RFK Jr Says Trump Administration ‘Committed’ to PBM Reform
As a new presidential administration begins to take shape, experts are curious about its promises of potential PBM reform within the pharmacy benefits industry.
At his Senate Finance Committee nomination, Robert F. Kennedy Jr. assured the public that the Trump Administration aims to enact long-awaited federal pharmacy benefit manager (PBM) reform within the next 4 years.1 Kennedy’s recent sentiments confirm President Donald Trump’s previous commitment to “knock out” PBMs, saying they “don’t do anything except they’re middlemen,” prior to entering office.2
“Trump is absolutely committed to fixing the PBMs,” Kennedy said at his hearing.1 “Trump wants to get the excess profits away from the PBMs and send it back to primary care, to patients in this country.”
Kennedy’s first hearing was conducted on January 29 in front of the Senate Finance Committee, while a second hearing took place the following day in front of the Senate Health, Education, Labor, and Pension Committee. Both hearings are part of the process that would confirm Kennedy as Secretary of the US Department of Health and Human Services (HHS).3
At both hearings, Kennedy was questioned on a variety of topics, with senators exploring key areas such as rural health care, Kennedy’s views on vaccines, prescription drug pricing, and the responsibilities of Medicare.4 Showing Congress’ bipartisan support for passing PBM reform legislation, Senator Maria Cantwell (D, Washington) and Senator Chuck Grassley (R, Iowa) both asked Kennedy about PBMs and their role in influencing drug prices.
Official logo of the US Department of Health and Human Services | image credit: A2Z AI / stock.adobe.com
READ MORE: NCPA Joins Class Action Suit Against GoodRx, Industry-Leading PBMs
“My approach to the administration of HHS will be radical transparency. If members of this committee or other members of Congress want information, the doors are open,” Kennedy told Senator Grassley.4 “If Congress asked me for information, you would get it immediately.”
Transparency is something PBM reform advocates are hopeful for. One of the key pieces of reform legislation is known as the “PBM Transparency Act.” In its effort to stop known PBM practices, this law would force PBMs to disclose costs, markups, reimbursements, and more when providing prescription drug benefits.5
The legislation was introduced in 2023 by Senator Cantwell and has been in the Senate ever since. It was ultimately designed to forbid PBMs from operating as middlemen, making the decisions on where money to drug manufacturers and pharmacies goes for prescription drugs.
“In response to questions from senators, Kennedy had multiple opportunities to discuss PBM practices and their role in rising drug costs. Kennedy recognized that PBMs directly contribute to rising drug costs and committed to working with Congress to create meaningful change,” wrote the National Community Pharmacists Association (NCPA) in a recent news release.6
The NCPA—along with other pharmacy advocacy groups—has been on the front lines when it comes to lobbying for PBM reform. Further highlighting the bipartisan support PBM reform has received, Kennedy relayed that over 50 senators consider these pharmacy benefits provisions to be “top-of-mind” issues.
As key legislative vehicles like the PBM Transparency Act continue to go unsigned, industry leaders are collecting evidence of PBM practices and how they impact prescription drug prices. The most notable investigation into PBM practices was conducted by the Federal Trade Commission (FTC) in its 2 interim staff reports from 2024 and 2025.
“Staff’s latest report found that the ‘Big 3 PBMs’—CVS Caremark Rx, Express Scripts, and OptumRx—marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017-2022,” read a news release detailing the Commission’s second report.7
In line with the rising costs of prescription drugs and the corruption behind the distribution of pharmacy benefits, Kennedy was also asked about his understanding of the Centers for Medicare & Medicaid (CMS)—a federal agency dealing with millions of Americans’ prescription medications that Kennedy would oversee if he were nominated.
While many Senate Finance Committee members shared his sentiments toward PBMs, their view on his understanding of CMS was more critical.
“So, Mr. Kennedy, you want us to confirm you to be in charge of Medicare, but it appears that you don’t know the basics of this program?” said Senator Maggie Hassan (D, New Hampshire) when asking Kennedy about the 4 Parts of Medicare coverage.8 Along with his controversial vaccine statements, the topics of Medicare and Medicaid steered the hearing into divisiveness.
Similar to PBMs and the ongoing FTC investigation into their practices, Medicare too has been significantly discussed as the organization continues to roll out provisions under the Inflation Reduction Act (IRA) of 2022, signed during the Biden-Harris Administration. Going into effect for the first time at the start of 2026, IRA provisions will force a Medicare and manufacturer-negotiated collection of drugs to receive lower list prices.
But NCPA believes drug price negotiations will lead to a larger issue that pharmacies will not be able to withstand.
“Like many government programs, the intent is good, but the unintended consequences undermine the goal,” said NCPA CEO B. Douglas Hoey, MBA.9 “That’s exactly the case here. Everyone wants to reduce drug costs for seniors and taxpayers. But, as our research shows, the program is structured in a way that will force many independent pharmacies out of the Medicare Part D program. Drug costs may come down, but there will be a shortage of pharmacies to dispense medicine. Seniors will be stranded without a pharmacy, and they won’t get the benefit of lower drug prices.”
Between bipartisan support, vocal industry advocates, and a new administration promising change, PBM reform may seem more likely now than it has in the recent past. The common goal many share is to lower drug prices for American patients. But despite the new administration’s stated commitment to putting an end to certain PBM practices, it’s not until key reform bills are signed into law that pharmacies and patients will see the potential benefits.
“We are paying far too much, because we are paying far more than other countries. We have laws that make it impossible to reduce [drug costs] and we have a thing called a ‘middleman’… that makes more money than the drug companies,” concluded Trump in a December press conference when asked about PBMs.2
READ MORE: Medicare Drug Price Negotiations Expose Community Pharmacies to Financial Risk
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