• Home
  • Latest
  • Fortune 500
  • Finance
  • Tech
  • Leadership
  • Lifestyle
  • Rankings
  • Multimedia

Trendingnow

1

The U.S. spent $30 billion to ditch textbooks for laptops and tablets: The result is the first generation less cognitively capable than their parents

2

Current price of oil as of July 13, 2026

3

Current price of silver as of Monday, July 13, 2026

1

The U.S. spent $30 billion to ditch textbooks for laptops and tablets: The result is the first generation less cognitively capable than their parents

2

Current price of oil as of July 13, 2026

3

Current price of silver as of Monday, July 13, 2026
CommentaryDrugs

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

By
Tony LoSasso
Tony LoSasso
Down Arrow Button Icon
By
Tony LoSasso
Tony LoSasso
Down Arrow Button Icon
March 4, 2026, 3:30 AM ET
Tony LoSasso is an economist and the Wagner Professor of Public Affairs at the University of Wisconsin, Madison.
cuban
Mark Cuban, co-founder of Cost Plus Drugs, during a Senate Special Committee on Aging hearing in Washington, DC, US, on Wednesday, Oct. 22, 2025. Stefani Reynolds/Bloomberg via Getty Images
Add Fortune on Google for similar content.

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.

Recommended Video

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.

The first mechanism that PBMs use is formulary leverage. Drug manufacturers that want preferred formulary placement—or to avoid exclusion from coverage—must offer better prices. That leverage for PBMs depends on a credible threat: lower your price or lose access to patients.

The law “delinks” PBM compensation from manufacturer rebates in Medicare and requires flat administrative fees, certified at fair market value. It also mandates that rebates be passed through to health plan sponsors in the employer-sponsored market. This sounds appealing, but incentives matter. When compensation no longer depends on securing better terms, bargaining effort becomes a cost center rather than a profit center. PBMs will still compete for contracts, but competition on administrative fees isn’t the same as competition on aggressive price concessions and won’t lower drug prices.

The second tool for PBMs operates downstream. By encouraging patients to use more efficient, lower-cost pharmacies, PBMs have reduced dispensing costs, enhanced patient quality, and reinforced their negotiating leverage upstream. The ability to direct volume toward lower-cost, high-value providers creates bargaining power.

The statute expands “any willing pharmacy” requirements, limiting that ability. In virtually every sector, purchasers obtain lower prices by steering volume toward lower-cost providers. When every provider must be included on standardized terms, bargaining power diminishes and costs tend to rise. Broader inclusion may feel consumer-friendly, but in negotiated markets it often shifts costs rather than reduces them.

To be sure, neither tool is costless. Formulary exclusions can inconvenience some patients, and encouraging patients to use lower-cost pharmacies can mean switching where they fill their prescriptions. But every healthcare system faces a choice: tolerate some limits or accept higher prices across the board. Negotiation requires leverage, and leverage requires the ability to say no—and to reward lower-cost drugs and providers with more business.

The irony is that Congress is weakening cost-control tools in the name of combating high drug costs.

Seniors on Medicare will pay the price

For decades, reformers have tried to move American health care away from cost-plus reimbursement and open-ended fee-for-service medicine toward competition, in which private plans negotiate hard and shift business to those offering better value. The new PBM regime would move in the opposite direction: toward regulatory supervision, standardized participation, and reduced discretion.

All participants in the prescription drug supply chain deserve scrutiny, but weakening the mechanisms that extract price concessions will not lower drug spending. The more likely outcomes are gains for drug companies and less efficient pharmacies, and higher drug costs. Effects will be especially felt by seniors on Medicare and by smaller employers that lack the leverage to offset the law’s new constraints.

If lawmakers want lower drug prices, they should strengthen competitive pressure, not regulate it into passivity. The politics are easy to understand. Attacking middlemen polls well. It allows lawmakers to appear tough on prices without directly confronting manufacturers. But the economics are less forgiving. Lower drug prices require bargaining power. Congress has just reduced it. Patients and taxpayers will bear the cost.

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

About the Author
By Tony LoSasso
See full bioRight Arrow Button Icon
Add Fortune on Google for similar content.

