The Trump administration can’t decide whether drug industry middlemen are the enemy — or part of the solution
WASHINGTON — Some days, President Trump vows to eliminate them.
But then, there are days when his top health lieutenants promise to empower them. There are even days when they do both.
The mixed and muddled signals from the administration are over the increasingly contentious role of the pharmacy benefit managers, or PBMs. Those discordant signals reflect a lack of clarity from Trump and his lieutenants over how best to address one of their top priorities: how to lower prescription drug prices.
In interviews with STAT, lobbyists, congressional staffers, and health policy experts all pointed to contradictions both in the administration’s public addresses and in its policymaking. They are scratching their collective heads, struggling to discern the administration’s overarching strategy and, in some cases, to settle on their own. PBMs themselves have been leaning into their lobbying activities all that much more, two congressional staffers told STAT.
“If you figure out what Trump’s up to, let me know,” one health care lobbyist said. “We don’t have a clue.”
In the past two years, pharmacy benefit managers have over high prescription drug prices. Their exact impact on drug prices is not altogether clear, since the exact details of their negotiations are secret. But in general, they help insurance companies negotiate discounts with drug makers for costly medicines. The three largest — CVS Caremark (owned by CVS Health), OptumRx (owned by UnitedHealth Group), and Express Scripts — have grown in the last decade into titans; together, they control 70 percent of the market.
