The maligned and misunderstood player that Big Pharma wants gone



Last week, a bipartisan group of senators introduced legislation on drug prices that specifically targets pharmacy benefit managers, exactly as Big Pharma prefers. Pharmaceutical companies have spent years trying to convince the public and policymakers that PBMs are the bad guys in the prescription supply chain, shadowy middlemen inflating prices and hurting innovation. That narrative is convenient, but it is also wrong. PBMs are introducing competition, eliminating waste, and driving down prices.

Which is precisely why Big Pharma wants them out of the way.

The truth is that pharmacy benefit managers are effective. And that is exactly why drugmakers are going after them.

The pharmaceutical industry spends more money than any other sector to sway government policy. In 2024, it poured $90 million into campaign contributions and nearly $400 million into lobbying — much of it through former government officials now on the payroll. Drugmakers also shelled out a whopping $11 billion on advertising, a sum that conveniently buys more than consumer attention. It pressures media outlets to look the other way, a racket the Trump administration is finally moving to rein in.

After the black eye of the opioid crisis and the COVID-19 debacle, Big Pharma needs a scapegoat for high drug prices. It found one in a quiet, little-known player most Americans have never heard of, much less understood.

But the numbers are clear. A recent study shows pharmacy benefit managers deliver at least $145 billion in net value every year, even after costs. Compared with a system where manufacturers dictate prices, PBMs create an additional $192 billion in value across the economy. That money doesn’t vanish into corporate coffers. It flows back into businesses, households, and the wallets of working Americans.

PBMs accomplish this by negotiating directly with manufacturers and pharmacies. They aggregate buying power for millions of people. They secure rebates and discounts that most individual plans could never get on their own. In 2020, PBM-managed rebate structures created $51 billion in value for patients and plan sponsors. That is a competitive market in action.

PBMs are expected to save health plans and consumers about $1.2 trillion over the next 10 years, averaging $1,154 per person per year. And for every dollar spent on PBM services, the system saves $10 in return. By steering patients toward generics and bio-similars, PBMs helped the health system save $445 billion in 2023 alone. That is what efficiency looks like.

Perhaps more importantly, they improve health outcomes. When patients can afford their prescriptions, they are more likely to take them. That means fewer hospitalizations and fewer emergency room visits. PBM-driven programs have led to as much as a 16% increase in medication adherence and a 10% drop in inpatient admissions.

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It’s an obvious good to have healthier Americans. But it’s also good for a productive economy.

By lowering premiums and drug costs in public programs, PBMs save taxpayers money as well. This alone accounts for $47 billion in annual savings. And by accelerating patient access to new therapies early in the patent cycle, PBMs support pharmaceutical innovation instead of stifling it.

PBMs currently manage 95% of retail prescriptions and serve 91% of plan participants. That’s because they work. Businesses in the free market use services they value. And they value PBMs because they allow employers to offer more affordable coverage without sacrificing quality.

The truth is that PBMs are effective. And that is exactly why drugmakers are going after them. PBMs bring down net prices and demand accountability. That cuts into Big Pharma’s profit margins. So the industry has launched a campaign to reframe PBMs as a problem rather than a solution.

For example, a Biden-era Federal Trade Commission report that painted PBMs in a negative light should be viewed with skepticism. Even FTC Commissioner Melissa Holyoak emphasized that the report ignores the hard evidence of PBM-driven savings and warned that it was “a premature and deficient report,” adding, “Our job is not to score cheap points for transient political favor.”

“Though facile arguments that rely on ideologically loaded buzzwords such as ‘control’ or ‘power’ may stir emotions and make for entertaining social media posts and television interviews, ideological buzzwords are no substitute for rational, evidence-based research,” Holyoak said.

Sadly, some lawmakers are swallowing Big Pharma’s spin. Bills moving at both the federal and state level would gut PBMs — and hand drugmakers exactly what they want. Even a Brookings Institution analysis found that targeting PBMs won’t lower costs and would only weaken bargaining power against manufacturers.

That isn’t reform. It’s malpractice. Weakening the only players who force price discipline amounts to doing Big Pharma’s bidding at the expense of patients.

This fight isn’t about patients versus middlemen. It’s about competition versus monopoly. It’s about market discipline versus unchecked corporate power.

PBMs work because they negotiate, they drive better drug choices, and they deliver real value. When the most powerful industry in America is desperate to kill them off, you don’t need a think tank study to see what’s at stake. That fact alone tells you everything you need to know.

