President Trump has repeatedly promised to bring down prescription drug prices. His Republican Congress says it shares that goal. But tucked inside the recently passed 2026 Consolidated Appropriations Act is a restructuring of the drug market that makes lower prices less likely, not more.
How does a Congress that promises lower prices end up weakening the bargaining tools that restrain them? The answer lies less in ideology than in political incentives. Pharmacy benefit managers (PBMs) are opaque intermediaries—and they are unpopular with figures including Mark Cuban, who told Fortune that the current rebate system is flawed.
The law transforms PBMs from hard-bargaining negotiators into micromanaged administrators and weaken the tools they use to discipline drug prices. Targeting PBMs is easier than confronting the suppliers who ultimately set prices. But in markets where prices are negotiated, weakening the intermediary often strengthens the firms on the other side of the table. Here’s how we got here.
Decades of growing leverage
For decades, PBMs have relied on two key mechanisms to reduce drug costs. It’s no accident that drug manufacturers—and independent pharmacies—have spent years trying to shift political attention towards PBMs. Hard bargaining works.
