President Donald Trump has signed two executive orders aimed at reducing the cost of prescription drugs, but pharmaceutical benefit managers have been a small part of the legislation.
Here’s what to know about the president’s approach to PBM policy so far:
- In December, then-President-elect Trump said he wanted to “knock out the middlemen” when it comes to drug pricing.
Before the president began his second term, he told reporters he would “get drug costs down at levels that nobody has ever seen before.” The comments sent stock prices for the largest PBM companies downward.
- In April, the Federal Trade Commission resumed a lawsuit alleging the three largest PBMs — UnitedHealth Group’s Optum, CVS Health’s Caremark and Cigna’s Express Scripts — steered patients toward highest-cost insulin to secure rebates. In March, two FTC commissioners recused themselves from the case, citing previous work on PBM matters. FTC Chair Andrew Ferguson later decided to rejoin the case. The lawsuit was first filed by the Biden administration in 2024.
- In April, President Trump signed an executive order aimed at reducing prescription drug prices. The order requires PBMs to disclose the fees they pay to brokers for enrolling employers in PBMs. The order also directs HHS to “develop reforms to promote a more competitive, transparent, efficient and resilient prescription drug value chain.”
- Congress has eyed PBM changes in budget legislation. The “One Big Beautiful Bill” budget reconciliation package would eliminate spread pricing for PBMs in Medicaid managed care plans.
- States have also implemented tougher PBM legislation in recent months. In April, Arkansas became the first state to ban PBMs from owning pharmacies. Major PBMs and trade groups have sued to block the legislation. In a letter, 39 state attorneys general called on Congress to enact similar legislation at the federal level.