Corporate America is eating its seed corn — and our future



“Don’t eat your seed corn.” Every farmer gets it. Every American with common sense gets it. The only people who don’t? The people who run corporate America.

A farmer keeps part of this year’s crop for planting next year. He could sell it now and pocket more cash — but then there’s nothing to plant, nothing to harvest, nothing to live on later. That’s obvious to anyone who works the land.

Capitalism creates wealth. But when wealth is extracted at the expense of the product, the people, and the future — that’s not capitalism. That’s predatory ransacking.

But in today’s boardrooms, the rule is reversed. Short-term profit is all that matters. Strip the future bare, cash out, and leave the mess for someone else to clean up.

The rewards for this corporate vandalism are massive: fat bonuses, stock windfalls, golden parachutes. The damage — lost jobs, gutted industries, shoddy products — is someone else’s problem.

And the fastest way to pull it off? Slash costs to the bone. Ship jobs overseas. Push out the people who know the business best. Wreck customer service. Kill innovation. Downgrade quality until the product barely passes as the same thing you used to make.

Private equity and corporate strategists have a new trick for squeezing customers dry: “revenue mining.” That means cross-selling, upselling, jacking up prices, and hiding the real costs in creative contracts.

At first, it works. Existing customers tend to stick around — inertia keeps them from bolting right away. But each gimmick drives off a slice of loyal business. Combine that with lower service quality and cheaper products, and the exodus accelerates. Before long, the company is stuck with an overpriced product, lousy service, and no easy way to attract new customers.

I’ve watched this play out in my own life. My exterminator. My alarm company. My HVAC service. All wrecked by the same formula. The local phone number? Redirected to a call center overseas — if I can navigate the phone tree. The people I used to know? Gone. The contract? Suddenly much more expensive.

The service I get for my trouble? Less than before. And when the tech finally arrives, all he says is, “Things are much different now.” They might wring one more payment out of me, but I’m already shopping for a local outfit that treats me like a customer instead of prey.

In short, they ate their seed corn. They got one fat harvest out of me, then pushed me straight into the arms of their competition — for good.

At least my dentist is still a one-man shop who owns his own business. But even dentistry is under siege. Private equity-backed dental chains are giving dentistry a bad name, pushing unnecessary procedures just to meet revenue targets.

A USA Today investigation titled “Dentists under pressure to drill ‘healthy teeth’ for profit” uncovered one such example:

Dental Express was part of North American Dental Group, a chain backed by private-equity investors. At least a year earlier, the company had told dentists like Griesmer to meet aggressive revenue targets or risk being kicked out of the chain. Those targets ratcheted up pressure to find problems that might not even exist.

In my professional career, I have seen too many examples of the same pattern: private equity buying and destroying great businesses that had loyal customer bases. To be fair, I have also seen examples of private equity groups buying a business, embracing its product, and continuing to provide good service. I wish it weren’t the exception, though.

More often, private equity groups treat the acquisition as a mine: extract the capital through dividends and existing customers while accruing significant debt. In fact, the funds used to purchase the business are often borrowed and never even repaid.

Dig until empty, leave a crater, and move on.

An X user put it perfectly:

Some private equity is genuinely investing in the business to grow a solid business. This is good, full stop.

Some private equity buys up dying businesses, breaks them up, sells off the valuable bits and sometimes lets the worthless bits go through bankruptcy, taking advantage of bankruptcy laws to profit. This is good, actually, as it recycles the resources of dying businesses into good businesses.

The third type of private equity buys good businesses that are doing OK or even doing well. Then they sell off all the assets, load the company up on as much debt as they can, pay themselves giant dividends, and then take advantage of the same bankruptcy laws to discharge all the debt so they never have to pay it back. This is really bad.

This isn’t just happening to small companies. It’s hitting America’s industrial backbone.

I’ve written before about how Carlos Tavares, the former CEO of Stellantis (corporate parent of Chrysler, Dodge, and Jeep), awarded himself a $39 million compensation package for making short-term decisions that briefly maximized profit before revenue and sales collapsed, leaving dealers with overpriced, outdated inventory. He made off with the profits, then left behind a hollow pipeline for the dealers truly committed to Stellantis.

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Greenseas via iStock/Getty Images

I also covered Boeing’s disastrous $43 billion stock buyback binge. The short-term boost to its share price came at the expense of critical investment in its products — and has cost the aerospace giant $35 billion since 2019. To plug the hole, Boeing had to raise another $15 billion in capital and push back the already overdue launch of the 777, citing “negligent engineering.”

