered it withdrawn.”
Our Republican-controlled Congress does recognize that the American people are not looking for more government intervention. We all want transparency, clarity, and a clear path toward lower health care costs. However, recent proposals to overhaul PBM regulations don’t meet this standard. Instead of reducing health care costs, it would create a labyrinth of regulations that only further entrench the very inefficiencies the Trump administration has promised to address.
To fulfill the promises made to the American people, Congress should reject PBM proposals that would only increase federal control over healthcare and not address drug costs.
Republican Ryan Costello served as the U.S. representative for Pennsylvania's 6th Congressional District (2015-2019) and serves as an advisor to the Pharmaceutical Care Management Association (PCMA).