The following content is sponsored by Americans for Limited Government and written by the organization’s executive director, Robert Romano.
For decades, Washington promised to fix health care and delivered nothing but higher prices, more paperwork, and a maze of middlemen getting rich while patients paid the bill. President Trump is doing what career politicians like Joe Biden and Kamala Harris never would: cutting out the middlemen and putting patients back in charge.
That’s the aim behind Trump’s push for direct-to-consumer health care solutions like Trump Rx. Instead of forcing Americans to beg permission from insurers, Pharmacy Benefit Managers (PBMs), and bureaucrats, Trump Rx lets patients access medications from manufacturers directly, with transparent pricing and fewer layers skimming off the top. It’s simple, easy to understand, and long overdue.
The real villains in the system aren’t doctors or medicine makers — they’re the middlemen. Pharmacy Benefit Managers, or PBMs, sit between patients, pharmacies, insurers, and manufacturers, quietly manipulating the system to their advantage. Their business model rewards higher list prices, bigger rebates, and more complexity. Patients lose. PBMs win.
President Trump is taking a sledgehammer to that system.
Trump just signed legislation cracking down on PBM payment schemes by preventing their compensation from being tied to drug list prices. That matters because when PBMs profit from higher list prices, they steer insurance plans toward expensive drugs even when cheaper, equally effective options exist. By severing that link, Trump is attacking the perverse incentives that have driven up prices for Americans.
This is not abstract policy talk. It’s a direct assault on a rigged system.
And the effort doesn’t stop there. Under Trump’s leadership, the Federal Trade Commission has refocused on protecting consumers instead of appeasing corporate gatekeepers. With Chairman Andrew Ferguson serving as enforcer of healthcare competition, the FTC is moving aggressively to rein in PBM abuses that distort competition and inflate costs.
That includes actions to stop dominant PBMs like Express Scripts from gaming formularies — preferring high-priced drugs over lower-cost equivalents simply because the rebates are bigger. When PBMs use their market power to block competition and pad profits, that’s not a free market. That’s cartel behavior, and Trump’s FTC is treating it that way.
Predictably, the swamp is furious.
PBMs and their allies warn that reform will “disrupt the system.” Translation: it will disrupt their revenue stream. They’ve spent years hiding behind complexity, hoping Americans wouldn’t notice who’s really driving up costs at the pharmacy counter. Trump noticed — and he acted.
This is what America First health care looks like. Fewer middlemen. More transparency. Real competition. Patients in control.
While Democrats stand with their Big Insurance political donors, Trump is doing what he’s always done: challenging entrenched interests and siding with everyday Americans. Whether it’s negotiating better trade deals, exposing middlemen markup schemes, or empowering consumers through direct access, the goal is the same — lower costs and better care.
Health care doesn’t need more Washington “experts.” It needs a wrecking ball aimed squarely at the middlemen who broke it in the first place. Trump promised to take a swing — and he is. Americans are better off for it.