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Healthcare & FDA

Trump's Proposed Medicare Drug Savings Rule Puts PBMs in the Crosshairs — and Gives Pharma a Mixed Signal

A rule designed to save Medicare patients $1.1 billion on drugs restructures the flow of money between manufacturers, middlemen, and patients.

Image: Money Racket
By at Money Racket · Jul 12, 2026

The Trump administration has proposed a rule it says could save Medicare patients $1.1 billion on drug costs. The proposal targets the structure of drug pricing in Medicare, with implications for pharmacy benefit managers and drug manufacturers.

Who's exposed: The three dominant PBMs — CVS Health's Caremark (CVS), Cigna's Express Scripts (CI), and UnitedHealth's Optum Rx (UNH) — are the most at-risk entities if the rule restructures rebate flows or mandates pass-through pricing. PBM reform has been a bipartisan target for years, and any rule that forces rebates to flow to patients rather than be retained by the middleman directly compresses PBM margins. UnitedHealth (UNH) is already under pressure from multiple directions; an Optum Rx margin squeeze adds to that. Large pharma companies like Pfizer (PFE) face a mixed signal — lower net prices could reduce revenue, but cleaner pricing structures reduce the administrative burden and potential clawback risk.

If rebates flow to patients instead of PBMs, CVS Caremark, Express Scripts, and Optum Rx lose a margin stream they've built their businesses around.

Who cashes in: Specialty pharmacies and direct-to-patient dispensing models benefit if PBM gatekeeping is reduced. Mark Cuban's Cost Plus Drugs is private, but the policy direction validates its model. Patients and, indirectly, Medicare Advantage insurers that can offer lower drug costs as a plan benefit gain a competitive edge — companies like Humana (HUM) and Elevance (ELV) could use lower drug costs to improve their star ratings and attract enrollment.

What to watch next: Whether the rule is finalized before the next Medicare Advantage bidding cycle. Timing matters enormously — a rule finalized in time for 2027 plan bids changes the competitive math for every MA insurer.

Source: original report ↗

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