The news: Shares of companies that own the three largest US pharmacy benefit managers (PBMs) fell on Monday after President-elect Donald Trump said he plans to “knock out” the pharma industry’s middlemen.

In comments to reporters, Trump referred to PBMs as “the horrible middleman that makes more money than the drug companies, and they don’t do anything,” according to Bloomberg.

Assessing the damage: The three largest PBMs processed nearly 80% of the approximately 6.6 billion prescriptions dispensed by US pharmacies in 2023. Each experienced a stock price dip following Trump’s remarks.

• CVS Health, parent of PBM CVS Caremark, saw its shares fall as much as 4.3%.
• Shares of UnitedHealth Group, parent to PBM OptumRx, dropped by as much as 3.9%.
• And Cigna Group, which owns Express Scripts PBM, saw its shares fall as much as 2.6%.

Zooming out: Trump’s comments echo much of the public uproar over the tremendous sway PBMs hold over drug prices and access.

Their lack of transparency and subpar service haven’t gone unnoticed, either.

• The three largest PBMs underperformed on overall transparency, rebate transparency, and revenue source transparency relative to smaller PBMs, according to a recent report from the Pharmaceutical Strategies Group (PSG).
• The Big 3 also underperformed on recommendation, renewal, service expectation, and satisfaction metrics.

Why it matters: The entities, which once seemed impenetrable, are set to face a reckoning that could come sooner than anticipated.

Congress appears to have reached a deal as part of a year-end spending package that would require PBMs to be more transparent about their business practices and limit their spread pricing tactics, per Fierce Healthcare.

The final word: Trump’s remarks signal that his incoming administration is likely to be kinder to drugmakers, who have previously called for PBM reform.

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