That phrase used to be unthinkable in the aerospace industry. Boeing made it possible by gutting its engineering and technical staff to feed Wall Street.

The consequences keep coming. This month, United Airlines grounded much of its fleet after a failure in its proprietary “Unimatic” flight system. The airline claims it doesn’t know what caused the failure.

But I have a strong suspicion.

In recent years, United has aggressively outsourced its technical operations to contractors using foreign labor — often H-1B visa workers — at lower cost. One subcontractor, Vista Applied Solutions Group, boasts that it helps clients “increase productivity” while achieving “considerable cost savings.”

That’s great — until the system fails and planes can’t fly. United may have saved on salaries. The short-term reduction in salary expense has eaten United’s seed corn, leaving the company with a technology system that can’t keep its planes in the air.

It is imperative for those of us who defend capitalism to also repudiate those engaged in practices that give it a bad name. Capitalism creates wealth. But when wealth is extracted at the expense of the product, the people, and the future — that’s not capitalism. That’s predatory ransacking.

And it deserves our scorn.

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Build back better? Then stop outsourcing our agricultural soul



Drive through our country’s heartland — past golden fields, cattle-speckled hills, and humming dairies — and you’ll see the soul of America at work. But look closer, and a bitter truth emerges: The hands harvesting our crops and milking our cows are too often foreign-born laborers here illegally or on a costly visa program.

In my state, the Idaho Dairymen’s Association admits a staggering 70% or more of dairy workers are using phony documents — illegal labor propping up Idaho’s top commodity and our country’s No. 3 milk-producing state.

Today, we’re fed a line that Americans have gone lazy, addicted to cubicles or city lights. Nonsense.

We’re told Americans won’t do these jobs. Really? From the 1880s through the 1940s, Americans built these very industries. So what changed? It’s not the workers. It’s the bosses who stopped believing in them.

American grit built our farms

Idaho’s dairies, ranches, and construction sites can thrive with American grit — if employers stop making excuses and start making offers.

Go back to the late 19th century, when Idaho’s Snake River Valley was raw desert. Local settlers — farmers, laborers, families — dug canals, built dams, and turned dust into fields of potatoes and alfalfa, as historian Mark Fiege shows in his 1999 book “Irrigated Eden.” These weren’t hired foreigners; they were Americans, mostly Western settlers, whose sweat and cooperation built an agricultural empire through the Depression and wartime into the 1940s.

Those were hard years. Yet, these people showed up, sleeves rolled, ready to work. They weren’t too soft for the sun on their necks or the ache of a long day.

Employers abandoned American workers

Today, we’re fed a line that Americans have gone lazy, addicted to cubicles or city lights. Nonsense. Some yes, but fewer than imagined. The problem isn’t our people; it’s an industry that’s forgotten how to call them home.

Don’t tell me Americans won’t work. Plenty of us still hunger for the kind of labor that smells of earth and steel — jobs that build calluses and communities. Idaho’s fields offer purpose: the roar of a tractor, the precision of robotic milkers, the quiet triumph of a harvest under wide skies.

Vice President JD Vance nailed it when he sarcastically gave in to the notion that deporting tens of millions of illegal aliens will send us back to 1960 — when homes apparently couldn’t be built without illegal labor. Absurd! The same goes for agriculture.

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Anton Skripachev via iStock/Getty Images

These aren’t dead-end gigs; they’re the backbone of our nation. But employers need to stop acting like foreign workers are the only option. If you are one of these employers who show up to the town parade waving Old Glory, singing Lee Greenwood’s “God Bless the U.S.A.” — if you claim to be America First — then hire Americans first. Anything less is just talk.

Illegal workers cost more

Here’s where the elites squirm. As state Rep. Stephanie Mickelsen (R-Idaho) noted during a House debate, Idaho employers often admit that foreign labor isn’t even cheaper. Visas, travel, lodging, meals, and transportation add up — often rivaling what an American might earn in salary and benefits. Yet, they claim no amount of money will lure American workers.

Have they tried? Really tried? Take those bloated costs — every dime spent on foreign logistics — and pour them into wages, health plans, or housing for locals. Build training programs to teach kids how to run today’s high-tech rigs. If tech giants can sell college grads on coding in Silicon Valley, Idaho’s dairies can sell our youth on feeding America.

