PBMs, pharma companies avoid drug price transparency

Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences those businesses and shapes what we all pay for care. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09.

Drug manufacturers and pharmacy benefit managers received a holiday gift from President Trump on Friday: They still will not have to publicly post the actual prices of prescription drugs, more than five years after federal law required them to do so.

Net drug prices — the amounts that health insurance companies and PBMs pay to drugmakers, after factoring in rebates — are highly valuable data that undergird the entire economic foundation of the U.S. pharmaceutical industry. But the decision from the Trump administration, rolled out in a new proposed rule, means that drug pricing data will likely remain locked out of public view for the foreseeable future.

The Affordable Care Act and other federal laws required widespread transparency of prices for the health care industry, which has historically kept its high prices hidden. Hospitals have had to post their prices since 2019, albeit with dismal compliance and enforcement along the way. Health insurers have had to air their negotiated rates for hospital and doctor services since 2022, albeit with massive file sizes and large chunks of relatively worthless pricing data — some of which the new proposed rule would address.