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Politics & Government

ALG Unpacks Trump Pitch to Cut Drug Costs by Cutting PBM Middleman

Pharmacy Benefit Managers (PBMs) have been coming under fire for years but is it possible that their time profiting off taxpayers is ending?

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L. A. "Tony" Kovach, Neighbor
Base image credit: X.com. Text and collage credits: MHProNews' L. A. "Tony" Kovach for this Patch.
Base image credit: X.com. Text and collage credits: MHProNews' L. A. "Tony" Kovach for this Patch.

"Pharmacy Benefit Manager (PBM) is a third-party company that administers prescription drug benefits for health plans, such as employer-sponsored insurance, Medicare Part D, and Medicaid," said left-leaning Google's AI powered Gemini. Americans for Limited Government (ALG) sponsored a post found here that promotes the end of PBMs, which is Part I below. But to tee their post up, a few X-posts on the important topic are insightful.

It's a bit of an exaggeration to say that no one knows about this. Among the groups that have been opposing PBMs for several years is the Association of Mature American Citizens (AMAC) orAMAC.us. More about AMAC in the post linked here that contrasts AMAC with AARP.

With that backdrop, here is the headline top per Americans for Limited Government (ALG).

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Part I

Trump ally Speaker Mike Johnson (R-LA) will start the president-elect’s plan to knock out the big insurance middleman in the end-of-year government spending package.

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President-elect Donald Trump vowed to take on big Pharmacy Benefit Managers (PBMs) at a Monday press conference at Mar-A-Lago. “The horrible middleman that makes more money, frankly, than the drug companies, and they don’t do anything except they’re a middleman. We’re going to knock out the middleman,” said President Trump.

Trump said that Health and Human Services nominee Robert F. Kennedy, Jr. and Center for Medicare and Medicaid Services nominee Dr. Mehmet Oz had discussed reforming PBMs extensively, “These middlemen are, but they are rich as we’re going to knock out the middlemen. We’re going to get drug costs down at levels that nobody has ever seen before, and that really, I tell you, we spend more time talking about that with Bobby and with the executives and Oz, all of them. We spent more time talking about that than anything else.”

Trump ally House Speaker Johnson will start “knocking out” the PBM middlemen as soon as this week. Speaker Johnson said the spending bill to clear the decks for the incoming Trump administration and keep the U.S. government operating is almost done. He expects the bill text to be released this week. It could include a critical part of Trump’s healthcare agenda: cracking down on Pharmacy Benefit Manager middlemen who drive up drug prices for seniors.

One of the biggest reasons for high prescription prices is Big Insurance PBMs. Three giant PBM middlemen—CVS Caremark, Express Scripts, and OptumRx—control about 80 percent of the entire PBM market and administer drug benefits for over 270 million Americans.

PBMs inflate their profits by pushing more expensive medicines when designing formularies and the list of drugs available to their customers. By setting favorable prices and cost-sharing amounts, PBMs practically dictate the amount patients pay out of pocket and which medicines they can access. If a drug isn’t on the formulary, insurers won’t cover it; and often, doctors won’t prescribe it even if the patient needs it.

Kevin Duane, a pharmacist from Jacksonville, Florida, recently told the House Committee on Oversight and Accountability, “Patients and their doctors have virtually no say in what drugs are used, since the PBM essentially forces which drugs can be used – not because a drug is better or worse, but because the PBM can make more money from it.”

Essentially, PBMs are incentivized to prescribe more expensive medicines. It’s a broken system that Trump started to fix before. In 2020, Trump introduced a policy allowing seniors to directly benefit from rebates that drug manufacturers pay to PBMs for preferential placement on insurers’ drug formularies. These rebates were intended to reduce the cost of expensive medications for seniors. Trump presented a detailed plan to deliver these savings to seniors, potentially saving them billions of dollars.

“So, the patients are going to be now getting the benefit, instead of these very wealthy individuals,” Trump said at the time. “Today’s action ends this injustice and requires that these discounts go directly to the people. These are the people that need it.”

Unfortunately, Joe Biden repealed the Trump drug rebate rule with the so-called Inflation Reduction Act, preventing those seniors most at risk from getting the savings they needed.

President Trump and his healthcare team will undoubtedly bring back the Trump Rebate Rule and massive savings for seniors. In the meantime, Speaker Johnson and Trump’s allies in Congress can get a head start on Trump’s healthcare agenda.