It’s not rocket science. It’s will.

The same elites twist unemployment numbers to prop up their narrative. They cite low jobless rates to argue that no one’s left to hire. But the Bureau of Labor Statistics excludes a key group: able-bodied men ages 25 to 54 who’ve dropped out of the workforce entirely. They’re not working, not looking, and not counted. That forgotten group alone includes an estimated seven million Americans.

Make American farming great again

Picture this: billboards across Idaho showing a young farmer steering a drone-guided planter, grinning like he owns the future. Community colleges partnering with ranchers to train veterans and high schoolers. County fairs where dairies hand out scholarships — not just milk samples. That’s not fantasy. That’s strategy. Businesses that want loyalty don’t wait for workers to show up — they go find them.

Right now, 70% of dairy workers rely on falsified papers. That’s not a workforce. It’s a failure of imagination. Legal, local labor builds trust, strengthens communities, and proves we take sovereignty seriously.

Idaho can lead the way. America’s watching.

Employers, quit hiding behind old excuses. Redirect your budgets, roll out campaigns, and watch Americans answer the call. Lawmakers, reduce or eliminate regulations that incentivize foreign labor.

Neighbors, cheer these jobs as the honorable work they are. Picture our fields alive with Americans, dairies humming with citizens who know this land as home.

That’s not just Idaho’s future, it’s America’s. We’ve done it before. We can do it again. All it takes is the guts to try.

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America last? Not anymore as Trump targets Big Pharma



President Trump’s executive order on Monday turned a harsh spotlight on pharmaceutical companies’ long-standing practice of charging Americans far more for prescription drugs than they charge consumers in other countries.

The order’s language remains vague — it mentions only future “price targets” and possible enforcement mechanisms — but the message is unmistakable: The U.S. government will no longer tolerate paying inflated prices for drugs when European governments negotiate far lower ones.

Americans crushed by high drug costs also vote — and they can elect a president and Congress willing to rewrite the rules.

Trump’s order addresses just one part of a larger, deeply rooted problem: the runaway cost of prescription drugs in the United States. A major contributor to that cost is the pricing of patent-protected drugs, which face no competition and often come with astronomical price tags.

Pharmaceutical companies now operate under a politically dangerous business model. They enjoy government-granted patent protections to block competition, while squeezing insurers and patients to extract maximum profit. This isn’t capitalism. It’s a merger of legal monopoly and short-sighted corporate greed — a textbook example of protectionism paired with profit-maximization stripped of ethical restraint.

Legally, these companies act within their rights. But politically, they’re playing with fire. Americans crushed by high drug costs also vote — and they can elect a president and Congress willing to rewrite the rules. Trump’s executive order sends a warning. If the pressure builds, Congress will follow with legislation.

In a free-market ideal, companies compete to win consumers by offering better, cheaper products. That’s good. But when a company invents something new — especially something as vital as a life-saving drug — it deserves a temporary monopoly to recoup research and development costs. That’s why the government issues patents. This, too, is good.

Yet, once the government grants monopoly rights, we’re no longer in a purely free market. The question then becomes: What responsibility does the government have not just to the patent-holder but also to the consumers who depend on that drug for survival?

Stephen Moore, a senior fellow at the Heritage Foundation, recently addressed one side of the debate in the Washington Times. He criticized so-called “compounders” — companies that tweak existing drugs and resell them without going through the same research-and-development and FDA approval process. Moore called these copycats unsafe and accused them of free-riding on innovation.

Compounders clearly respond to market demand but so do pharmaceutical companies charging monopoly prices under government protection. Both “cash in.” One simply does so with fewer legal barriers.

If the government takes seriously its role in enforcing patents, it must also consider whether those monopolies serve the public good — or exploit it. Monopoly pricing for essential drugs carries moral consequences. Government can’t ignore them.

This brings us to another, equally troubling aspect of the problem: the "America last" approach embedded in current drug pricing practices.

Many Americans struggle to afford life-changing medications, while pharmaceutical companies sell those same drugs overseas — at a fraction of the U.S. price. Industry defenders argue that American consumers must bear the brunt of R and D costs, allowing foreign countries to buy at lower “incremental” prices. Without those sales, they say, U.S. prices would rise even higher.

But that argument wears thin.