Latest in Commentary

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025

Most Popular

Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Finance
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam
By Fortune Editors
October 20, 2025
Fortune Secondary Logo
Rankings
  • 100 Best Companies
  • Fortune 500
  • Global 500
  • Fortune 500 Europe
  • Most Powerful Women
  • World's Most Admired Companies
  • See All Rankings
  • Lists Calendar
Sections
  • Finance
  • Fortune Crypto
  • Features
  • Leadership
  • Health
  • Commentary
  • Success
  • Retail
  • Mpw
  • Tech
  • Lifestyle
  • CEO Initiative
  • Asia
  • Politics
  • Conferences
  • Europe
  • Newsletters
  • Personal Finance
  • Environment
  • Magazine
  • Education
Customer Support
  • Frequently Asked Questions
  • Customer Service Portal
  • Privacy Policy
  • Terms Of Use
  • Single Issues For Purchase
  • International Print
Commercial Services
  • Advertising
  • Fortune Brand Studio
  • Fortune Analytics
  • Fortune Conferences
  • Business Development
  • Group Subscriptions
About Us
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • About Us
  • Press Center
  • Work At Fortune
  • Terms And Conditions
  • Site Map
  • Facebook icon
  • Twitter icon
  • LinkedIn icon
  • Instagram icon
  • Pinterest icon

Latest in Commentary

b
CommentaryWorld Cup
Columbia Business School professors: What the Balogun red card can teach us about AI and judgment
By Oded Netzer, Christopher Frank and Paul MagnoneJuly 13, 2026
18 hours ago
usa
Commentary250 Years of Innovation
For 250 years, work defined American identity. That era Is ending
By Keith Ferrazzi and Wendy SmithJuly 11, 2026
3 days ago
m
Commentarymedicine
America’s bone health is quietly headed for a $19 billion crisis
By Matthew T. DrakeJuly 9, 2026
5 days ago
t
CommentaryEducation
AI is about to disrupt millions of jobs. A century ago, America’s answer was to build a new high school
By Tim KnowlesJuly 8, 2026
6 days ago
amit
CommentaryVenture Capital
Physical AI’s $50 trillion opportunity requires long-term conviction, but the payoff is huge 
By Amit ChaturvedyJuly 8, 2026
6 days ago
heat
Commentaryclimate change
McKinsey Global Institute: Climate planning has prioritized floods. Heat demands equal attention
By Sylvain Johansson, Mekala Krishnan, Kanmani Chockalingam and Annabel FarrJuly 7, 2026
7 days ago

Most Popular

The U.S. spent $30 billion to ditch textbooks for laptops and tablets: The result is the first generation less cognitively capable than their parents
Innovation
The U.S. spent $30 billion to ditch textbooks for laptops and tablets: The result is the first generation less cognitively capable than their parents
By Sasha RogelbergJuly 12, 2026
2 days ago
Current price of oil as of July 13, 2026
Personal Finance
Current price of oil as of July 13, 2026
By Joseph HostetlerJuly 13, 2026
24 hours ago
Current price of silver as of Monday, July 13, 2026
Personal Finance
Current price of silver as of Monday, July 13, 2026
By Joseph HostetlerJuly 13, 2026
24 hours ago
How Pete Hegseth's DEI order just put Scouting America's future at stake
North America
How Pete Hegseth's DEI order just put Scouting America's future at stake
By Seth T. Kannarr, Derek H. Alderman and The ConversationJuly 13, 2026
14 hours ago
Trump embraces Australian retirement system backed by Larry Fink
Personal Finance
Trump embraces Australian retirement system backed by Larry Fink
By Brianna Sosa and BloombergJuly 12, 2026
2 days ago
The U.S. and Iran can't agree on fully reopening the Strait of Hormuz. The solution could be straight out of the Old Testament
Middle East
The U.S. and Iran can't agree on fully reopening the Strait of Hormuz. The solution could be straight out of the Old Testament
By Jason MaJuly 11, 2026
2 days ago

© 2026 Fortune Media IP Limited. All Rights Reserved. Use of this site constitutes acceptance of our Terms of Use and Privacy Policy | CA Notice at Collection and Privacy Notice | Do Not Sell/Share My Personal Information
FORTUNE is a trademark of Fortune Media IP Limited, registered in the U.S. and other countries. FORTUNE may receive compensation for some links to products and services on this website. Offers may be subject to change without notice.