Trump promised lower drug prices. Here’s how Congress virtually guaranteed the opposite

Fortune

by Tony LoSasso

March 4, 2026

AI-Generated Deep Dive Summary

President Trump and his Republican allies have long pledged to lower prescription drug prices, yet a provision in the 2026 Consolidated Appropriations Act is making this goal harder to achieve. Instead of strengthening mechanisms to control costs, the law weakens the tools that Pharmacy Benefit Managers (PBMs) use to negotiate better deals with drug manufacturers. PBMs have historically played a crucial role in reducing prices by leveraging their formulary power and steering patients to lower-cost pharmacies. However, the new law decouples PBM compensation from manufacturer rebates, turning them into administrators rather than negotiators s. This shift turns price negotiation into a cost center for PBMs, reducing their incentive to secure better deals. Additionally, the law limits their ability to direct patients to more affordable pharmacies, which has historically been a key strategy for driving down costs. The impact of these changes is significant. While PBMs have faced criticism from figures like Mark Cuban, who highlights their opaque pricing practices, their role in negotiating lower drug prices cannot be overlooked. By limiting their bargaining power and administrative flexibility, the law undermines one of the most effective tools for controlling prescription drug costs. This move ultimately benefits drug manufacturers by reducing pressure on them to lower prices. The irony is that Congress is weakening cost-control measures under the guise of addressing high drug prices. Seniors on Medicare will feel the brunt of this change, as they are often among those most reliant on affordable prescription drugs. The law’s provisions not only undermine decades of progress in managing healthcare costs but also align with broader trends in U.S. healthcare, where competition and negotiation have been key to driving value. From a business perspective, this issue highlights the delicate balance between regulation and market dynamics. While the intention to lower drug prices is commendable, the unintended consequences of policy decisions can often complicate efforts to achieve meaningful change. As the law takes effect, stakeholders across the healthcare spectrum—from PBMs to patients—will need to adapt to a new landscape where cost-control tools are weaker and prices may rise as a result.

Verticals

businessfinance

Originally published on Fortune on 3/4/2026