Charles Rotter recently posted on X that U.S. drug pricing amounts to backdoor foreign aid. “Other countries’ healthcare systems stay sustainable and affordable because American patients bankroll the difference,” he wrote. “Why should a senior in the U.S. pay dramatically more for the same pill than a senior in France, effectively subsidizing France’s national health system?”

Pharmaceutical pricing isn’t just a pocketbook problem. It reflects a broader failure to prioritize American citizens. Companies obeying the letter of the law still fail the test of loyalty and common sense. The system persists only because voters haven’t yet forced change. Trump’s executive order signals they’re starting to.

Congress could go further by revisiting patent protections and demanding greater price transparency. The message to Big Pharma should be clear: You can choose to act like responsible corporate citizens and stop bleeding patients dry, or you can wait for the government to do it for you.

If drug companies continue to exploit their monopolies, they shouldn’t be surprised when voters — and their elected representatives — decide to break them.

Trump’s pharma fix might make Reagan squirm — but it’s needed



President Trump on Monday signed an executive order to lower prescription drug prices for Americans by up to 80%. The move — called the “most favored nations” pricing policy — seeks to require pharmaceutical companies to charge U.S. consumers no more than what they charge consumers in other developed nations.

To many Americans, this may sound like simple fairness. After all, why should U.S. citizens pay two, three, or even four times more for the exact same medication than citizens in countries like France, Japan, or Canada?

When the market has been effectively captured, Trump’s executive order is not government overreach but rather a corrective intervention.

But this price disparity is not accidental — it’s systemic. For decades, the United States has quietly subsidized the rest of the world’s access to pharmaceuticals.

Global drug manufacturers earn their profits not in Berlin or Brussels, but in Des Moines and Dallas. In effect, Americans have been the financial backbone of an international pricing scheme that benefits other nations at our expense.

President Trump’s executive order directly challenges this arrangement. It stipulates that if a drug company offers a product to another country at a lower price, the United States should receive the same rate. It’s a reciprocal principle: no more preferential treatment for foreign buyers.

This is a significant departure from business as usual in Washington, and it’s not hard to see why the policy is resonating with the public. At face value, it offers a rare and overdue measure of accountability in a system where Americans are consistently overcharged for lifesaving medication. For anyone who has ever had to ration insulin, split pills, or go without treatment due to cost, this action likely feels like justice.

What free market?

But for those of us who believe strongly in the free market — and I count myself among them — this executive order raises uncomfortable questions.

In principle, I oppose government interference in pricing. I’ve long warned that when the government inserts itself into private industry, the result is usually distortion, inefficiency, and unintended consequences. History offers plenty of examples. In the 1990s, then-first lady Hillary Clinton’s health care proposals — including a federal mandate that vaccine manufacturers sell to the government at deeply discounted prices — led to supply shortages and industry retreat. When profit disappears, so does innovation and availability. That pattern tends to repeat.

So why am I not condemning President Trump’s latest move outright?

Because we no longer operate in a truly free market. In the pharmaceutical industry, the system is already so burdened with lobbying, regulation, and insurance complexity that the idea of unencumbered market exchange is little more than a fiction. Prices are not driven by consumer choice or transparent competition. Instead, they are the product of negotiations between drug companies, insurance providers, and governments — while the average American is left footing the bill without a seat at the table.

In this environment, where the market has been effectively captured, Trump’s executive order can be seen not as government overreach but as a corrective intervention. It's an attempt to level a playing field that was rigged long ago. The United States is the single largest buyer of pharmaceuticals in the world, and yet we have consistently refused to leverage that bargaining power.

Every other country negotiates drug prices. We don’t. That isn’t capitalism; it’s capitulation.

A necessary disruption

To be clear, I am not advocating long-term price controls. The risks of such policies are well-documented: reduced innovation, fewer treatment options, and deeper government dependency. But I also refuse to pretend that what we currently have is a functioning free market. It isn’t. And continuing to prop up a broken system in the name of “principle” is not conservatism — it’s negligence.

We should still scrutinize the details. We should remain skeptical. But we should also acknowledge this: The current system is unsustainable. Americans are being overcharged for medications so that other countries can pay less. Call it what you want, but don’t call it capitalism — or justice. I’d call it a redistribution scheme masquerading as market logic.

President Trump is right on one crucial point: America has been getting ripped off for far too long. His executive order is a necessary disruption to a system that has failed the very people it was supposed to serve.

It’s time we stopped playing the chump.

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Glenn: This Is What YOU Should Do as the Price of EVERYTHING Rises | @glennbeck
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