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

President Trump has repeatedly promised to bring down prescription drug prices. His Republican Congress says it shares that goal. But tucked inside the 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 way they bargain over drug prices is absurd, something that would never happen at the very same pharmacies buying a package of Pringles potato-chip products. (Cuban has been working to directly disrupt the PBM space with his business, Cost Plus Drugs.)

If passed into law, this act would transform 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........

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