Recently, over 20 conservative groups encouraged Congress to pass The Modernizing and Ensuring PBM Accountability Act (S. 2973). The bill would reset the money-making incentives to benefit patients by delinking PBM fees from the price of medicine. Breaking the link between the price of drugs and the fees PBMs charge will help to fix incentives in the system that drive up seniors’ drug costs and PBM profits.

Congress can pass the final bill before Christmas. Fix a corrupt system. Deliver savings to America’s seniors. It would be a great start to Trump’s healthcare agenda.

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Part II - Additional Information and topics

On July 12, 2024 — The Federal Trade Commission accused middlemen in the prescription drug supply chain of “inflating drug costs and squeezing Main Street pharmacies.”

A pair of federal investigators probing claimed corruption at HUD told MHProNews some time ago that much of the federal budget can be traced back to various interest groups that can earn hundreds of thousands of dollars, or even millions to billions of dollars, due to their feeding at the federal trough. Those investigators raised that concern years before Senator Mike Braun (OH-R) brought that same issue up during a video interview with right-leaning Fox Business.

PBMs merit being rooted out of the federal feeding trough. But so do other programs. The topic of DOGE potentially targeting as much as $2 trillion dollars’ worth of potential fat in federal spending is no exaggeration. Without cutting into the muscle, removing fat and corruption from federal spending is just common sense for "We the People," but it may not be appealing at all to politicos and insiders who benefit from the status quo.

https://patch.com/florida/lake...

https://patch.com/florida/lake...

https://patch.com/florida/lake...

The sad reality is that the federal budget is massively bloated, wasteful and yes...corrupt. Trump and the MAGA movement have targeted that mess. Let's hope, pray and support that for the sake of all who aren't corrupted.

https://patch.com/florida/lake...

For those who care about getting more affordable housing, as this writer does and has for over 30 years, check out the articles on the HUD nominee Scott Turner, and on the corruption that is holding back manufactured homes.

> Affordable Manufactured Home History-Associations-21st Century Scandal

> Top 10 States for Homelessness & Top Cities for Crime=Shocking Lessons

> Controversy-Manufactured Housing Institute-Lesli Gooch-Mark Bowersox

> Niskanen Center Praises Manufactured Home ‘Cost Savings’ and ‘Quality’

---

> ‘Mobile Home Values Rising Faster Than Single-Family’ House-Wow Fact$

--> Realtor-What Is a Manufactured Home? The Next Step Beyond Mobile Homes

> Orlando RE Agent Smith-Younger Adults Will Need $8500 Monthly for Rent

> Blankley-Goodbye American Dream? Only 10% Polled Can Buy a House; But

--> Frank Rolfe-Special Interests ‘Don’t Want to Solve Affordable Housing'

---> TARK-‘I’m a Teen and Know the Solution to Affordable Housing Crisis’

---> Renting? Rent too High? Odds Are DOJ Suit vs RealPage Matters to You

> New-Certified “Half Price Homes” - Affordable Housing Solution Redux

> Solution: “Would-Be Homebuyers Need 80% More Income Than 4 Years Ago”

Examples of Other subjects in my ongoing series on this Patch.

--- Songs, music videos and lyrics ---

> The Rose - Bette Midler - Music Video - Behind the Scenes Insights

> Frank Sinatra - Someone To Watch Over Me (Remastered) - Old Blue Eyes

> 'Send In the Clowns' - Judy Collins, Frank Sinatra - Lyrics & Meaning

---movies and videos to spark thought and inspire ---

> POWER: Movie Buffs –Fictional Insights Into How Real Politicos Operate

> The Creepy Line-Peter Schweizer-Dr. Jordan Peterson-Dr. Robert Epstein

> Movie Buffs – Movie Classic - “Enemy of the State” – Lessons Learned

--- The backstory to big business scandals, political, economic, housing, and more subjects ---

> Stunning. Tracking Endowments to Top U.S. College and Universities

> Neighbors and Fellow Americans-You Could be Guilty of 3 Felonies a Day

> Why do Liars Lie? Why do those Engaged in Paltering and Spin Palter?

---> L. A. “Tony” Kovach is a publisher who has earned multiple awards in history. He and his family live in a manufactured home on private property in Winter Haven, FL. He is the co-founder of Manufactured Home Living News.com (MHLivingNews.com) and Manufactured Home Pro News.com (MHProNews.com), trade publications serving segments of the manufactured home industry. Having worked in several segments of the manufactured home industry for over 3 decades, Kovach is a widely acknowledged and often praised expert on manufactured housing. ###

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