For all the outrage aimed at rising drug costs in America, policymakers are targeting the wrong villain.
Instead of confronting the pharmaceutical manufacturers who set sky-high launch prices and raise them annually without consequence, Congress has decided to go after pharmacy benefit managers (PBMs)—the very entities that negotiate prices down.
It’s a politically convenient move. PBMs are complex. Their work isn’t easily understood. And in today’s populist climate, “middleman” is a dirty word. But scapegoating PBMs won’t reduce drug costs. In fact, it will do the opposite.
PBMs are among the only players in the health care ecosystem pushing back against Big Pharma’s pricing power. They operate in competitive markets, align employer and insurer
incentives, and deliver billions in negotiated rebates and discounts—savings that flow directly to plans and consumers. When vertically integrated with insurers and pharmacies, PBMs can coordinate benefits more efficiently, cut administrative waste, and improve adherence to lower-cost therapies. That’s not market failure. That’s market correction.
So why the sudden bipartisan appetite to dismantle or heavily regulate PBMs? The answer isn’t patient advocacy—it’s Big Pharma’s lobbying muscle.
The pharmaceutical industry has a powerful incentive to eliminate the few remaining constraints on its pricing. PBMs are a threat to that pricing power. Vertical integration is a threat to that pricing power. So the drug lobby is doing what it does best: shifting blame.
Unfortunately, Congress is playing along. Lawmakers on both sides of the aisle have introduced legislation that would cap PBM revenues, ban common negotiating tools, and effectively eliminate the leverage PBMs use to force price concessions from drugmakers.
These measures aren’t just misguided—they’re dangerous. They would drive costs up, not down.
At the American Growth & Innovation Forum, we believe in the power of scale and integration to deliver value. Consolidation for its own sake is not the goal—but integration that improves coordination, reduces redundancy, and aligns incentives is not only good policy, it’s common sense.
If we want to take on Big Pharma, the solution is not to dismantle the only entities holding them accountable. It’s to empower them. Let vertically integrated systems continue to innovate. Let them leverage data and scale to bring prices down. And let’s stop pretending that disjointed, siloed care is somehow preferable just because it’s easier to understand.
Drug prices are not high because of PBMs. They’re high because manufacturers are allowed to charge whatever they want. Any serious policy response must begin there.
Don’t break the very system that’s trying to fix the problem. If we want lower drug prices, we need more competition, more integration, and more pressure on the companies that have been gaming the system for decades.
Mike Crispi is an experienced talk show host, TV reporter, businessman and political activist. He is currently the host of ‘Last Call with Mike Crispi’ on Real America’s Voice TV and a field correspondent and commentator with the network as well. Crispi’s broadcasts are among the most popular in conservative media.
